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Opioid-prescribing Outcomes of Medicare Beneficiaries Managed by Nurse Practitioners and Physicians

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Primary care providers are at the center of the opioid epidemic. Whether nurse practitioners (NPs) have different opioid-prescribing outcomes from physicians is not known.


To examine opioid-prescribing outcomes of Medicare beneficiaries receiving care from NPs and physicians in primary care.

Research Design:

We used Medicare data from 2009 to 2013 and a propensity score–weighted analysis.


Beneficiaries residing in states in which NPs are able to prescribe controlled substances without physician oversight and who did not have a cancer diagnosis, hospice care, or end-stage renal disease.


First, we measured whether beneficiaries received any opioid prescription. Second, for beneficiaries who received opioids, we measured acute (<90 d supply) and chronic (≥90 d supply) use at baseline (2009–2010) and follow-up (2012–2013). Third, we measured potential misuse of opioid prescribing using a daily morphine milligram equivalent dose of >100 mg, overlapping prescriptions of opioids >7 days, and overlapping prescriptions of opioids with benzodiazepines >7 days.


Beneficiaries managed by NPs were less likely to receive an opioid [odds ratio (OR), 0.87; P<0.001], were less likely to be acute users at baseline (OR, 0.84; P<0.001), and were more likely to receive a high daily opioid dose of morphine milligram equivalent >100 mg compared with physician-managed beneficiaries (OR, 1.11; P=0.048).


Findings suggest educational programs and clinical guidelines may require approaches tailored to different providers. Future research should examine the contributing factors of these patterns to ensure high-quality pain management and guide policy makers on NP-controlled substance-prescribing regulations.
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Keywords: Medicare part D; nurse practitioners; opioid prescribing; primary care

Document Type: Research Article

Affiliations: 1: Department of Social and Behavioral Sciences, School of Nursing 2: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA 3: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan 4: The Chinese University of Hong Kong, Shatin, N.T. Hong Kong 5: The Heller School, Brandeis University, Waltham, MA

Publication date: June 1, 2019

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