Resources & Information

Safe Opioid Prescribing Initiative

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.