In a move to step up the fight against prescription drug abuse, North Carolina’s Medical Board is investigating 60 doctors and physician assistants with patients who died of overdoses.
By law state officials cannot release the names, but said each physician had two or more patients fatally overdose on prescription painkillers within a 12-month span. The Medical Board is also investigating 12 other doctors and physicians assistants who prescribed high doses or large volumes of opioids.
In some cases, the agency says, there is no direct link between the deaths and the doctor’s prescribing. But regulators will look into whether patients received substandard care.
Doctors who over-prescribe OxyContin, Percocet and other narcotic painkillers known as opioids are widely seen as partly responsible for a dramatic rise in drug overdose deaths over the last two decades. Fatal overdoses kill more than 1,000 people a year in North Carolina and nearly half involve prescriptions written within 60 days of the victim’s death.
Regulators seeking to curb deaths are now using a statewide database to spot potentially reckless prescribing.
“The Safe Opioid Prescribing Initiative” represents a more aggressive approach for the Medical Board, which has been criticized for its slow response to the overdose crisis. Officials say they will review the state data every three months and launch investigations in addition to receiving complaints.
Spokeswoman Jean Fisher Brinkley said the change signals that the Board wants to increase the number of investigations into improper prescribing.
From 2013 through 2015, the Medical Board investigated more than 7,000 cases. But only in about 343 cases, or about 5 percent of the time, was prescribing the primary issue even though the agency itself has labeled the rising overdose death rate a public health crisis. Of those cases, 109 resulted in public sanctions.
“The Board views this as a serious problem that requires ongoing attention,” said Dr. Scott Kirby, the agency’s chief medical officer. “They have no tolerance for incorrect or substandard prescribing.”
States such as Kentucky, Tennessee and Texas for years have used prescription databases to spot improper prescribing and send information to law enforcement or medical boards for review.
North Carolina has maintained a prescription database since 2007, but it was used only to help physicians and pharmacists check whether patients were getting drugs from multiple providers. The database is operated by the N.C. Drug Control Unit and access is limited even for law enforcement to protect patient privacy.
The Medical Board did not receive permission to access the information until last year.
Officials said they are already hearing complaints from patients that physicians are arbitrarily reducing the strength and quantity of painkillers that they prescribe out of fear of being investigated.
Kirby said the Medical Board is trying to strike the right balance between protecting the public from dangerous prescribing and ensuring medication is accessible for cancer patients, the terminally ill and others suffering with severe chronic pain.
Authorities believe a few doctors are responsible for the bulk of problem, Kirby said. Other cases involve well-meaning physicians who err in the course of helping patients, Kirby said.
A 2014 state report by the General Assembly’s research arm criticized the Medical Board and other state agencies’ response to the overdose crisis as slow and insufficient.
The Medical Board failed to provide doctors enough detailed guidance as the crisis worsened in the early 2000s, the report said. The board did release a lengthy position statement in 2014 giving physicians advice on how to prescribe painkillers.
Dr. Andrew Kolodny, the nationally known chief medical officer for Phoenix House, a New York non-profit drug treatment organization, asserts that medical boards actually played a role in worsening the epidemic.
When new narcotic painkillers were introduced in the 1990s, doctors feared they could lead to addiction. Historically, physicians had reserved such narcotics for cancer patients and the terminally ill.
But medical boards in North Carolina and elsewhere adopted model legislation from the Federation of State Medical Boards that emphasized the treatment of pain and pushed doctors to use highly-addictive medication for common conditions, Kolodny said.
“Not only did they fail to protect the public, they played a role in spreading opioids,” he said.
State Rep. Craig Horn, a Union County Republican, who supports stricter oversight of prescribing practices, said the current crisis calls for stiff sanctions for improper prescribing.
“There needs to be more accountability,” Horn said. “A higher level of accountability must be met when you impact the lives of others.”