Resources & Information

Physicians, including residents who hold a full NC medical license, and physician assistants who prescribe controlled substances.

The CS CME requirement is ongoing. Licensees who prescribe controlled substances must earn CS CME during each new CME cycle.

Yes. Licensees who have not prescribed ANY controlled substances (opioid or non-opioid) since they last renewed their license and physicians holding a Resident Training License are exempt from the requirement.

It is not necessary to request exemption. However, NCMB will continue to conduct random CME audits to verify exempt status.

The total hours of CME taken to fulfill the requirement, not individual courses, ultimately must cover all three topics. As approved, the requirement stipulates only that courses cover “controlled substances prescribing practices, recognizing signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management.” As long as the collective CME taken meets these three basic requirements, licensees are encouraged to choose the courses that they think will be most practice relevant.

Yes. Licensees who prescribe, order, supply, administer, or otherwise provide controlled substances to patients under their care must complete the mandated CME.

The Board has determined that hospital or institutional based licensees (with the exception of physicians holding only a Resident Training License) who order and/or administer any controlled substance to a patient using either their own DEA registration or by means of an institutional DEA registration, directly or indirectly, are required to obtain the CME.

Yes. The requirement applies to physicians and PAs who prescribed ANY controlled substances (including non-opioids) during their most recent CME cycle.

Yes. The requirement applies to physicians and PAs who prescribed ANY controlled substances (including non-opioids) during their most recent CME cycle.

Possibly. If the instruction is focused on your specific area of practice, but the primary topic of the instruction is controlled substances prescribing practices, recognizing signs of the abuse or misuse of controlled substances or controlled substance prescribing for chronic pain management, then that instruction will count towards the requirement. However, the total hours of CME taken to fulfill the proposed requirement ultimately must cover all three topics.

Yes. There is no exemption for licensees who practice outside of NC. If you prescribe controlled substances and hold a NC license, you must comply with the CME requirement for controlled substances prescribers.

No. Only licensees who prescribed controlled substances (including non-opioids) during their most recent CME cycle are subject to the requirement.

No. If you did not prescribe any controlled substances in your most recent CME cycle, you are not subject to the requirement. However, as previously required, retired physicians or PAs who maintain an active license will still need to comply with the general CME requirement currently in place.

There are three topics that must be covered:

• Controlled substances prescribing practices
• Recognizing signs of the abuse or misuse of controlled substances
• Controlled substance prescribing for chronic pain management

Keep in mind that each course need not cover each education topic. Licensees simply must ensure that each education topic is covered at least once during each CME cycle.

There are many existing online and in-person CME courses that appear to meet the requirement. Licensees may select any course that is ACCME Category 1 or similar that covers “controlled substances prescribing practices, recognizing signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management,” as stated in the revised rule.

Yes. The Board provides links to high quality free and low-cost opioid prescribing courses on its website as it becomes aware of them. Check www.ncmedboard.org/prescribingCME for access to these resources.

However, licensees are ultimately responsible for ensuring courses meet the content requirements to fulfill the CME requirement.

The CS CME cycle is the same as the licensee’s general CME cycle. If a physician does not know his or her cycle year, he or she can email the renewal coordinator at registration@ncmedboard.org to inquire about the CS CME cycle year.

PAs may follow their two-year NCMB CME cycle or, if certified through NCCPA, they may follow that organization’s two-year certification cycle. PAs should pick one method for determining their CS CME cycles and follow it consistently.

PAs who maintain NCCPA certification, and are exempt from the general requirement to report CME hours to the Board, may use their current NCCPA two-year cycle. 

PAs who currently report CME hours to the Board should use the two-year cycle that started on their first birthday after obtaining licensure.

Licensees are not required to notify NCMB that they have completed the required CS CME. Please DO NOT email, fax or send CME certificates to the Board. NCMB recommends that licensees keep documentation of CME courses completed. If selected for a CME compliance audit, you will be asked to provide documentation at that time.

During annual license renewal, licensees who prescribe controlled substances are asked to acknowledge that they have been informed of the CS CME requirement and that they understand they are responsible for complying.

Yes. Licensees who are subject to NCMB’s controlled substances CME requirement may use CME hours completed to satisfy the new one-time 8 hour training requirement established by the federal government to satisfy their full North Carolina CME requirement. Physicians who prescribe controlled substances must earn 3 hours of controlled substances CME in each three year CME cycle; PAs who prescribe must earn two hours in each two year cycle.

No. All physicians licensed by the Board (other than those holding a Residency Training License) who prescribe controlled substances must satisfy the controlled-substance prescribing CME requirement set forth in 21 NCAC 32R .0101. 

