From the North Carolina Medical Board
The 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 program this week.
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:

  • The prescriber falls within the top 1 percent of those prescribing 100 milligrams of morphine equivalents (MME) per patient per day.
  • The prescriber falls within the top 1 percent of those prescribing 100 MMEs per patient per day in combination with any benzodiazepine and is within the top 1 percent of all controlled substance prescribers by volume.
  • The prescriber has had two or more patient deaths in the preceding 12 months due to opioid poisoning.

The Medical 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.  In its email to physicians and PAs, the Board acknowledged 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 wrote that it 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. According to the Board, cases that result in public action against the prescriber universally involve one or more significant departures from accepted standards of care.