On June 29, Gov. Roy Cooper signed the Strengthen Opioid Misuse Prevention (STOP) Act of 2017 into law. Aimed at curtailing the opioid abuse epidemic in the state, the North Carolina Medical Society (NCMS) supported this legislation. Read the law and a comprehensive history of its passage on the NCMS 2017 Legislative Blog.
This new legislation may impact how you prescribe opioids. The North Carolina Medical Board (NCMB) sent a letter to all licensees the day after the STOP Act became law outlining its provisions, which include:
- Limits on the number of days of opioids that may lawfully be prescribed upon initial consultation to patients with acute pain (no more than a five day supply) and following surgeries (no more than a seven day supply)
- A requirement that prescribers review the patient’s 12-month history with the NC Controlled Substances Reporting System (NCCSRS), before issuing an initial prescription for a Schedule II or Schedule III opioid or narcotic, and subsequent reviews every three months as long as the patient continues on the drug. NCMB offers a streamlined NCCSRS registration process on its website. Use this visual guide to find it
- Faster reporting of prescriptions to NCCSRS by pharmacies that dispense controlled substances (within one day versus the former requirement of three days), as well as financial penalties for pharmacies that fail to correct missing or incomplete information.
initial addiction for those with the mu opioid receptor disease (heavily documented in the literature for 20!yrs as the etiology of addiction) can occur with very small amounts one or two days. Limiting the initial prescription will not stop addiction.
The new database in pharmacies has not yet been validated or reliability studies conducted to show that the expense and additional non-clinical time will be worth the effort
By being forced to check with the database places physicians in the role of law-enforcement not a role we have been trained or agreed to participate in
people trying to “score” by going to more than one doctor is very rare. It is more common for older people to go to more than one pharmacy because they are under treated
only 5 to 20% of prescribed, prescription opiates ever reach the street The majority of the street prescription type of opiates which includes all opiates given that heroin is a prescription opiates in other countries are stolen or manufactured by cartels
Stories of deaths in perfectly normal young folks stir the despiate but high sounding failed methods of supply restriction which all studies have shown make Street addiction worse
True mu receptor addiction disease is rare 0.5%. Therefore 99.5% of the population will never become addicted. You either have the gene or you don’t. There are no cases of created addictions in people already exposed to alcohol or opiates without showing intense seeking
to prevent addiction we need to have high school educational programs identifying those four per thousand students with the genes for addiction and identifying them when suddenly sneaky, seeking behaviors, develop after exposure to alcohol or opiates. No part of the law addressed this issue.
since alcohol and opiates can both cause addiction through the same mu receptor polymorphisms it is a waste of time to try to control opiates without controlling alcohol