NC Medical Board

The NCMB endorses 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 believes these guidelines can provide useful, up-to-date information to licensees related to the appropriate considerations to be made prior to and during treatment plans involving opioids.

The CDC Guideline for Prescribing Opioids for Chronic Pain can be found at https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm. 

Further CDC guidance regarding the Guideline: https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html

Important Legislation

State:

The NCMB supported passage of the Strengthen Opioid Misuse Prevention (STOP) Act of 2017, an effort to reduce the supply of unused, misused and diverted opioids circulating in NC and improve care by requiring prescribers to use tools and resources that help prevent inappropriate prescribing.

Federal:

The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act was passed into law by Congress in 2018. It followed the passage of CARA and the 21st Century Cures Act. The SUPPORT Act reauthorizes and continues funding for many of the key elements of both preceding acts and introduces several new initiatives to ensure the programs started under CARA and 21st Century Cures reach their full potential and benefit the lives of as many U.S. citizens as possible.

    NC Medical Board

    The NCMB Safer Opioid Prescribing Page provides resources including:

    Clinical guidance documents

    Enforcement activities

    Outreach

    Prescriber resources

    NC Board of Dental Examiners

    The latest information.

    NC Board of Nursing

    Clinical Guidance Documents
    NCMB Policy on the use of opiates for the treatment of pain

    Reporting Rule
    Controlled Substance Reporting Rule: Implications for Advanced Practice Nurse Prescribers (B. Lowery, June 2016)

    NC Board of Podiatry Examiners

    Clinical guidance documents

    Prescriber Resources

    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.
    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)