Politics Nurses can help reduce opioid deaths — if policymakers let them
What US policymakers can learn from the UK's COVID-19 response
Slow start aside, the UK recognized an area of need in its pandemic response and acted accordingly. Now it has a new executive agency, the UKHSA, that is being given the necessary tools and funding to properly deal with this pandemic and any others to come.Given the U.S.'s shortcomings in implementing the most basic of public health strategies, it's clear that a similar area of need exists here. The difference? A noticeable lack of action. The result? Depending on your postal code, you may have been given coherent guidelines and mandates or left with a policy that actively stymies efforts in COVID control.
As the world continues to grapple with new iterations of COVID-19, it's easy for some to lose sight of other significant public health issues like the opioid crisis. The Centers for Disease Control and Prevention (CDC) note thathave continued to rise steadily over the past two decades, and recent from the Mayo Clinic indicates that COVID has made the opioid epidemic even worse, with emergency room visits due to opioid overdoses up 29 percent last year.
Just like our efforts to combat COVID, dealing with opioid addiction requires an all-hands-on-deck approach, yet some policymakers insist on fighting this battle with one hand tied behind our backs when they limit activity by nurse practitioners (NPs). Myshows that by eliminating certain scope-of-practice restrictions, we may be able to prevent one out of 11 opioid-related deaths overall and as many as one out of four in rural areas.
Use of OxyContin profits to fight opioids formally approved
A judge formally approved a plan Friday to turn OxyContin maker Purdue Pharma into a new company no longer owned by members of the Sackler family and with its profits going to fight the opioid epidemic. U.S. Bankruptcy Judge Robert Drain officially confirmed the reorganization Friday, more than two weeks after he announced he would do so pending two largely technical changes to the plan presented by the company and hashed out with lawyers representing those with claims against the company. His confirmation took more than six hours to read in court earlier this month, and the written version is 159 pages long, full of reasoning that appeals courts can consider later.
The last time you physically went to a medical doctor's office, you may not have even seen an MD, especially if you visited a pharmacy's retail clinic or an urgent care center. There's a good chance an NP provided your care. The number of NPs has increased rapidly over the last several decades, providing newer and more convenient health care options. They've also expanded access to care in rural areas while increasing capacity in urban and suburban areas.
Despite the success of NPs in addressing the access-to-care problem that has dominated health policy debates for over a decade, they're not always treated equally. Currently,require that physicians supervise NPs when the latter care for patients. Without this supervision, which often requires a substantial fee paid to the physician, NPs aren't allowed to practice.
Purdue Pharma Owners Won't Give Billions to Opioid Settlement Unless Removed From Lawsuits
"We need a release that's sufficient to get our goals accomplished," Sackler said responding to the U.S. bankruptcy trustee's lawyer.In a rare public appearance, David Sackler, the grandson of one of the brothers who originally bought the company that later became Purdue almost 70 years ago, said at a hearing in federal bankruptcy court in White Plains, New York that without legal protection, "I believe we would litigate the claims to their final outcomes.
States generally justify these scope-of-practice restrictions as necessary to protect patient safety, and physician groups are often the biggest proponents of these laws. One of the most recent arguments against allowing NPs to practice independently exploits the opioid crisis.
Before California passed a new law granting NPs independence last year, the American Medical Associationthat such a law would lead to a rise in opioid prescriptions, exacerbating the opioid crisis. The association made a similar when Mississippi considered granting independence to nurse practitioners earlier this year. If true, these troubling claims may warrant restricting the ability of NPs to care for patients, even at the expense of reduced access to care.
But recent research into these arguments and justifications found no empirical support. Instead, my new research finds the opposite - that allowing NPs to practice without physician supervision reduces all opioid-related deaths by about 9.3 percent. Prescription-opioid-related deaths decline by about 7.6 percent, and illegal-opioid-related deaths decline by about 5.5 percent when NPs are granted legal authority to practice independently. Even synthetic-opioid-related deaths decline. In rural counties, the effect is much more dramatic, with all opioid related deaths declining there by between 14 and 28 percent.
Opioid prescriptions fell over past decade while drug overdose deaths climbed: AMA report
Physicians have prescribed 44 percent less opioids over the past decade, yet fatal and non-fatal drug overdoses have continued to climb, according to a new report from the American Medical Association (AMA). The association called on lawmakers to "act now" over the overdose statistic. AMA's report documented a 44.4 percent decrease in opioid prescriptions between 2011 and 2020, with a 6.9 percent reduction between 2019 and last year, with more doctors using prescription drug monitoring programs (PDMPs).
These reductions in opioid-related deaths follow legal changes to NPs' authority and likely stem from two important sources: First, in stark contrast to claims that they might increase, the data show that opioid prescriptions generallyfollowing grants of independence to NPs. Second, these legal changes allow NPs to treatment options for opioid use disorder. This contributes to an overall reduction in opioid-related deaths.
When some states bar NPs from practicing independently, they restrict access to care for millions of patients - and as COVID clearly demonstrates, these restrictions matter. To expand access to care rapidly during the pandemic, states such as New York, Kentucky and Louisiana temporarily suspended their restrictions on NPs. Yet as these temporary relaxations begin to lapse, the old laws once again bind the hands of NPs.
As the nation struggles to combat the COVID-19 pandemic, with all of the lessons about access to care that it has taught, states that took interim measures to empower NPs would be well advised to make those changes permanent. And states that have yet to liberalize their restrictive laws should begin to do so.
Granting nurse practitioners independence will not, by itself, solve the opioid crisis. But justifications for restricting their scope of practice, which erroneously appeal to the opioid crisis and patient safety, are simply not supported by the research. If we take access to care seriously, these simple legal changes offer an easy option for making important progress and lending a helping hand to those in need. In the end, the science says it will save lives.
is an assistant professor at the University of Alabama Law School and author of the new study " ," published by the Mercatus Center at George Mason University.
Health workers once saluted as heroes now get threats .
OMAHA, Neb. (AP) — More than a year after U.S. health care workers on the front lines against COVID-19 were saluted as heroes with nightly clapping from windows and balconies, some are being issued panic buttons in case of assault and ditching their scrubs before going out in public for fear of harassment. Across the country, doctors and nurses are dealing with hostility, threats and violence from patients angry over safety rules designed to keep the virus from spreading. (AP Photo/Jae C. Hong, File) Across the country, doctors and nurses are dealing with hostility, threats and violence from patients angry keep the scourge from spreading.