Medical Board Launches New Program To Monitor Opioid Prescribing

From the North Carolina Medical Board

The North Carolina Medical Board is launching a new effort to address potentially unsafe opioid prescribing in an attempt to reduce patient harm from misuse and abuse of these medications. The Board emailed licensed physicians and physician assistants (PAs) about the new program this week.

Using data provided in accordance with state law by the NC Department of Health and Human Services (NCDHHS), the Board will investigate prescribers who meet one or more of the following criteria:

  • The prescriber falls within the top 1 percent of those prescribing 100 milligrams of morphine equivalents (MME) per patient per day.
  • The prescriber falls within the top 1 percent of those prescribing 100 MMEs per patient per day in combination with any benzodiazepine and is within the top 1 percent of all controlled substance prescribers by volume.
  • The prescriber has had two or more patient deaths in the preceding 12 months due to opioid poisoning.

The Medical Board will determine the appropriateness of prescribing through standard methods, including review of patient records, independent expert medical reviews and written responses from the prescriber.  In its email to physicians and PAs, the Board acknowledged prescribers identified through the stated criteria may be practicing and prescribing in accordance with accepted standards of care. Given the known risks of opioids and the rising incidence of unintentional overdose deaths, the Board wrote that it has an obligation to verify that care and prescribing is clinically appropriate.

Physicians and others who treat chronic pain are encouraged to review current standards of care by reading NCMB’s position statement on use of opiates for the treatment of pain. According to the Board, cases that result in public action against the prescriber universally involve one or more significant departures from accepted standards of care.


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  • Dr. Willis,

    Thank you for your comment. NCMB recognizes that chronic pain is an important clinical issue and fully supports appropriate care, including the use of opioids. However, the ready availability of opioid medications, the known risks of these medications and the rising incidence of overdose deaths related to them make the Board’s obligation to ensure appropriate prescribing clear.

    Traditionally, NCMB’s enforcement efforts have been reactive, responding to complaints and other information received. The new investigative program, the Safe Opioid Prescribing Initiative, is an effort to proactively identify potentially unsafe prescribing so the Board can take appropriate action. However, regulatory action is just one part of the Board’s approach. NCMB’s expectation for any physician or PA treating chronic pain is that care meets current standards of care. The Board adopted a comprehensive position statement that provides detailed guidance on using opioids for the treatment of pain to help prescribers understand what standard of care looks like. Put simply, a licensee who follows NCMB’s pain policy will not get into trouble. Read it here:

    Finally, NCMB wishes to clarify an important point. The Board receives prescribing data from NCDHHS in accordance with recent changes to state law. The NC General Assembly authorized this release of data to NCMB and other regulatory boards with the implicit expectation that regulators would use the information to enhance their abilities to investigate prescribing issues. Some feedback the Board has received has suggested that NCMB’s criteria are not aggressive enough. Indeed, the Board does not expect a large number of licensees to meet them.

    Jean F. Brinkley, NCMB Communications Director

  • Kerry Willis

    Awesome! so Physicians were encouraged a few years ago and threatened with unethical behavior if they didn’t treat pain needs for patients. Now we plan to profile them and harass them if they do nothing wrong than write prescriptions as far as we know. We can’t profile terrorists but we can profile physicians ….Its a great country we live in…..

    Far be it from me to suggest that perhaps the development of an ideal treatment program should be developed modeled after successful programs in other States.Perhaps we should educate and enable physicians to safely monitor and prescribe medications without fear of incrimination or condemnation by a Medical Board who could provide leadership rather than suspect use of databases in manner that may be illegal.