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Jun 8 2016

Clarifying some points about NCMB’s new opioid investigations program

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In April, the Board emailed its licensees about a new effort to address potentially unsafe opioid prescribing in North Carolina. The Safe Opioid Prescribing Initiative is an attempt to reduce patient harm from misuse and abuse of prescription opioids by identifying and, where necessary, intervening to prevent excessive and/or inappropriate prescribing.

The Safe Opioid Prescribing Initiative will use data provided in accordance with state law by the NC Department of Health and Human Services and will investigate physicians and physician assistants identified through criteria established by the Board with help from an advisory committee. The first group of licensees received notices of investigation in mid-April. (Selection criteria for these investigations are listed at the end of this article.) NCMB has received feedback from licensees and patients that some prescribers have responded to the Board’s new program by arbitrarily reducing patient dosages, ceasing prescribing or discharging patients in an attempt to avoid Board scrutiny. This response is not warranted or advisable.

One myth that appears to be circulating, based on information received from patients who have contacted the Board, is that NCMB has established a maximum acceptable dose for opioids or limit on how much medication patients should be prescribed. This is not the case. The type and amount of medication prescribed should be determined by the prescriber, based on objective clinical information. The Board encourages care that conforms to current accepted standards, regardless of the quantity or dose of medication prescribed.

As with all Medical Board investigations, NCMB’s new Safe Opioid Prescribing Initiative will determine the appropriateness of care through standard methods, including written responses from prescribers, review of patient records, and independent expert medical reviews. The Board clearly recognizes that prescribers identified through its selection criteria may be practicing and prescribing in accordance with accepted standards of care. However, given the current public health crisis, the known risks of opioids and the rising incidence of unintentional overdose deaths, the legislature and the public expect the Board to take a leadership role in devising solutions. The Board 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 and other resources. Visit NCMB’s responsible opioid prescribing page.


The Board will investigate prescribers who meet one or more of the following criteria:

1. The prescriber falls within the top one percent of those prescribing 100 milligrams of morphine equivalents (MME) per patient, per day.

2. The prescriber falls within the top one percent of those prescribing 100 MMEs per patient, per day in combination with any benzodiazepine and is within the top one percent of all controlled substance prescribers by volume.

3. The prescriber has prescribed to two or more patients who died in the preceding twelve months due to opioid poisoning.

Read FAQs about the Safe Opioid Prescribing Initiative

 Comments on this article:

“This response is not warranted or advisable.”

No, but certainly foreseeable and understandable.  I should think you would have expected many clinicians to take this approach to avoid the scrutiny of a government agency with devastating enforcement prerogatives.

By Randy Peters on Jun 10, 2016 at 5:30am

If we as a prescriber of controlled substances, are following what would be considered the standard of care in our practices, then we should have no problems whatsoever coming out smelling like roses no matter how rigorously or for what reasons we are scrutinized! 

We have reached a point where this level of scrutiny is necessary to protect patient safety which, above all, is the Board’s primary objective. 

If as a providers we are changing our opioid prescribing out of fear of being scrutinized rather than out doing what is right and best for our patients then I would consider a serious change in our approach.

By Ronald Prucha on Jun 19, 2016 at 12:09pm

I have been seen by the same neurologist since 2012. Prior to seeing him, I had horrible pain for 2 years from a failed lumbar fusion and what turned out to be Fibromyalgia (He diagnosed me).
After trial and error with meds to try to help the pain, he prescribed a Fentanyl patch. I ended up at a dose of 75mcg (changing patch every 72 hrs)
When the CDC restrictions came out, he told me he could no longer prescribe the patch and he would wean me off, which he did over 3 months (Sept, 2018)
Since then, I have had to suffer once more. I have read where you can keep a patient on a dose if they have been on it and had no ill effects. I have been on a pain contract since the beginning.
I feel doctors are fearful of being sanctioned, even when the patient has done well on opioid prescriptions. 
So, I am back where I began. In constant pain. (He referred me to a pain clinic and doc gave me 12.5 mcg Fentanyl patches for 2 months). Told her I couldn’t tell a difference in pain level. Instead of increasing the dosage, she said, “If you can’t feel it, it is not going to help to increase the dose”. Why couldn’t she increase each month and see how I did? I will never know. I went back to the neurologist,  because he is a great doctor. I am on 30mg Morphine Sulfate,  every 8 hrs. Not as helpful as Fentanyl, but better than nothing.
Now, he tells me he will decrease me to twice a day!!! These guidelines are not serving people in real pain, who follow all the rules.

By Allison Shavitz on Aug 26, 2019 at 10:50am
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