In North Carolina, there are four mechanisms to monitor and prevent the abuse of prescribed controlled substances: oversight of prescribers and dispensers, the Controlled Substances Reporting System (CSRS), Medicaid lock-in, and law enforcement. Currently, prescribing guidelines and continuing education requirements for prescribers are insufficient. The CSRS is underutilized and lacks important features for security and data analysis. Meanwhile, the lock-in program has been non-operational since July 2013, costing the Medicaid program an estimated $1.3 million to $2 million. The General Assembly should direct the development and adoption of statewide prescribing guidelines and require continuing education, and should also direct the Department of Health and Human Services to modify the contract for the CSRS to improve performance, improve the effectiveness of the Medicaid lock-in program, and develop a strategic plan and performance management system.
Related Evaluations:
- DHHS Should Integrate State Substance Abuse Treatment Facilities into the Community-Based System and Improve Performance Management (November 2014)
- North Carolina Needs a Coordinated Strategy to Guide the Changing Landscape of Veterans Programs (September 2014)
Relevant Legislation:
- Session Law 2015-241, Section 12F.16 requires adoption of statewide opioid prescribing guidelines and continuing education on the abuse of controlled substances for practitioners; directs the Department of Health and Human Services (DHHS) to improve Controlled Substances Reporting System (CSRS) access and utilization, improve the CSRS contract, and expand CSRS monitoring capacity; directs the Division of Medical Assistance (DMA) to improve the effectiveness and efficiency of the Medicaid lock-in program; and creates the Prescription Drug Abuse Advisory Committee and directs it to develop a statewide strategic plan and performance management system to combat prescription drug abuse.
- Senate Bill 609 (2015–16): An act to require prescribers and dispensers to review information in the Controlled Substances Reporting System prior to prescribing or dispensing a controlled substance to a patient and to make a violation of that requirement a criminal offense. This legislation was not enacted.
Agency Actions:
- In September 2016, the North Carolina Medical Board (NCMB) tentatively approved replacing the current opioid position statement with CDC’s Guideline for Prescribing Opioids for Chronic Pain, which was published in March 2016. NCMB expects to finalize their decision in January 2017.
- NCMB implemented a new continuing medical education requirement to ensure that licensees who prescribe controlled substances, particularly opioids, do so in a manner that is safe, appropriate, and consistent with current standards of care. The new requirement will be effective July 1, 2017
- The Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) launched the CSRS redesign on March 17, 2015, providing prescribers and pharmacists with more intuitive control of the site as well as new features like password reset, registrant’s profile update, practitioner’s prescribing history, and new easy-to-read reports.
- DMH/DD/SAS has negotiated, developed, and executed a contract with Health Information Designs that included a 17.5% reduction ($46,892) for the cost of maintenance and operation of the CSRS system.
- DMH/DD/SAS has been involved in a number of analytical projects to provide accurate and timely controlled substances prescribing data to stakeholders across the state.
- Per legislation, DMA will conduct an audit within six months of implementation of changes to the Medicaid lock-in program and report on fiscal impact within one year of implementation. DHHS submitted the DMA Legislative Report: SL 2015-268, Section 4.4. (Medicaid Lock-In Program) to JLPEOC on September 30, 2016.
- In September 2014, North Carolina was invited to participate in the National Governors Association Policy Academy on Reducing Prescription Drug Abuse, which resulted in the development of North Carolina’s Strategic Plan to Reduce Rx Drug Abuse. In accordance with Session Law 2015-241, Section 12F.16(m), the DHHS Prescription Drug Abuse Advisory Committee (PDAAC) was established in early 2016.