Licensee Response to the North Carolina Medical Board’s Efforts to Reduce Unsafe Opioid Prescribing
Creators: name: Wilson, Aliya
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2017

description: Background: North Carolina has been hit hard by the opioid epidemic plaguing the United States. In 2015, 738 people in the state died of overdose on prescription opioids. Recent Centers for Disease Control and Prevention (CDC) data shows that in North Carolina, there are approximately 97 opioid prescriptions written per 100 people in the state.2 An important perspective popular view on solving this crisis involves decreasing unsafe prescribing, particularly unsafe prescribing. by health care providers. In response, the North Carolina Medical Board has enacted several initiatives to decrease unsafe opioid prescribing by physicians and physician assistants in the state, including a new continuing medical education requirement for certain licensees, adoption of the CDC guideline on opioid prescribing, and a novel monitoring program called the Safe Opioid Prescribing Initiative. Purpose: The goal of this study is to characterize North Carolina Medical Board licensee attitudes toward each of the Board's three initiativesefforts to detect and decrease unsafe opioid prescribing in the state. in order to help refine current policy efforts and guide the creation of new ones. Methods: Letters, emails, and website correspondence submitted directly to the NCMB as well as online comments posted to NCMB newsletter articles pertaining to the three initiatives were analyzed. Comments posted to the articles were analyzed and coded as were the initial letters. Select items of interest were identified and recorded in a codebook, available in appendix 2. Demographic information related to the sender included origination of the letter (reply to an NCMB communication, or a letter that was originated by sender.) We also included the format of the communication, person or group sending the letter, and licensee specialty when provided. Content areas abstracted from each letter included letter tone, advocacy, and theme. Quantitative analysis was limited to calculating simple frequencies and percentages of demographic and content areas of interest. Results: Forty-nine letters were obtained for analysis. The majority of articles (43) were comments left on the NCMB website in response to articles about SOPI, the new CME requirements, or the CDC guidelines. Most respondents did not sign with their credentials or indicate practice specialty in the body of their letter. The majority of the letters, 25 (51%) were solely negative, or critical of the policy that they referenced. 10 letters (20.4%) were positive, praising the policy. 2 letters (4.1%) were both positive and negative, presenting “pros and cons” of the policy. Nearly one quarter of letters 12(24.5%), however, had an undetermined/unascertainable tonea tone that could not be determined. Respondents overwhelmingly advocated for the interests of themselves and their fellow licensees, with 35 letters (71.4%) addressing the concerns only of physicians. Letter themes varied widely as well, with 35% providing alternative policy recommendations and 22% lamenting the added CME burden facing licensees. 16% represented praise for the policy being enacted. Fear of under prescribing, diminished access to patient care, and general policy discussion each received 8% of the references, with increased provider burnout and stress representing less than one percent. Conclusion: NCMB licensees have varying views on the initiatives that the Board has put forth to combat unsafe opioid prescribing. While the majority of communications were negative in tone, many responded with alternative policy recommendations, showing stakeholder engagement in the process. In order to optimize its connection to licensees, best serve its licensees, the Board must continue to communicate new opioids prescribing policies and refine them as necessary to prevent unsafe prescribing while protecting the practice of appropriate pain management.