Any physician who qualifies for the MOC exemption in 21 NCAC 32R .0103 and who, as part of their MOC process, completed CME that specifically satisfies the requirement in 21 NCAC 32R .0101 is not required to take controlled-substance prescribing CME beyond that included in their MOC process. 

Licensees whose MOC activities do not include controlled substance prescribing CME as required by 21 NCAC 32R .0101 must complete additional CME that satisfies the requirement. All physicians subject to 21 NCAC 32R .0101 will be asked to affirm that they have completed the required CME, but will not be required to submit documentation of courses completed unless specifically requested by the Board.

The law requires licensees to report, within 30 days, to the Board incidents involving the following misconduct by a licensee of the North Carolina Medical Board:

1. Sexual misconduct with a patient.
2. Fraudulent prescribing, drug diversion or theft of controlled substances.

The law states that the medical professional reporting misconduct is obligated to make a report to NCMB if he or she “reasonably believes” that the reported misconduct has occurred.

The law does not define this. “Belief” or “believes” denotes that the reporting licensee actually supposes their report to be true.  There is no requirement of certainty, and the belief may be inferred from circumstances.  The belief is “reasonable” if an ordinary, prudent licensee could arrive at the same belief, presented with the same circumstances.

For the purposes of the Duty to Report requirement pursuant to G.S 90-5.4, sexual misconduct is defined in G.S. 14-27.20(4), (5), (6) as “sexual acts,” “sexual contact” or “touching.”  For a complete definition of those terms, see: http://www.ncleg.gov/EnactedLegislation/Statutes/PDF/BySection/Chapter_14/GS_14-27.20.pdf

Please note that, under the law, patient consent or patient initiation of sexual contact does not relieve a licensee of the duty to report sexual misconduct.

Also, consistent with NCMB’s position statement, Sexual Misconduct Involving Patients, there are other matters a licensee should report that are not covered by G.S. 90-5.4.

G.S. 90-5.4(a)(2) requires licensees to report other licensees for “fraudulent prescribing, drug diversion, or theft of controlled substances.” Drug diversion is specifically defined by the statute as transferring controlled substances or prescriptions for controlled substances to:

(i) the licensee for his own personal use;
(ii) a licensee’s immediate family member;
(iii) any other person living in the same residence as the licensee;
(iv) any individual with whom the licensee is having a sexual relationship; or
(v) any individual unless for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.

Immediate family members will include a spouse, parent, child, sibling, any step-family member or in-law coextensive with the preceding identified relatives.

Fraudulent prescribing is not specifically defined and will overlap with drug diversion, but it is a prescription that is written for the purpose of obtaining a controlled substance for an illicit use. Examples include selling prescriptions, writing prescriptions in exchange for sexual favors, writing prescriptions for fictitious patients, or forging prescriptions on another licensee’s prescription pad.

Theft of controlled substances will include stealing any controlled substances from patients, clinics, practices, pharmacies, hospitals or other healthcare facility. It will also include stealing prescription samples or drugs intended for disposal in drug take back programs.

NCMB requires certain essential facts to conduct an investigation, regardless of the subject of the case. The individual making the report will be expected to provide the name of the licensee who engaged in misconduct, a description of what is alleged or believed to have occurred, date or dates of occurrences, if known, and the name of the patient or patients involved, if known. Individuals submitting reports may attached photos, documents or any other files they believe will help the Board to investigate the reported misconduct.

NCMB has established an online form specifically for medical professionals who have information to report to the Board. Going forward, medical professionals who wish to report a matter of concern to NCMB will use this portal and NOT the consumer/patient complaint form. A dedicated reporting form is something medical professionals have requested of NCMB for some time. Access the portal from the home page of http://www.ncmedboard.org by clicking on the button labeled “File a complaint/report” at the center left of the page. Then, select the health professional reporting form from the list of options.

The Board accepts “anonymous” reports in that it can typically investigate a case without revealing the name of the person who submitted the report to the licensee who is being investigated. The online form requires the name and contact information of the person making the report. This will confirm the person has discharged his/her duties under the statute.

In cases where the Board determines that it will pursue public action against a licensee, it may not be possible for the individual who originally reported the misconduct to remain anonymous. The Board generally must have contact information for an individual reporting a concern so that he or she can be reached if NCMB has questions or requires further information.

Yes. The institution should use the same form a medical professional would use to report information to the Board.

Any person who reports under the new Duty to Report law (G.S. 90-5.4) in good faith and without fraud or malice shall be immune from civil liability. Reports made in bad faith, fraudulently, or maliciously shall constitute unprofessional conduct and shall be grounds for discipline under G.S.90-14(a)(6).

