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Med Care. 2019 Jun;57(6):482-489. doi: 10.1097/MLR.0000000000001126.

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

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Department of Social and Behavioral Sciences, School of Nursing.
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.
The Chinese University of Hong Kong, Shatin, N.T. Hong Kong.
The Heller School, Brandeis University, Waltham, MA.



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.


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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