More than 80,000 Americans died from drug overdoses in 2024. While this represents a 26 percent decline from the previous year, the crisis is far from over. Many of those lives could have been saved by proven therapies, like medication for opioid use disorder (MOUD), a treatment that combines counseling with lifesaving opioid replacement medication. MOUD is one of the most effective tools we have to reduce the risk of overdose, according to the evidence. Yet, access is still constrained by scope-of-practice and supervision laws that dictate which medications clinicians can prescribe and in which settings they may do so.
These rules are often shaped by professional and regulatory organizations like the American Medical Association, whose influence on state and medical boards, as well as legislatures, affects who is authorized to prescribe and manage MOUD care. While rural areas frequently lack clinicians due to lower population densities, these restrictions make existing shortages worse by preventing qualified providers from offering care where it is most needed.
Beyond these restrictions, outdated regulations on how and where patients can receive care, such as limits on telehealth and medication delivery, further compound access barriers. Reducing these unnecessarily restrictive occupational licensing and delivery barriers is a practical and evidence-based way to close these gaps and expand access to lifesaving care.
Nurse practitioners (NPs) are already a significant part of the solution. In 2016, Congress passed a law enabling some NPs to prescribe buprenorphine, one of three approved medications for opioid use disorder. However, in 22 states, NPs are not permitted to do so without a supervising physician. This limitation reduces access to MOUD, especially in areas where doctors are in short supply. In states that grant NPs autonomy in prescribing, the number of available MOUD prescribers roughly doubles and significantly increases local treatment access. A national analysis shows that expanding prescribing to NPs had a particularly significant impact in very rural areas, where NPs and physician assistants were responsible for 1.3 times more buprenorphine prescriptions than in urban areas.
Additionally, the study found that areas where NPs were allowed to prescribe had roughly twice as many registered NPs compared to regions where NPs are barred from prescribing. This may be due in part to the fact that the lack of prescribing authority makes NPs seem less valuable to employers, who then instead opt for physicians. Because NPs are more likely than physicians to relocate to rural communities and to remain there long term, granting them prescribing power would be a meaningful step toward closing treatment gaps where they are most severe.
Pharmacists undergo the most extensive training in pharmacology of any healthcare professional. Idaho has successfully authorized pharmacists to prescribe medications for a range of conditions. Through House Bill 191, which passed in March of 2017, the state granted the Idaho Board of Pharmacy the authority to determine when pharmacists can prescribe medications independently using clinical judgment consistent with the standard practices of healthcare providers. This applied to minor or time-sensitive conditions that did not require a new diagnosis. Within the first year, pharmacists were able to treat over 20 common ailments, and the state reported no safety complaints, showing that pharmacist-led prescribing can safely expand access to care in underserved areas.
At the national level, the 2021 Mainstreaming Addiction Treatment Act (MAT Act) eliminated the requirement for clinicians to register for and receive a waiver from the Drug Enforcement Administration (DEA) to prescribe buprenorphine for opioid use disorder. Any clinician who can prescribe DEA Schedule III drugs, such as buprenorphine, may now prescribe them in states that recognize pharmacists as prescribers. Within the first year of implementation, pharmacist-issued prescriptions increased eightfold, rising from about 0.1 percent to 0.8 percent of all buprenorphine dispensations nationwide. The increase was most pronounced in states that had already authorized pharmacist prescribers, such as Idaho, New Mexico, and Rhode Island. Still, 90 percent of states continue to restrict pharmacists from prescribing buprenorphine independently. Where pharmacists can prescribe independently, they primarily serve rural and medically underserved areas, increasing the number of filled buprenorphine prescriptions by 5 to 10 percent in counties that previously had no such prescribers.
The Department of Veterans Affairs (VA) offers a clear example of how pharmacist prescribers can operate successfully as part of a coordinated healthcare team. Veterans experience disproportionately high rates of chronic pain and opioid dependence. Overdose deaths among veterans increased by more than 50 percent between 2010 and 2019, and as many as one in three service members prescribed opioids during active duty met the criteria for dependence.
Continue reading at Reason.
Edward Timmons, PhD, is Vice President of Policy at the Archbridge Institute. He leads the institute's economic policy strategy, identifying focus areas and disseminating work to key stakeholders and policymakers. His own research focuses on labor economics and regulatory policy; he is regularly asked to provide expert testimony to U.S. states on occupational licensing reform and the practice authority of nurse practitioners. Dr. Timmons received his Ph.D. in economics from Lehigh University and his B.A. in economics and actuarial science from Lebanon Valley College. He publishes a weekly newsletter on Substack with the latest research and policy insights surrounding occupational licensing.
