Nurse Practitioners’ Scope of Practice and Prescription Drug Abuse

Tuesday, June 12, 2018: 3:30 PM
5001 - Fifth Floor (Rollins School of Public Health)

Author(s): Anca M. Grecu; Andrew Friedson

Discussant: Monica Deza

As the health care market expanded rapidly over time, provider shortages came to the forefront of policy making. To address this problem, alongside regulations targeting the cost of physician practice the policy makers currently consider alternative delivery methods, and expanding the scope of practice of various types of health care providers. The National Council of State Legislatures (NCSL) reported tracking 827 bills to redefine health providers’ scope of practice in 2012 alone.[1]

This paper investigates the impact of regulations allowing nurse practitioners (NPs) to prescribe schedule II prescription drugs such as opioids and stimulants. This topic is of particular importance in light of the recent increase in prescription (Rx) drug abuse. According to 2014 National Survey on Drug Use and Health approximately 54 million people, the equivalent of more than 20 percent of people over 12 years old, have used prescription drugs for nonmedical reasons at least once in their lifetime.[2] Many of them obtained the drugs from a health care provider; for instance, approximately 17.3% of people who abuse prescription painkillers report that a physician prescribed the drugs.[3]

Laws allowing NPs to prescribe schedule II drugs effectively expand the number of providers allowed to prescribe these drugs but also change the characteristics of the labor force engaged in drug prescribing. If limiting the ability of nurse practitioners to prescribe drugs enhances service quality, an expansion of prescribing rights of NPs might lead to more prescription drug misuse. In addition, an increase in the number of providers eases access to prescription drugs possibly aggravating of the current drug diversion problem. On the other hand, physician shortages could be the reason behind the high rate of misuse of prescription drugs. Existing physicians might not have enough time and resources to establish a close relationship with their patients or investigate the possibility of fraudulent claims. In this case increasing the number of drug-prescribing providers could alleviate the pressure and reduce illicit access to prescription drugs. Using difference-in-difference and triple-difference econometric models we find that legislation allowing nurse practitioners to prescribe schedule II drugs is associated with less opioid misuse but no statistically significant change in stimulants misuse. The results are robust across several datasets including Treatment Episode Data Set (TEDS) and Mortality Multiple Causes of Death files.

[1] Source: accessed 1/21/2017

[2] Source:, accessed 1/20, 2017

[3] Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings.