Resources & Information

All NC licensed physicians, except those holding a residency training license, and physician assistants who prescribe controlled substances must meet the CS CME.

The CS CME requirement is ongoing. Licensees who prescribe controlled substances must earn CS CME during each new CME cycle. Physicians are required to complete 3 hours of CS CME for each 3-year cycle.  Physician Assistants are required to complete 2 hours of CS CME for each 2-year cycle.

The total hours of CS CME taken to fulfill the requirement (not individual courses), ultimately must cover all controlled substances prescribing practices and controlled substance prescribing for chronic pain management. As long as the collective CS CME taken covers these topics, licensees are encouraged to choose the courses that they think will be most practice relevant. CME that includes recognizing signs of the abuse or misuse of controlled substances or non-opioid treatment options shall qualify for CS CME. Also, licensees completing the one-time federal Medication Access and Training Expansion Act (MATE) training shall be deemed in compliance with the CS CME requirement during the period in which the MATE training was completed.

Yes. Except for resident training license holders, licensees who prescribe, order, supply, administer, or otherwise provide controlled substances to patients under their care must complete the mandated CS CME. This includes any hospital or institutional based licensees ordering and/or administering controlled substances to a patient using either directly or indirectly their own DEA registration or an institutional DEA registration.

Yes. The requirement applies to physicians and PAs who prescribed ANY controlled substances (including non-opioids) during their most recent CME cycle.

Yes. The requirement applies to physicians and PAs who prescribed ANY controlled substances (including non-opioids) during their most recent CME cycle.

Possibly. If the instruction is focused on your specific area of practice, but the primary topic of the instruction is controlled substances prescribing practices, recognizing signs of the abuse or misuse of controlled substances or controlled substance prescribing for chronic pain management, then that instruction will count towards the requirement. However, the total hours of CME taken to fulfill the proposed requirement ultimately must cover all three topics.

Yes. There is no exemption for licensees who practice outside of NC. If you prescribe controlled substances and hold a NC license, you must comply with the CS CME requirement.

There are many existing online and in-person CS CME courses that appear to meet the requirement. Licensees may select any course that is AMA or ACCME Category 1 or similar that covers controlled substances prescribing practices and controlled substance prescribing for chronic pain management. Keep in mind that each course need not cover each education topic. Licensees simply must ensure that each education topic is covered at least once during each CME cycle.

Yes. The Board provides links to high quality free and low-cost opioid prescribing courses on its website as it becomes aware of them. Check www.ncmedboard.org/prescribingCME for access to these resources.

However, licensees are ultimately responsible for ensuring courses meet the content requirements to fulfill the CME requirement.

The CS CME cycle is the same as the licensee’s general CME cycle. If a physician does not know his or her cycle year, he or she can email the renewal coordinator at .(JavaScript must be enabled to view this email address) to inquire about the CS CME cycle year.

PAs may follow their two-year NCMB CME cycle or, if certified through NCCPA, they may follow that organization’s two-year certification cycle. PAs should pick one method for determining their CS CME cycles and follow it consistently.

PAs who maintain NCCPA certification, and are exempt from the general requirement to report CME hours to the Board, may use their current NCCPA two-year cycle. 

PAs who currently report CME hours to the Board should use the two-year cycle that started on their first birthday after obtaining licensure.

Licensees are not required to notify NCMB that they have completed the required CS CME. Please DO NOT email, fax or send CME certificates to the Board. NCMB recommends that licensees keep documentation of CME courses completed. If selected for a CME compliance audit, you will be asked to provide documentation at that time.

During annual license renewal, licensees who prescribe controlled substances are asked to acknowledge that they have been informed of the CS CME requirement and that they understand they are responsible for complying.

Yes. Licensees who are subject to NCMB’s controlled substances CME requirement may use CME hours completed to satisfy the new one-time 8 hour training requirement established by the federal government to satisfy their full North Carolina CME requirement. Physicians who prescribe controlled substances must earn 3 hours of controlled substances CME in each three year CME cycle; PAs who prescribe must earn two hours in each two year cycle.

No. All physicians licensed by the Board (other than those holding a Residency Training License) who prescribe controlled substances must satisfy the controlled-substance prescribing CME requirement set forth in 21 NCAC 32R .0101. 

Any physician who qualifies for the MOC exemption in 21 NCAC 32R .0103 and who, as part of their MOC process, completed CME that specifically satisfies the requirement in 21 NCAC 32R .0101 is not required to take controlled-substance prescribing CME beyond that included in their MOC process. 

Licensees whose MOC activities do not include controlled substance prescribing CME as required by 21 NCAC 32R .0101 must complete additional CME that satisfies the requirement. All physicians subject to 21 NCAC 32R .0101 will be asked to affirm that they have completed the required CME, but will not be required to submit documentation of courses completed unless specifically requested by the Board.

The law requires licensees to report, within 30 days, to the Board incidents involving the following misconduct by a licensee of the North Carolina Medical Board:

1. Sexual misconduct with a patient.
2. Fraudulent prescribing, drug diversion or theft of controlled substances.

The law states that the medical professional reporting misconduct is obligated to make a report to the Board if he or she “reasonably believes” that the reported misconduct has occurred.

The law does not define this. “Belief” or “believes” denotes that the reporting licensee actually supposes their report to be true.  There is no requirement of certainty, and the belief may be inferred from circumstances.  The belief is “reasonable” if an ordinary, prudent licensee could arrive at the same belief, presented with the same circumstances.

For the purposes of the Duty to Report requirement pursuant to N.C.G.S. § 90-5.4, sexual misconduct is defined in N.C.G.S. § 14-27.20(4), (5), (6) as “sexual acts,” “sexual contact” or “touching.” For a complete definition of those terms, see: https://www.ncleg.gov/EnactedLegislation/Statutes/PDF/BySection/Chapter_14/GS_14-27.20.pdf

Please note that, under the law, patient consent or patient initiation of sexual contact does not relieve a licensee of the duty to report sexual misconduct.

Also, consistent with the Board’s Position Statement 2.2.1, Sexual Misconduct Involving Patients, there are other matters a licensee should report that are not covered by N.C.G.S. § 90-5.4.

N.C.G.S. § 90-5.4(a)(2) requires licensees to report other licensees for “fraudulent prescribing, drug diversion, or theft of controlled substances.” Drug diversion is specifically defined by the statute as transferring controlled substances or prescriptions for controlled substances to:

(i) the licensee for his own personal use;
(ii) a licensee’s immediate family member;
(iii) any other person living in the same residence as the licensee;
(iv) any individual with whom the licensee is having a sexual relationship; or
(v) any individual unless for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.

Immediate family members will include a spouse, parent, child, sibling, any step-family member or in-law coextensive with the preceding identified relatives.

Fraudulent prescribing is not specifically defined and will overlap with drug diversion, but it is a prescription that is written for the purpose of obtaining a controlled substance for an illicit use. Examples include selling prescriptions, writing prescriptions in exchange for sexual favors, writing prescriptions for fictitious patients, or forging prescriptions on another licensee’s prescription pad.

Theft of controlled substances will include stealing any controlled substances from patients, clinics, practices, pharmacies, hospitals, or other healthcare facility. It will also include stealing prescription samples or drugs intended for disposal in drug take back programs.

The Board requires certain essential facts to conduct an investigation, regardless of the subject of the case. The individual making the report will be expected to provide the name of the licensee who engaged in misconduct, a description of what is alleged or believed to have occurred, date or dates of occurrences, if known, and the name of the patient or patients involved, if known. Individuals submitting reports may attach photos, documents or any other files they believe will help the Board to investigate the reported misconduct.

The Board has established an online form specifically for medical professionals who have information to report to the Board. Going forward, medical professionals who wish to report a matter of concern to the Board will use this portal and NOT the consumer/patient complaint form. A dedicated reporting form is something medical professionals have requested of the Board for some time. Access the professional complaint form here.

The Board accepts “anonymous” reports in that it can typically investigate a case without revealing the name of the person who submitted the report to the licensee who is being investigated. The online form requires the name and contact information of the person making the report. This will confirm the person has discharged his/her duties under the statute.

In cases where the Board determines that it will pursue public action against a licensee, it may not be possible for the individual who originally reported the misconduct to remain anonymous. The Board generally must have contact information for an individual reporting a concern so that he or she can be reached if the Board has questions or requires further information.

Yes. The institution should use the same form a medical professional would use to report information to the Board.

Any person who reports under the new Duty to Report law (N.C.G.S. § 90-5.4) in good faith and without fraud or malice shall be immune from civil liability. Reports made in bad faith, fraudulently, or maliciously shall constitute unprofessional conduct and shall be grounds for discipline under N.C.G.S. § 90-14(a)(6).

For all other reports to the Board, N.C.G.S. § 90-14(f) provides, in relevant part, that a person acting in good faith without fraud or malice shall be immune from civil liability for reporting to the Board the acts of a licensee that violate the Medical Practice Act.

Health care professionals are welcome to use the health professionals reporting form to make the Board aware of any misconduct or substandard practice by a licensee. The Duty to Report statute is simply what prompted the Board to establish this new portal. Note: Hospitals that need to report a change in staff privileges or insurance carriers that need to report professional liability payments made on behalf of licensees should continue to use established methods for reporting this information to the Board.

Any report made to the Board will be thoroughly evaluated through standard investigative methods.

There will be an application specifically designated for ITPE applicants, but it will not be available until January 2026 when the law becomes effective. Please do not apply for any other application for which you do not qualify and please do not submit any materials via email to Board staff.

There are at least 11 criteria applicants must satisfy in order to qualify for an ITPE license, including:

• An offer of full-time employment from an NC hospital or a rural medical practice with an on-site NC licensed physician.
• A foreign medical license that is:
  • Active, current, and in good standing, OR
  • Active and in good standing within the past 5 years.
• 130 weeks of Medical Education from a medical school listed in the World Dictionary of Medical Schools
• Eligible to be certified by the Education Commission for Foreign Medical Graduates, which includes having the applicant’s medical school verified, passing USMLE Step 1 and 2, and completing any additional assessments as required by applicant’s selected Pathway.

• Postgraduate Training that is either:
  

  • 2 years of Graduate Medical Education approved by the applicant’s country of licensure, OR
  • Actively practiced medicine in country of licensure for at least 10 years after graduation.

• Additional Competency Examination. In addition to the examinations required for ECFMG eligibility, the applicant must also provide successful passage of one of the following examinations:
  

  • Examinations currently accepted by state law and board rules, including USMLE Step 3
  • Examinations accepted for licensure in other countries that are members of IAMRA and the exam must be comparable to the USMLE and tests for ability to practice medicine, medical knowledge, skills and understanding of clinical science essential to patient care, communication and interpersonal skills, and interactive testing component.
  • Board Certification from American Board of Medical Specialties (AMBS), American Osteopathic Association (AOA), or Royal College of Physicians and Surgeons of Canada (RCPS).
  • Comprehensive Assessment demonstrating clinical competence by a program approved by the Board.
  • The Board may waive the additional exam requirements but must require the applicant to successfully pass the SPEX or PLAS within one year. The Board will not issue a waiver for the additional examination unless all other requirements of the license have been met.
• No disciplinary history and no pending investigations in any jurisdiction.
• No criminal history. A criminal background check will be required from the applicant’s country of licensure.
• Practice experience. Applicants have to have practiced medicine for at least five years.
• Communication. Applicants must be proficient in English.
• Immigration Status. Applicants must be authorized to work in the United States.

There will also be an application fee of $400. Applications will not be processed until the application fee is submitted.

Proof of any of the above credentials must be primary source verified, meaning documentation must be received from the originating source. The Board will not accept credentialing documents directly from an applicant.

You must have either (1) a current and active license in good standing to practice medicine in a foreign country, or (2) had an active license in good standing to practice medicine within five years immediately preceding the submission of your application.

Applicants must have completed 130 weeks of medical education at a medical school that is listed in the World Dictionary of Medical Schools. The applicant must also be eligible for Educational Commission for Foreign Medical Graduates (ECFMG) certification, meaning the school must be recognized by the ECFMG and the applicant must pass the USMLE Step 1 and Step 2 along with any additional assessment requirements under a selected ECFMG pathway.

No, you do not have to be ECFMG certified, but you must have completed all the steps to be eligible for ECFMG certification. This includes having your medical school verified by the ECFMG, passing both USMLE Step 1 and Step 2, as well as any additional assessments required under your selected Pathway within the time frame set by the ECFMG.

Please visit: https://www.ecfmg.org/certification-pathways/pathway-schools.html

Please visit: https://www.ecfmg.org/.

You must have attended the medical school at the time designated by the ECFMG.

Yes, to be ECFMG eligible you must pass USMLE Step 1 and Step 2 as well as any assessments required by your ECFMG Pathway.

There are two options. You must either have completed two years of postgraduate training in a graduate medical education program approved by your country of licensure OR have actively practiced medicine in your country of licensure for at least 10 years.

The requirement to be ECFMG eligible will require the applicant to successfully pass USMLE Step 1 and Step 2, along with any assessment required to complete an ECFMG pathway. In addition, the applicant must also successfully pass one of the following exams:

Examinations currently accepted under G.S. 90-10.1, which includes successful passage of all USMLE steps, including USMLE Step 3.
• Examinations accepted for licensure in other countries that are members of IAMRA and the exam must be comparable to the USMLE and tests for ability to practice medicine, medical knowledge, skills and understanding of clinical science essential to patient care, communication and interpersonal skills, and interactive testing component.
• Board Certification from American Board of Medical Specialties (AMBS), American Osteopathic Association (AOA), or Royal College of Physicians and Surgeons of Canada (RCPS).
• Comprehensive Assessment demonstrating clinical competence by a program approved by the Board.
• The Board may waive the exam requirements but must require the applicant to successfully pass the SPEX or PLAS within one year. The Board will not issue a waiver of the additional examination requirement unless all other requirements of the license have been met.

Applicants must have practiced medicine for at least five years in their country of licensure.

The Board cannot assist you in securing an offer of full-time employment. You should search for any available job opportunities at NC licensed hospitals or rural medical practices and follow the employer’s process for applying.

There are two options. ITPEs must have an offer letter of full-time employment from either (1) a hospital located and licensed in North Carolina, OR (2) a medical practice in a rural area where there will be a NC licensed physician on-site.

The hospital must be located and licensed in North Carolina. Click here for a list of hospitals licensed in North Carolina

No. The hospital must be located and licensed in North Carolina. Click here for a list of hospitals licensed in North Carolina

The medical practice must be located in a North Carolina rural medical practice with a population of less than 500 people per square mile, where a fully licensed NC physician is physically practicing on-site. Click here to see a list of rural counties in North Carolina with less than 500 people per square mile.

Prior to initially prescribing any “targeted controlled substance” (Schedule II or Schedule III opioid or narcotics) practitioners are required to review a patient’s 12-month prescription history in the NC Controlled Substances Reporting System (NC CSRS). For every subsequent three-month period that the Schedule II or Schedule III opioid or narcotic remains part of the patient’s medical care, practitioners are required to review the patient’s 12-month history in the NC CSRS.

Yes. In accordance with statute, clinicians who issue prescriptions in any of the following situations may but are not required to check a patient’s 12-month prescription history with NC CSRS:

• Controlled substances administered in a health care setting, hospital, nursing home, outpatient dialysis facility or residential care facility.

• Controlled substances prescribed for the treatment of cancer or another condition associated with cancer.

• Controlled substances prescribed to patients in hospice care or palliative care.

The STOP Act applies to all “targeted controlled substances”. This is a term coined by the law to indicate all Schedule II and Schedule III opioids or narcotics, specifically those listed in N.C. Gen. Stat. § 90-90(1), (2) and 90-91(d). Find a complete list of affected medications here.

No. Targeted controlled substances are Schedule II and III opioids and narcotics per the North Carolina Controlled Substances Act, specifically those listed in N.C. Gen. Stat. § 90-90(1), (2) or 90-91(d). Ritalin and other stimulants are listed in N.C. Gen. Stat. § 90-90 (3) and, thus, are not considered targeted controlled substances under the STOP Act. Therefore, it is not required under the law to check the patient’s 12-month controlled substances prescription history before prescribing Ritalin or another stimulant medication.

Integrating your EHR system with NC CSRS greatly increases the ease of conducting 12-month prescription history reviews. For prescribers who access NC CSRS directly to conduct manual patient queries, remember that NC CSRS allows prescribers to register delegates (nurses, non-clinician medical office staff) who can run queries on behalf of the prescriber. Delegates must have their own registration (prescribers are not allowed to let a delegate login using his or her credentials) and must be assigned to each of the prescribers he or she is to run patient queries for.

Prescribers, practices or health care facilities that use electronic health records systems should inquire about integrating their EHR system with NC CSRS, as this is the most efficient way of using the system. Prescribers who are not able to integrate should register for access here and use the system to look up individual patent histories.

NC CSRS has developed a video training that may be helpful. Find it here.

It is necessary to apply to NC DHHS for approval to integrate with the NC CSRS system. There are four forms to submit to complete an integration request.

  1. Complete the Integration Request Form. Be sure to identify the primary contact as the person who is championing the effort on your organization’s behalf, as well as a contact for your software vendor.  Note: Only authorized decision makers should fill out the form.

  2. A Terms and Conditions Agreement will be emailed to the primary contact within 24-48 hours of receipt of the Request Form.  Review and electronically sign the Agreement.

  3. Complete the Prescriber List and email to .(JavaScript must be enabled to view this email address).
 
  4. Complete the Gateway Licensee Questionnaire for requesting CSRS data from other approving states.
 
ALL documents before NC DHHS will review your request.  Once approved, Appriss Health, the vendor, will contact you to discuss next steps.

Yes, NC CSRS has obtained grant funding to provide one-on-one technical assistance to prescribers upon request. To request assistance, email .(JavaScript must be enabled to view this email address).

The fact that the 12-month prescription history was obtained and reviewed should be documented in the record, but it is not necessary to retain a copy of the actual prescription history report in the medical record.

The STOP Act mandates electronic prescriptions for certain controlled substances, or “targeted controlled substances.”

Targeted controlled substances include all Schedule II and Schedule III opioids and narcotics. For a complete list of Schedule II and III opioids and narcotics that must be e-prescribed, please review:
• N.C.G.S. § 90-90 Sections (1) & (2) only
• N.C.G.S. § 90-91 Section (d) only

The law specifies the following exemptions:

1. A practitioner, other than a pharmacist, who dispenses directly to an ultimate user.
2. A practitioner who orders a controlled substance to be administered in a hospital, nursing home, hospice facility, outpatient dialysis facility, or residential care facility.
3. A practitioner who experiences temporary technological or electrical failure or other extenuating circumstances that prevents the prescription from being transmitted electronically; provided, however, that the practitioner documents the reason for this exception in the patient’s medical record.
4. A practitioner who writes a prescription to be dispensed by a pharmacy located on federal property; provided, however, that the practitioner documents the reason for this exception in the patient’s medical record.
5. A person licensed to practice veterinary medicine.

There is no specific consequence established by the STOP Act. The Board would evaluate each situation and determine an appropriate resolution based on the individual circumstances of each case.

The Board cannot recommend specific vendors or products. Prescribers who do not currently have e-prescribing capability are strongly encouraged to identify an e-prescribing solution that complies with the law, including privacy and security requirements.

Professional and specialty organizations (NC Medical Society, Old North State Medical Society, NC Academy of Family Physicians, NC Academy of Physician Assistants, NC Osteopathic Medical Association, etc.) may be able to offer additional information or guidance.

No. Choosing not to develop e-prescribing capability, whatever the reason, does not qualify as an “extenuating circumstance” in the Board’s view and would not exempt a licensee from the STOP Act e-prescribing requirement.

No. Choosing not to develop e-prescribing capability, whatever the reason, does not qualify as an “extenuating circumstance” in the Board’s view and would not exempt a licensee from the STOP Act e-prescribing requirement.

The STOP Act specifically exempts pharmacies and pharmacists from having to determine whether individual prescriptions are valid or comply with the e-prescribing mandate, and states at N.C.G.S. § 90-106 (a2), “A dispenser may continue to dispense targeted controlled substances from valid written, oral, or facsimile prescriptions that are otherwise consistent with applicable laws.” Therefore, if presented with a paper prescription for a targeted controlled substance, a pharmacy may lawfully fill it. Per the NC Board of Pharmacy, repeated instances of noncompliance (e.g. continued use of paper prescriptions for Schedule II and Schedule III opioids and narcotics) could lead a pharmacist to address the issue. This could include reaching out to the prescriber to ensure he or she is aware of the e-prescribing mandate. Alternatively, pharmacists could report prescribers who persist in writing paper prescriptions to the Board, which would investigate.

Yes. To provide multiple one-month prescriptions to a patient, the prescriber may issue a separate e-prescription for each month and indicate a “do not fill” until date on each prescription to indicate the appropriate fill date.

The prescriber or a member of the practice support staff can contact the pharmacy to ask them to cancel the prescription. Then, the prescriber may reissue the prescription to another pharmacy.