Economics of Flourishing
More than 80,000 Americans died from drug overdoses in 2024. While this represents a 26 percent decline from the previous year, the crisis is far from over. Many of those lives could have been saved by proven therapies, like medication for opioid use disorder (MOUD), a treatment that combines counseling with lifesaving opioid replacement medication. MOUD is one of the most effective tools we have to reduce the risk of overdose, according to the evidence. Yet, access is still constrained by scope-of-practice and supervision laws that dictate which medications clinicians can prescribe and in which settings they may do so.
These rules are often shaped by professional and regulatory organizations like the American Medical Association, whose influence on state and medical boards, as well as legislatures, affects who is authorized to prescribe and manage MOUD care. While rural areas frequently lack clinicians due to lower population densities, these restrictions make existing shortages worse by preventing qualified providers from offering care where it is most needed.
Beyond these restrictions, outdated regulations on how and where patients can receive care, such as limits on telehealth and medication delivery, further compound access barriers. Reducing these unnecessarily restrictive occupational licensing and delivery barriers is a practical and evidence-based way to close these gaps and expand access to lifesaving care.
Nurse practitioners (NPs) are already a significant part of the solution. In 2016, Congress passed a law enabling some NPs to prescribe buprenorphine, one of three approved medications for opioid use disorder. However, in 22 states, NPs are not permitted to do so without a supervising physician. This limitation reduces access to MOUD, especially in areas where doctors are in short supply. In states that grant NPs autonomy in prescribing, the number of available MOUD prescribers roughly doubles and significantly increases local treatment access. A national analysis shows that expanding prescribing to NPs had a particularly significant impact in very rural areas, where NPs and physician assistants were responsible for 1.3 times more buprenorphine prescriptions than in urban areas.
Additionally, the study found that areas where NPs were allowed to prescribe had roughly twice as many registered NPs compared to regions where NPs are barred from prescribing. This may be due in part to the fact that the lack of prescribing authority makes NPs seem less valuable to employers, who then instead opt for physicians. Because NPs are more likely than physicians to relocate to rural communities and to remain there long term, granting them prescribing power would be a meaningful step toward closing treatment gaps where they are most severe.
Pharmacists undergo the most extensive training in pharmacology of any healthcare professional. Idaho has successfully authorized pharmacists to prescribe medications for a range of conditions. Through House Bill 191, which passed in March of 2017, the state granted the Idaho Board of Pharmacy the authority to determine when pharmacists can prescribe medications independently using clinical judgment consistent with the standard practices of healthcare providers. This applied to minor or time-sensitive conditions that did not require a new diagnosis. Within the first year, pharmacists were able to treat over 20 common ailments, and the state reported no safety complaints, showing that pharmacist-led prescribing can safely expand access to care in underserved areas.
At the national level, the 2021 Mainstreaming Addiction Treatment Act (MAT Act) eliminated the requirement for clinicians to register for and receive a waiver from the Drug Enforcement Administration (DEA) to prescribe buprenorphine for opioid use disorder. Any clinician who can prescribe DEA Schedule III drugs, such as buprenorphine, may now prescribe them in states that recognize pharmacists as prescribers. Within the first year of implementation, pharmacist-issued prescriptions increased eightfold, rising from about 0.1 percent to 0.8 percent of all buprenorphine dispensations nationwide. The increase was most pronounced in states that had already authorized pharmacist prescribers, such as Idaho, New Mexico, and Rhode Island. Still, 90 percent of states continue to restrict pharmacists from prescribing buprenorphine independently. Where pharmacists can prescribe independently, they primarily serve rural and medically underserved areas, increasing the number of filled buprenorphine prescriptions by 5 to 10 percent in counties that previously had no such prescribers.
The Department of Veterans Affairs (VA) offers a clear example of how pharmacist prescribers can operate successfully as part of a coordinated healthcare team. Veterans experience disproportionately high rates of chronic pain and opioid dependence. Overdose deaths among veterans increased by more than 50 percent between 2010 and 2019, and as many as one in three service members prescribed opioids during active duty met the criteria for dependence.
Continue reading at Reason.
Layal Bou Harfouch
Edward Timmons
Edward Timmons, PhD, is Vice President of Policy at the Archbridge Institute. He leads the institute's economic policy strategy, identifying focus areas and disseminating work to key stakeholders and policymakers. His own research focuses on labor economics and regulatory policy; he is regularly asked to provide expert testimony to U.S. states on occupational licensing reform and the practice authority of nurse practitioners. Dr. Timmons received his Ph.D. in economics from Lehigh University and his B.A. in economics and actuarial science from Lebanon Valley College. He publishes a weekly newsletter on Substack with the latest research and policy insights surrounding occupational licensing.
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