Resources & Information


Coming to terms with opioid prescribing: Safe treatment is the goal

In recent months, I’ve sent emails to all North Carolina Medical Board (NCMB or the Board) licensees to make them aware of the Board’s recent effort to increase oversight of opioid prescribing, the Safe Opioid Prescribing Initiative (SOPI). Many physicians and physician assistants (PAs) are concerned about the prospect of being investigated in relation to the initiative. It is my expectation that SOPI will impact a small fraction of NCMB’s 45,000 licensees (to date, approximately 70 cases have been opened through the new initiative). Nonetheless, some prescribers have contacted the Board with questions and concerns, indicating they are unsure what NCMB expects of licensees who treat pain.

NCMB approaches matters related to quality of care with the conviction that, given good information about standards and expectations, the vast majority of licensees will act appropriately. Opioid prescribing is no exception. NCMB has no desire to see chronic and acute pain go untreated or undertreated for fear of regulatory intervention. The Board wants pain to be effectively treated, including treatment with opioids, in a responsible manner. That is NCMB’s ultimate goal.

Prescribers in this state are granted the discretion, by the Board and through NC law, to exercise appropriate professional judgment in managing patient care, including opioid prescribing. Some states have taken a more heavy-handed approach, enacting laws to limit the number of days of opioid medications patients can receive, or establishing legal limits on opioid dosages. New York is the most recent to pass an opioids law, and several other states in the Northeast have enacted similar ones.

Put simply, the Board expects its licensees to practice in accordance with generally accepted standards of medical practice in NC whenever they prescribe opioids. NCMB does not tell its licensees in advance whether to prescribe opioids, or specify what dosage or amount of opioids should be prescribed. NCMB encourages safe and appropriate practice by directing licensees to resources that can be used to guide opioid prescribing decisions. These resources include policies developed by the Board, as well as information and instructional modules developed by government and/or independent clinical and educational organizations. I am in the process of completing the Safe and Competent Opioid Prescribing Education (SCOPE of Care) modules created by Boston University and have found them to be excellent. This free course and other resources are available at

There’s no doubt opioid prescribing is currently subject to an unprecedented level of scrutiny. I expect that will continue, as will the Board’s efforts to proactively address this issue. The best advice I can give licensees is to keep the focus on providing safe and appropriate care. This will serve you, and your patients, well.