New NCMB program addresses opioid crisis
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 Safe Opioid Prescribing Initiative in April. The first group of prescribers who meet criteria for investigation were notified the same month.
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 established by NCMB:
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 had two or more patient deaths in the preceding twelve months due to opioid poisoning. (The initial group of prescribers under investigations were reviewed for the period beginning July 2014 and ending June 2015.)
So far, NCMB has opened investigations on 72 prescribers (physicians and PAs), 12 of whom meet criteria under No. 1 and/or No. 2 and 60 who meet criteria described in No. 3. The Board will open investigations on additional prescribers as more are identified through the selection criteria. NCMB will receive quarterly data updates from DHHS.
The 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.
It is important to understand that 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 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. Cases that result in public action against the prescriber universally involve one or more significant departures from accepted standards of care.