Impact of Nurse Practitioner Scope of Practice on Treatment for Chronic Pain and Opioid Use Disorder: A Scoping Review

Abstract

Background Chronic pain affects nearly 50 million Americans, and its treatment is complicated by the opioid epidemic and physician shortage. Nurse practitioners (NPs) have a unique role in expanding access to care while still providing high-quality pain management; however, state restrictions prevent NPs from treating both chronic pain as well as opioid use disorder (OUD). Purpose The aim of this systematic scoping review was to examine the impact of these state-level restrictions on access to effective pain management. Methods In this systematic scoping review, the PubMed and CINAHL (Cumulative Index of Nursing and Allied Health Literature) databases were searched for articles published between 2008 and 2019. Grey literature from the same timeframe was searched via ProQuest, including policy documents, reports, doctoral student capstones and dissertations, and letters. Only peer-reviewed publications or acceptable forms of grey literature addressing either NP scope of practice or prescriptive authority laws and either pain management or opioid use disorder were included. Results Fifteen journal articles and 18 grey literature items met all inclusion criteria. We collapsed our findings into three themes pertaining to our research questions: (1) NP practice authority and chronic pain prescribing; (2) NP practice authority and OUD treatment; and (3) Changes in comprehensive education about chronic pain and OUD. Secondary findings included the trend toward autonomy in chronic pain care and policy initiatives to remove barriers to NP prescribing of medication-assisted therapy for OUD. Conclusion : A complex set of relationships exists between NP scope of practice, chronic pain care, and management of OUD. Findings suggest that scope of practice limitations have not necessarily met their intended goals of managing chronic pain while reducing opioid misuse. Policymakers should consider the impact of nursing regulatory laws on patient access to needed care for both chronic pain and OUD. Furthermore, trends toward NP leadership and autonomy in the management of both chronic pain and OUD highlight the need to further develop educational opportunities for NPs.