Board adopts extensive new policy on prescribing controlled substances for pain
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The NCMB has adopted a comprehensive new position statement on the subject of treating pain with prescription opioid medications. This position statement, “Policy for the use of opiates for the treatment of pain,” replaces the former NCMB position entitled, “Policy for the use of controlled substances for the treatment of pain.” The latter had been in place since September 2008. The new pain policy is in effect as of June 2014.
The new pain policy breaks ground for Board position statements in that it provides far more specific clinical guidance and information about Board expectations for patient management than is typically conveyed in a position statement. Most position statements convey general guidelines or principles, which licensees are then expected to interpret and apply to their specific circumstances.
With regard to opioid prescribing, however, the Board determined that more specific and detailed guidance would benefit patient safety and the licensees who prescribe these medications.
Deaths from opioid overdose have reached epidemic proportions in North Carolina and across the nation. Analyses of overdose deaths have shown that, in most situations, the drugs involved in overdose deaths were originally obtained with a valid prescription from a licensed physician, physician assistant or other authorized prescriber. Inappropriate prescribing of opioid medications is one of the most serious quality of care issues the Board addresses, accounting for a significant percentage of adverse public actions each year. It is the Board’s hope that making more comprehensive guidelines available to licensees who are treating pain will encourage responsible prescribing, reduce deaths from accidental overdose and avoid regulatory problems for prescribers.
The new Position Statement is organized in three sections. The first section includes general information and a statement of the Board’s goals; The second, and longest, section provides detailed guidelines linked to the principles articulated in section one; The final section includes a glossary of terms. Also included in the Position Statement: an extensive reference list of all resources used to create the new pain policy. The NCMB’s pain policy draws heavily on the Federation of State Medical Board’s 2013 Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain. It also borrows content, with permission, from “First Do No Harm, The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain.”
Read the NCMB’s new pain policy online here.
Recently reviewed position statements
Board position statements are reviewed on a periodic basis and revised as needed. In recent months, the Board has reviewed the following position statements. Where applicable, changes to the position statement are noted.
Retention of medical records: Reviewed July 2013; No changes necessary
Capital punishment: Reviewed July 2013; No changes necessary
Professional obligations pertaining to incompetence, impairment or unethical conduct of licensees: Reviewed Sept. 2013; No changes necessary
Unethical agreements in complaint settlements: Reviewed Sept. 2013; No changes necessary
Guidelines for avoiding misunderstandings during physical examinations: Reviewed Jan. 2014; No changes necessary
Departures from or closings of medical practices: Reviewed May 2014; No changes necessary
Treatment of Obesity: Reviewed May 2014 and revised; Deleted reference to use of hCG for weight loss and reaffirms NCMB’s intention to continue to investigate, when reported to the Board, treatment modalities that are not based on sound scientific evidence.
The new pain policy breaks ground for Board position statements in that it provides far more specific clinical guidance and information about Board expectations for patient management than is typically conveyed in a position statement. Most position statements convey general guidelines or principles, which licensees are then expected to interpret and apply to their specific circumstances.
With regard to opioid prescribing, however, the Board determined that more specific and detailed guidance would benefit patient safety and the licensees who prescribe these medications.
Deaths from opioid overdose have reached epidemic proportions in North Carolina and across the nation. Analyses of overdose deaths have shown that, in most situations, the drugs involved in overdose deaths were originally obtained with a valid prescription from a licensed physician, physician assistant or other authorized prescriber. Inappropriate prescribing of opioid medications is one of the most serious quality of care issues the Board addresses, accounting for a significant percentage of adverse public actions each year. It is the Board’s hope that making more comprehensive guidelines available to licensees who are treating pain will encourage responsible prescribing, reduce deaths from accidental overdose and avoid regulatory problems for prescribers.
The new Position Statement is organized in three sections. The first section includes general information and a statement of the Board’s goals; The second, and longest, section provides detailed guidelines linked to the principles articulated in section one; The final section includes a glossary of terms. Also included in the Position Statement: an extensive reference list of all resources used to create the new pain policy. The NCMB’s pain policy draws heavily on the Federation of State Medical Board’s 2013 Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain. It also borrows content, with permission, from “First Do No Harm, The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain.”
Read the NCMB’s new pain policy online here.
Recently reviewed position statements
Board position statements are reviewed on a periodic basis and revised as needed. In recent months, the Board has reviewed the following position statements. Where applicable, changes to the position statement are noted.
Retention of medical records: Reviewed July 2013; No changes necessary
Capital punishment: Reviewed July 2013; No changes necessary
Professional obligations pertaining to incompetence, impairment or unethical conduct of licensees: Reviewed Sept. 2013; No changes necessary
Unethical agreements in complaint settlements: Reviewed Sept. 2013; No changes necessary
Guidelines for avoiding misunderstandings during physical examinations: Reviewed Jan. 2014; No changes necessary
Departures from or closings of medical practices: Reviewed May 2014; No changes necessary
Treatment of Obesity: Reviewed May 2014 and revised; Deleted reference to use of hCG for weight loss and reaffirms NCMB’s intention to continue to investigate, when reported to the Board, treatment modalities that are not based on sound scientific evidence.
Comments on this article:
THANK you for making these changes! I am board certified in Pain Medicine, but believe opioids have been overprescribed for about two decades now, mostly at the behest of Big Pharma who has made hundreds of billions of dollars in profits on these cheap to manufacture medications. But this has been at the expense of unbelievable adverse public health impact of at least 16,000 deaths per year and untold expense of treated and untreated addiction.
By Allan Zacher, MD on Jun 12, 2014 at 1:02pm
