Opioid Prescribing Article Didn’t Tell Full Story

A recent article in that first appeared in the Raleigh News & Observer with the headline, “Thousands of NC Doctors Are Over Prescribing Opioids Despite a New State Law,” was based on data that does not tell the complete story of why the prescriptions may have exceeded the STOP Act rules. The North Carolina Medical Society (NCMS) responded to the article with a written opinion piece we hope will be published on the paper’s editorial page. In the meantime, we offer our response to you to help set the record straight. Read NCMS CEO Robert W. Seligson’s response.

The NC Department of Health and Human Services and the NC Medical Board also submitted the joint statement below in response to the article as well as background information clarifying the facts.

JOINT STATEMENT to the News & Observer sent May 4, 2018:

Below is a joint statement from the North Carolina Department of Health and Human Services and the North Carolina Medical Board. We feel that the story, even with the recent changes, still does not frame things accurately. We are asking that this statement be added to the Sunday print edition of the News & Observer and updated online as well. 

Joint Statement

The North Carolina Department of Health and Human Services and the North Carolina Medical Board are committed to fighting the opioid overdose epidemic and ensuring North Carolinians are receiving appropriate medical care. Based on the limited prescribing information available in the Controlled Substances Reporting System and a preliminary report, there is absolutely no way to know that any prescribers are breaking the law. At no point has either agency expressed that any prescriber is violating state law, and suggesting such is a gross mischaracterization of the facts. North Carolina’s doctors are expected to educate themselves about the prescribing limits imposed by the STOP Act and comply as appropriate, but should not fear being investigated for writing legitimate prescriptions.

INFORMATION/BACKGROUND sent to the paper on May 2, 2018

  • The headline and much of the framing in your article is incorrect.  It is incorrect to say “According to the state health department, more than 16,000 physicians across the state prescribed too many opioids in March alone.
  • The most you could possibly claim is that these 16,000 prescribers have at least one prescription where more information is necessary to determine if the prescription is consistent with the STOP Act.
  • We have no specific reason to think any of these prescriptions violate the law, and to suggest otherwise is inaccurate. 
  • The data you reference, which was pulled from the CSRS, was simply an initial report using data parameters discussed with the North Carolina Medical Board.
  • It does not equate to prescriptions written in violation of the STOP Act.
  • The CSRS – by law – includes certain data elements about the prescriber and the prescription that was written.  It does not contain detailed information about an individual’s health care history.
  • Whether or not a given prescription complies with the terms of the STOP Act depends on a variety of factors related to the individual patient, their medical history, and their relationship with the provider.  Most of those data elements are not part of the CSRS record. 
    • More specifically, the STOP Act limits prescriptions only for certain prescribers during the initial consultation with a patient for acute pain or after surgery.
    • Prescriptions written after that initial consultation, or any prescriptions administered in a hospital, nursing home licensed under Chapter 131E of the General Statutes, hospice facility, or residential care facility, or written for patients who have cancer, are in hospice or palliative care, or under medication-assisted treatment for substance use disorder are not limited by the STOP Act.
  • The CSRS contains no data on, for example, whether the patient has cancer, whether a patient is in palliative care, or whether there has been a prior consultation for pain that did not result in an opioid prescription. 
  • This data is simply a list of providers who had at least one patient with an opioid prescription of over a week and who had not had a prescription within the last six months.  A great deal of additional information, which is not included in the CSRS, is necessary to determine which, if any, of those prescriptions are inconsistent with the STOP Act. 
  • It is ultimately the responsibility of NCMB to enforce the requirements of the STOP Act with its licensees.
  • The CSRS is not intended as primarily an enforcement tool, but rather as a tool to help prescribers understand a specific patient’s history with controlled substances schedule II through V. This prescriber should use this knowledge alongside their own assessment of the patient’s status to determine the appropriate and lawful prescription based on their own clinical judgement. 

 

 
 

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