Ending the inappropriate prescribing of opioid painkillers has been a priority for the North Carolina Medical Board for at least a decade, but we can and should do more.
The May 15 news article “Officials hope to curb overdose deaths” accurately noted that NCMB is expanding its efforts to investigate potentially unsafe opioid prescribing. However, increased enforcement is just one aspect of the board’s efforts.
The best way to address inappropriate prescribing is to prevent it. To that end, NCMB adopted a policy in June 2014 that gives opioid prescribers the information they need to treat pain safely. It covers establishing whether a patient has a legitimate medical need for opioids, guarding against abuse and intervening in the face of evidence that a patient is not taking medications as directed. In addition, the board is in the process of establishing rules that will require all physicians and physician assistants who prescribe controlled substances to complete regular training in pain management and preventing abuse.
The article repeatedly suggested that NCMB has been “soft” on providers who prescribe opioids inappropriately or in excessive quantities. This is not the case. NCMB does not hesitate to revoke, suspend or limit a license when the circumstances warrant it. But it has a duty, both to the public it is sworn to protect and to the medical professionals it is entrusted with regulating, to ensure that its decisions are fair and based on objective information.
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Medical board decisions cannot and should not be based solely on patient outcomes, no matter how tragic. They are made based on current accepted standards of care. In lay terms, standard of care is the level of care a typical, prudent physician or PA in North Carolina would be expected to deliver.
When the medical board has evidence that care is not within accepted standards, then it has a basis to commence action against the provider. Medical knowledge is constantly evolving, and standards of care evolve with it. It is not fair or reasonable to apply today’s standards of care to clinical decisions that occurred years ago.
Finally, pain remains a legitimate medical issue for many patients, and these individuals have a right to appropriate pain relief.
As NCMB and other agencies work together to address the alarming increase in opioid overdose deaths, we cannot allow these patients to become collateral damage. With NCMB’s pain policy and similar guidance recently published by the U.S. Centers for Disease Control and Prevention, medical professionals have the information they need to prescribe opioids safely. NCMB will continue to do its part by making sure North Carolina physicians and PAs use it.
Pascal O. Udekwu, M.D.
President, North Carolina Medical Board
The length limit was waived to permit a fuller response to the article.