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In April 2016, NCMB launched a first-of-its-kind investigative program to increase the Board’s oversight of opioid prescribing. Using data from the NC Controlled Substances Reporting System and the state Medical Examiner’s office, the program identifies potentially unsafe prescribing for investigation by the Board. Here are some of the lessons learned so far, with two full years of investigations in the books.

1. SOPI investigative criteria are effective at identifying prescribing of concern – In 39 percent of all SOPI cases to date, NCMB’s investigation found evidence of substandard prescribing sufficient to warrant either public or private action. Public action was the least common outcome, with about 8.5 percent of cases resulting in public action or issuance of a notice of charges & allegations (which sets a disciplinary hearing in motion).
2. Meeting SOPI criteria for investigation is NOT evidence of substandard practice – As of May 2018, 61 percent of all cases opened through SOPI were closed with no action against the physician or PA, because the Board did not find evidence that care/prescribing was below accepted clinical standards. Investigative criteria are useful in focusing the Board’s oversight of opioid prescribing – it is the results of the investigation that determine whether care is substandard.
3. SOPI and NCMB’s typical complaint-driven system achieve comparable results – Based on years of history, complaints received from patients and the public typically break down this way: 10 percent result in public action; 25 percent receive private action and 65 percent are closed with no formal action. Results to date suggest that SOPI is slightly more likely to identify cases that involve substandard care than the traditional complaint-driven system, but only by a slim margin. NCMB sees both investigative methods as useful ways of monitoring licensee conduct.
4. NCMB is still learning, and SOPI continues to evolve – The Board broke new ground when it implemented SOPI, and did not know what to expect when it established initial investigative criteria. NCMB always anticipated that the program might have to be adjusted to ensure best results. For example, after reviewing SOPI results at the one-year mark, the Board added additional “filters” to ensure that cases opened based on multiple opioid overdose deaths only proceeded with investigation if prescribers authorized 30 or more tablets of an opioid to the patient within 60 days of the death. NCMB is currently proceeding with plans to add additional SOPI investigative criteria that track certain patient and prescriber behaviors to identify potentially unsafe prescribing practices (See article, “New SOPI investigative criteria proposed” here). NCMB will continue to refine its criteria to ensure that the investigative reports it receives are as specific and sensitive as possible.
5. SOPI is an extremely targeted program – As of May 2018, 109 cases had been opened through SOPI, directly touching approximately 0.2 percent of licensed physicians and PAs. Prescribers are urged to remember that clinical decisions about treatment should be based on the patient’s medical needs and current standards of care, not concern that authorizing a prescription that exceeds the level specified in NCMB’s investigative criteria will automatically trigger an investigation. The Board’s expectation has always been, and remains, that clinicians provide care that is prudent and appropriate, regardless of the specific medication or dose prescribed.