For all other reports to the Board, G.S. 90-14(f) provides, in relevant part, that a person acting in good faith without fraud or malice shall be immune from civil liability for reporting to the Board the acts of a licensee that violate the Medical Practice Act.

Health care professionals are welcome to use the health professionals reporting form to make NCMB aware of any misconduct or substandard practice by a licensee. The Duty to Report statute is simply what prompted NCMB to establish this new portal. Note: Hospitals that need to report a change in staff privileges or insurance carriers that need to report professional liability payments made on behalf of licensees should continue to use established methods for reporting this information to the Board.

Any report made to the Board will be thoroughly evaluated through standard investigative methods.

Prior to initially prescribing any “targeted controlled substance” (Schedule II or Schedule III opioid or narcotics) practitioners are required to review a patient’s 12-month prescription history in the NC Controlled Substances Reporting System (NC CSRS). For every subsequent three-month period that the Schedule II or Schedule III opioid or narcotic remains part of the patient’s medical care, practitioners are required to review the patient’s 12-month history in the NC CSRS.

Yes. In accordance with statute, clinicians who issue prescriptions in any of the following situations may but are not required to check a patient’s 12-month prescription history with NC CSRS:

• Controlled substances administered in a health care setting, hospital, nursing home, outpatient dialysis facility or residential care facility.

• Controlled substances prescribed for the treatment of cancer or another condition associated with cancer.

• Controlled substances prescribed to patients in hospice care or palliative care.

The STOP Act applies to all “targeted controlled substances”. This is a term coined by the law to indicate all Schedule II and Schedule III opioids or narcotics, specifically those listed in N.C. Gen. Stat. § 90-90(1), (2) and 90-91(d). Find a complete list of affected medications here.

No. Targeted controlled substances are Schedule II and III opioids and narcotics per the North Carolina Controlled Substances Act, specifically those listed in N.C. Gen. Stat. § 90-90(1), (2) or 90-91(d). Ritalin and other stimulants are listed in N.C. Gen. Stat. § 90-90 (3) and, thus, are not considered targeted controlled substances under the STOP Act. Therefore, it is not required under the law to check the patient’s 12-month controlled substances prescription history before prescribing Ritalin or another stimulant medication.

Integrating your EHR system with NC CSRS greatly increases the ease of conducting 12-month prescription history reviews. For prescribers who access NC CSRS directly to conduct manual patient queries, remember that NC CSRS allows prescribers to register delegates (nurses, non-clinician medical office staff) who can run queries on behalf of the prescriber. Delegates must have their own registration (prescribers are not allowed to let a delegate login using his or her credentials) and must be assigned to each of the prescribers he or she is to run patient queries for.

Prescribers, practices or health care facilities that use electronic health records systems should inquire about integrating their EHR system with NC CSRS, as this is the most efficient way of using the system. Prescribers who are not able to integrate should register for access here and use the system to look up individual patent histories.

NC CSRS has developed a video training that may be helpful. Find it here.

It is necessary to apply to NC DHHS for approval to integrate with the NC CSRS system. There are four forms to submit to complete an integration request.

  1. Complete the Integration Request Form. Be sure to identify the primary contact as the person who is championing the effort on your organization’s behalf, as well as a contact for your software vendor.  Note: Only authorized decision makers should fill out the form.

  2. A Terms and Conditions Agreement will be emailed to the primary contact within 24-48 hours of receipt of the Request Form.  Review and electronically sign the Agreement.

  3. Complete the Prescriber List and email to NCCSRS.Gateway.Integration@dhhs.nc.gov.
 
  4. Complete the Gateway Licensee Questionnaire for requesting CSRS data from other approving states.
 
ALL documents before NC DHHS will review your request.  Once approved, Appriss Health, the vendor, will contact you to discuss next steps.

Yes, NC CSRS has obtained grant funding to provide one-on-one technical assistance to prescribers upon request. To request assistance, email CSRS.Utilization@dhhs.nc.gov.

The fact that the 12-month prescription history was obtained and reviewed should be documented in the record, but it is not necessary to retain a copy of the actual prescription history report in the medical record.

The rate of patient deaths due to opioid overdose has risen sharply over the past several years, to the point where the state of North Carolina considers it to be a public health crisis. As an agency that regulates large numbers of prescribers – physicians and PAs – NCMB has an obligation to do all it can to identify inappropriate prescribing.

The objective is to reduce or eliminate inappropriate opioid prescribing. If prescribing and associated care conform to current standards of care, the Board has no issues with it. If prescribing is inappropriate or excessive then, yes, the Board’s goal is stop it.

