Statewide Adoption of NCMB Opioid Prescribing Policy

Current Opioid Prescribing Policy: The NC Medical Board updated its policy for the use of opioids for the treatment of pain in January 2017. In order to provide its licensees with guidance that reflects the most current medical and scientific research and recommended practices, the Board has decided to adopt and endorse the CDC Guideline for Prescribing Opioids for Chronic Pain written and maintained by the Centers for Disease Control and Prevention (“CDC”). While these guidelines do not constitute regulations or necessarily state the standard of care in North Carolina in every context, the Board’s believes that these guidelines can provide useful information to licensees related to the appropriate considerations to be made prior to and during treatment plans involving opioids.

The Board notes that a failure to provide opioid treatment consistent with the standard of care in North Carolina may subject a licensee to disciplinary action by the Board.

The CDC Guideline for Prescribing Opioids for Chronic Pain
NCMB Safer Prescribing Guidance Resources

Background: Section 12F.16.(a) of Session Law 2015-241 required certain state health provider licensing boards and health agencies within state government to adopt the NCMB policy by July 1, 2016. This decision was motivated in part by a 2014 report to the Joint Legislative Program Evaluation Oversight Committee. The report concluded that NC needs to strengthen its monitoring and prevention of prescription opioid abuse and specifically noted that NC prescribers lack clear, authoritative standards for treating pain with prescription opioid medications.

Adopted in June 2014, the NCMB opioid prescribing policy, Policy for the Use of Opiates for the Treatment of Pain provides detailed guidance for clinicians seeking to provide appropriate patient care to individuals with a legitimate need for treatment while following accepted best practices to prevent abuse, misuse and diversion of opioid painkillers.

Further, the 2016 law directed that the following State health agencies and health care provider licensing boards adopt NCMB’s opioid prescribing policy:

Required Continuing Education on Safer Opioid Prescribing

Another portion of the same law, Section 12F.16(b) directs the licensing boards to require continuing education on the use of controlled substances for health care providers who prescribe controlled substances. It further specifies “at least one hour of the total required continuing education hours consists of a course designed specifically to address prescribing practices. The course shall include, but not be limited to, instruction on controlled substance prescribing practices and controlled substance prescribing for chronic pain management.”

Safe Opioid Prescribing FAQ

Will NCMB discipline licensees solely because they prescribe 100 MMEs per day or more to their patients?

No. NCMB is investigating the top two percent of licensees prescribing 100 MMEs per patient, per day. This amount is selection criteria for investigation only. In fact, North Carolina General Statute § 90-113.74(b2) states that the selection criteria “shall not be a basis for disciplinary action.”

 

Does the Medical Board want physicians and other prescribers to stop treating chronic pain?

Certainly not. The Board recognizes that chronic pain is a legitimate medical issue and understands that patients need appropriate care. The Board’s primary goal regarding opioid prescribing is to ensure that care is safe and appropriate.”

Is the objective of the Safe Opioid Prescribing initiative to reduce opioid prescribing?

The objective is to reduce or eliminate inappropriate opioid prescribing. If prescribing and associated care conform to current standards of care, the Board has no issues with it. If prescribing is inappropriate or excessive then, yes, the Board’s goal is stop it.

Does the Medical Board consider 100 MMEs per day to be the highest dose a physician or PA should prescribe to a chronic pain patient?

No. There is no “limit” or maximum acceptable dose for chronic pain patients.The type of medication prescribed and dosage ordered will depend on the patient’s medical needs, prior history of opioid use and other factors to be determined by the prescriber, in accordance with current standards of care.

Is cutting patient dosages/quantities so that they fall below the 100 MMEs per patient, per day threshold an acceptable response to NCMB’s Safe Opioid Prescribing initiative?

No. Clinical decisions, including adjustments to medication dosages, should always be made based on objective clinical information in accordance with current accepted standards of care.

Arbitrarily adjusting or ceasing treatment for a patient on long term opioids in an attempt to avoid investigation could result in substandard care that is in itself grounds for regulatory action by the Board.

How is the Safe Opioid Prescribing initiative different from NCMB’s existing investigative methods?
The Board’s traditional investigative methods are complaint-driven – NCMB acts, or reacts, based on the information received. The Safe Opioid Prescribing initiative will help NCMB proactively screen and identify prescribers of interest where no complaint has been received.
Why is NCMB expanding its investigations into opioid prescribing?
The rate of patient deaths due to opioid overdose has risen sharply over the past several years, to the point where the state of North Carolina considers it to be a public health crisis. As an agency that regulates large numbers of prescribers – physicians and PAs – NCMB has an obligation to do all it can to identify inappropriate prescribing.

“Today, more than three North Carolinians die every day from an overdose – now the leading cause of accidental deaths in the state – a nearly 50 percent higher mortality rate than car accidents.”

- Rahn Bailey, M.D., Chairman Department of Psychiatry and Behavioral Medicine at Wake Forest School of Medicine - News & Observer (August 2016)