Scope-of-Practice Laws and Patient Safety: Evidence from the Opioid Crisis

47 Pages Posted: 14 Dec 2018

Date Written: December 12, 2018


Scope-of-practice laws that restrict Nurse Practitioners’ (NPs) ability to deliver healthcare are justified as necessary to promote patient safety and protect patients from providers with less training than physicians. Analyzing a dataset of over 1.3 billion opioid prescriptions at the individual-provider level, I evaluate this justification in the context of the ongoing opioid crisis. I examine whether allowing NPs to practice independently of physicians increases opioid prescriptions. Granting NPs independence increases NP opioid prescriptions but decreases physician opioid prescriptions across three different measures of prescriptions. The net effect is an overall decrease of about 1.2 percent in morphine milligram equivalents prescribed across all providers. The results suggest that restrictive scope-of-practice laws are not necessary to protect patients from the overuse of dangerous drugs and that these laws may increase the use of these medications and undermine patient safety.

Keywords: opioid, nurse practitioner, scope of practice, healthcare workforce

Suggested Citation

McMichael, Benjamin J., Scope-of-Practice Laws and Patient Safety: Evidence from the Opioid Crisis (December 12, 2018). U of Alabama Legal Studies Research Paper No. 3300365, Available at SSRN: or

Benjamin J. McMichael (Contact Author)

University of Alabama - School of Law ( email )

P.O. Box 870382
Tuscaloosa, AL 35487
United States

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