The Board’s traditional investigative methods are complaint-driven – NCMB acts, or reacts, based on the information received. The Safe Opioid Prescribing initiative will help NCMB proactively screen and identify prescribers of interest where no complaint has been received.

Certainly not. The Board recognizes that chronic pain is a legitimate medical issue and understands that patients need appropriate care. The Board’s primary goal regarding opioid prescribing is to ensure that care is safe and appropriate.

No. There is no “limit” or maximum acceptable dose for chronic pain patients. The type of medication prescribed and dosage ordered will depend on the patient’s medical needs, prior history of opioid use and other factors to be determined by the prescriber, in accordance with current standards of care.

No. Clinical decisions, including adjustments to medication dosages, should always be made based on objective clinical information in accordance with current accepted standards of care.

Arbitrarily adjusting or ceasing treatment for a patient on long term opioids in an attempt to avoid investigation could result in substandard care that is in itself grounds for regulatory action by the Board.

No. NCMB is investigating the top two percent of licensees prescribing 100 MMEs per patient, per day. This amount is selection criteria for investigation only. In fact, North Carolina General Statute § 90-113.74(b2) states that the selection criteria “shall not be a basis for disciplinary action.”

The STOP Act mandates that all prescriptions for targeted controlled substances – a designation that includes all Schedule II and Schedule III opioids and narcotics – that are issued on or after Jan. 1, 2020, be e-prescribed.

All “targeted controlled substances” – a category created by the STOP Act – must be e-prescribed, effective Jan. 1, 2020. All Schedule II and Schedule III opioids and narcotics are in this group. A complete list can be found here.

The law specifies the following exemptions:

1. A practitioner, other than a pharmacist, who dispenses directly to an ultimate user.
2. A practitioner who orders a controlled substance to be administered in a hospital, nursing home, hospice facility, outpatient dialysis facility, or residential care facility
3. A practitioner who experiences temporary technological or electrical failure or other extenuating circumstance that prevents the prescription from being transmitted electronically; provided, however, that the practitioner documents the reason for this exception in the patient’s medical record.
4. A practitioner who writes a prescription to be dispensed by a pharmacy located on federal property; provided, however, that the practitioner documents the reason for this exception in the patient’s medical record.
5. A person licensed to practice veterinary medicine.

There is no specific consequence established by the STOP Act. NCMB would evaluate each situation and determine an appropriate resolution based on the individual circumstances of each case.

The Board cannot provide specific advice or recommendations to its licensees. Prescribers who do not currently have e-prescribing capability are strongly encouraged to identify an e-prescribing solution that complies with the law. Commercial products, such as an e-prescribing app for your smartphone or standalone e-prescribing software, may be an option (provided the product selected meets applicable privacy and security standards). Again, NCMB cannot recommend specific vendors or products.

Professional and specialty organizations (NC Medical Society, Old North State Medical Society, NC Academy of Family Physicians, NC Academy of Physician Assistants, NC Osteopathic Medical Association, etc.) may be able to offer additional information or guidance.

No. Choosing not to develop e-prescribing capability, whatever the reason, does not qualify as an “extenuating circumstance” in the Board’s view and would not exempt a licensee from the STOP Act e-prescribing requirement.

No, the Board would not consider this an acceptable practice. Directing established patients to a hospital emergency room or other medical provider for treatment could constitute patient abandonment, depending on the circumstances. Licensees are strongly encouraged to develop e-prescribing capability if they will continue to prescribe Schedule II and Schedule III opioids and narcotics after Jan. 1, 2020.

The STOP Act specifically exempts pharmacies and pharmacists from having to determine whether individual prescriptions are valid or comply with the e-prescribing mandate, and states at § 90-106 (a2), “A dispenser may continue to dispense targeted controlled substances from valid written, oral, or facsimile prescriptions that are otherwise consistent with applicable laws.” Therefore, if presented with a paper prescription for a targeted controlled substance after Jan. 1, 2020, a pharmacy may lawfully fill it. Per the NC Board of Pharmacy, repeated instances of noncompliance (e.g. continued use of paper prescriptions for Schedule II and Schedule III opioids and narcotics) could lead a pharmacist to address the issue. This could include reaching out to the prescriber to ensure he or she is aware of the e-prescribing mandate. Alternatively, pharmacists could report prescribers who persist in writing paper prescriptions to NCMB, which would investigate.

Yes. To provide multiple one-month prescriptions to a patient, the prescriber may issue a separate e-prescription for each month and indicate a “do not fill” until date on each prescription to indicate the appropriate fill date.

The prescriber or a member of the practice support staff can contact the pharmacy to ask them to cancel the prescription. Then, the prescriber may reissue the prescription to another pharmacy.