This June, Gov. Roy Cooper signed the Strengthen Opioid Misuse Prevention (STOP) Act of 2017 into law. The Act is intended to stem the opioid epidemic that has had such a severe impact in North Carolina, primarily by establishing practices aimed at reducing inappropriate and excessive opioid prescribing. The Board has prepared a short summary of the Act that highlights provisions that will have the most direct impact on licensees. STOP Act provisions are listed in order of their effective dates. An expanded summary that includes information on additional provisions of the law that affect NCMB licensees is available at
www.ncmedboard.org/safeopioids.
Effective July 1, 2017
Opioid Prescribing Consultations with Supervising Physician
Physician Assistants and Nurse Practitioners prescribing targeted controlled substances are required to personally consult with the supervising physician if (1) the patient is being treated at a facility that primarily engages in the treatment of pain by prescribing narcotic medications or advertises for any type of pain management services, and (2) the therapeutic use of the prescription will, or is expected to, exceed 30 days.
Furthermore, when prescribing to the same patient continuously, Physician Assistants and Nurse Practitioners are required to consult with a supervising physician at least once every 90 days to verify that the prescription remains medically appropriate.
The Board has directed NCMB staff to develop a formal definition of “consultation,” with the intention of eventually adopting rules to guide PAs, NPs and their supervisors. Draft language is expected to be presented to the Board for review at the September 2017 Board meeting.
Streamlined Set Up of Delegate Accounts
This provision streamlines the process of creating delegate accounts for prescribers in emergency departments in the North Carolina Controlled Substances Reporting System (NC CSRS). To register delegates visit
www.ncmedboard.org/NCCSRS. Delegate accounts must be linked or associated with the prescriber(s) for whom the delegate will complete queries.
Effective September 1, 2017
Timely and Accurate Prescription Reporting by Pharmacies Pharmacies are required to report prescriptions to NC CSRS by the close of business the day after a prescription is delivered (previously the law required pharmacies to report the prescription within three days of the date it was delivered).
In addition, the STOP Act authorizes NC CSRS to assess monetary penalties against pharmacies that do not supply correct data to NC CSRS after being informed that information is missing or incomplete.
Provisions effective January 1, 2018
Limitations on Prescriptions for Acute Pain Acute pain is defined as pain, whether resulting from disease, accident, intentional trauma, or other cause, that the practitioner reasonably expects to last for three months or less. It does not include chronic pain or pain being treated as part of cancer care, hospice care, palliative care, or medication-assisted treatment for substance use disorder.
Practitioners cannot prescribe more than a five-day supply of any Schedule II or Schedule III opioid ornarcotic upon the initial consultation and treatment of a patient for acute pain unless the prescription is for postoperative acute pain relief for immediate use following a surgical procedure, in which case the prescription cannot exceed a seven-day supply.
Upon subsequent consultation for the same pain, practitioners may issue any appropriate renewal, refill, or new prescription for a targeted controlled substance.
This provision does not apply to prescriptions issued by practitioners ordering targeted controlled substances to be wholly administered in a hospital, nursing home, hospice facility, or residential care facility.
Practitioners acting in accordance with these limitations are immune from civil liability and disciplinary action from this Board.
Provisions effective January 1, 2020
Electronic Prescribing
Practitioners must prescribe electronically for all targeted controlled substances. This provision does not apply to:
Practitioners, other than a pharmacist, dispensing directly to an ultimate user.
Practitioners ordering for administration in a hospital, nursing home, hospice facility, outpatient dialysis facility or residential care facility.
Practitioners experiencing temporary technological or electrical failure or other extenuating circumstances that prevent the prescription from being transmitted electronically. Practitioners must document the reason for this exception within a patient’s medical record.
Practitioners writing a prescription to be dispensed by a pharmacy located on federal property. Practitioners must document the reason for this exception in the patient’s medical record.
Persons licensed to practice veterinary medicine.
Provision effective upon completion of NC CSRS technical upgrades* (date TBD) Mandatory Review of NC CSRS
*DHHS will work on various technical upgrades to NC CSRS in order to make the system more user-friendly, improve reporting capabilities, provide inter-state connectivity with other Prescription Drug Monitoring Systems, and connect to the statewide health information exchange. Mandatory NC CSRS registration and use provisions become effective once the State Chief Information Officer confirms the required upgrades to NC CSRS are fully operational within the Department of Information Technology and the system is connected to the statewide health information exchange.
Prior to prescribing a Schedule II and Schedule III opioid or narcotic, practitioners are required to review a patient’s 12-month prescription history in 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.
Reviews should be documented within the patient’s medical record, along with any electrical or technological failure that prevents such review. Practitioners are required to review the history and document the review once the electrical or technological failure has resolved.
Certain practitioners may,
but are not required to, review NC CSRS when prescribing a targeted controlled substance to a patient in any of the following circumstances:
Medication is administered in a health care setting, hospital, nursing home, outpatient dialysis facility or residential care facility.
Medications are prescribed for the treatment of cancer or another condition associated with cancer.
Medications are prescribed to patients in hospice care or palliative care.
The STOP Act authorizes NC CSRS to conduct periodic audits to determine prescriber compliance with review requirements. NC CSRS shall report to the Board any licensee found to be in violation of the requirement to check the system; violations may result in regulatory action by the Board.
What are targeted controlled substances?
Most of the provisions in the STOP Act apply to licensees who prescribe “targeted” controlled substances. These are select medications listed in N.C. Gen. Stat. § 90-90(1), (2) or 90-91(d).
What’s on the list?
All Schedule II and Schedule III opioids and narcotics; medical professionals who prescribe must comply with STOP Act provisions.
What’s not?
Stimulants and hormones; any other medication that is NOT listed in N.C. Gen. Stat. §
90-90(1), (2) or
90-91(d)
