North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 23 - INDUSTRIAL COMMISSION › Subchapter M - RULES FOR THE UTILIZATION OF OPIOIDS, RELATED PRESCRIPTIONS, AND PAIN MANAGEMENT TREATMENT IN WORKERS' COMPENSATION CLAIMS › Section .0200 - UTILIZATION RULES FOR OPIOID AND OTHER PHARMACOLOGICAL PAIN MANAGEMENT TREATMENT › Section 23M .0201 - FIRST PRESCRIPTION OF MEDICATION FOR PAIN IN AN ACUTE PHASE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) This Rule applies to the first
				  prescription of any medication to an employee for pain in an acute
				  phase.
(b) Before prescribing a
				  targeted controlled substance, a health care provider shall document his or her
				  medical opinion in the medical record that non-pharmacological and non-opioid
				  therapies are insufficient to treat the employee's pain.
(c) A health care provider shall not
				  prescribe more than one targeted controlled substance at the time of the first
				  prescription. A health care provider shall not provide at the time of the first
				  prescription any additional prescription for a targeted controlled substance to
				  be dispensed at a later time.
(d) A
				  health care provider shall prescribe the lowest number of days' supply of a
				  targeted controlled substance necessary in his or her medical opinion to treat
				  an employee's pain, not to exceed a five-day supply. However, the first
				  prescription of any targeted controlled substance for post-operative pain
				  immediately following a surgical procedure may exceed five days but shall not
				  exceed a seven-day supply.
(e) A
				  health care provider shall prescribe the lowest effective dosage of a targeted
				  controlled substance, not to exceed a 50 mg morphine equivalent dose per day,
				  using only short-acting opioids. However, a health care provider may prescribe
				  more than a 50 mg morphine equivalent dose per day, if the employee was being
				  prescribed a targeted controlled substance immediately prior to the first
				  prescription. The dosage limits in this Paragraph apply only to an opioid
				  prescription being prescribed pursuant to this Rule.
(f) A health care provider shall not
				  prescribe transcutaneous, transdermal, transmucosal, or buccal opioid
				  preparations without documentation in the medical record that oral opioid
				  dosing is medically contraindicated for the employee.
(g) A health care provider shall not
				  prescribe fentanyl for pain in an acute phase.
(h) A health care provider shall not
				  prescribe benzodiazepines for pain or as muscle relaxers in an acute
				  phase.
(i) A health care provider
				  shall not prescribe carisoprodol and a targeted controlled substance in an
				  acute phase.
(j) If an employee is
				  taking benzodiazepines or carisoprodol prescribed by another health care
				  provider, the health care provider shall not prescribe a targeted controlled
				  substance to the employee without advising the employee of the potential risks
				  of combining a targeted controlled substance and benzodiazepines or
				  carisoprodol. The health care provider shall also communicate with the health
				  care provider prescribing the benzodiazepines or carisoprodol to inform that
				  health care provider of the prescription of a targeted controlled
				  substance.
(k) A health care
				  provider shall review the information in the CSRS pertaining to the employee
				  for the 12-month period preceding the first prescription. The health care
				  provider shall document in the medical record the review and any potential
				  contraindications to prescribing a targeted controlled substance found in the
				  CSRS. The effective date of this Paragraph is November 1, 2018, or shall
				  coincide with the date of application in S.L. 2017-74, s. 15.(e), and any
				  amendments thereto, whichever is earlier.
Authority
					 G.S.
					 90-106(a3);
					 90-113.74C(a);
					 97-25;
					 97-25.4;
					 97-80(a); S.L.
					 2017-203, s. 4;
Eff. May 1, 2018;
Recodified from
					 04 NCAC
					 10M .0201 Eff. June 1,
					 2018.