North Carolina Board of Nursing

Nursing Practice

Advanced Practice Registered Nurse

Controlled Substance Prescribing Information

  1. What is the CE requirement for APRNs with prescriptive authority?

  2. When will the requirement be in effect?

  3. Is this a one-time requirement or will licensees be required to earn CE in controlled substances prescribing on an ongoing basis?

  4. May I claim credit for CE hours I have already completed if the course content fulfills the requirements stated in the rule?

  5. What if I am at the end of my CE cycle when the rule takes effect but I have not completed any CE that fulfills the requirement?

  6. When does my CE cycle end?

  7. Are any licensees be exempt from the new CE requirement?

  8. I prescribe medications but I do not prescribe any controlled drugs. Do I have to comply with the requirement?

  9. I prescribe medications, including controlled substances (e.g. hormones, psychoactive medications, stimulants), but I do not prescribe ANY opioids. Do I have to comply with the requirement?

  10. How will licensees find CE courses that fulfill the requirement?

  11. What education topics must be covered for courses to count towards the new CE requirement?

  12. How will the Board communicate the CS requirements to licensees?

  13. I am a APRN who only orders or administers controlled substances to hospitalized patients, patients at an ambulatory care surgery or procedure center, or similar facility (e.g., NP/CNM working in hospitalist roles, out-patient procedural units, etc.), and I do not "prescribe" controlled substance by means of a written or electronic prescription. Am I required to obtain the required controlled substance continuing education (CE)?

  14. Why is NCBON implementing a controlled substances CE requirement?

  15. Who is subject to the controlled substance CE requirement?

  16. What is the controlled substance reporting system (CSRS)?

  17. I do not prescribe controlled substances, am I required to enroll in the controlled reporting system (CSRS)?

  18. How does the Board notify licensees of the requirement for the CSRS?

  19. I work in a federal healthcare system, am I required to enroll and utilize the CSRS?

  20. Who is authorized to access the CSRS?

  21. Can I use the CSRS to monitor patient prescriptions across state/jurisdictional boarders?

  22. Are APRN prescribers authorized to prescribe Medically Assisted Therapy (MAT)?

  23. What is the STOP Act?

  24. Is the goal of the STOP Act to get clinicians with prescriptive authority to stop treating chronic pain?

  25. What medications does the STOP Act impact?

  26. When does the Personal consultation with the supervising physician for Schedule II and III Opioids go into effect?

  27. Does the STOP Act apply to APRN prescribers who do not work in pain management settings?

  1. What is the CE requirement for APRNs with prescriptive authority?

    The CE requirements for APRNs with prescriptive authority are stipulated in NC Administrative Code 21 NCAC 36 .0807 and 21 NCAC 33 .0111.
    APRNs who prescribe controlled substances shall complete a minimum of one contact hour of CE addressing controlled substance prescribing practices, signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management. This one contact hour is inclusive of (not an expansion of) the total contact hours required each year during the annual renewal cycle. Documentation shall be maintained by the nurse practitioner for the previous five calendar years and made available upon request to either Board.
  2. When will the requirement be in effect?

    The new requirement is effective March 1, 2017. Any licensee whose CE cycle renews in 2017 and whose birthday is on or after March 1, 2017 will be required to fulfill the new CE requirement. The date on which you renew your license does not affect whether you are required to fulfill the new CE requirement.

  3. Is this a one-time requirement or will licensees be required to earn CE in controlled substances prescribing on an ongoing basis?

    This is an ongoing requirement.

  4. May I claim credit for CE hours I have already completed if the course content fulfills the requirements stated in the rule?

    Yes. If the CE course is completed during a cycle that renews on or after March 1, 2017, then the credit can be claimed even if the course was taken prior to March 1, 2017 (Note: again, the course must have been completed within that CE/approval cycle. *See Continuing Education Requirements).

  5. What if I am at the end of my CE cycle when the rule takes effect but I have not completed any CE that fulfills the requirement?

    Licensees are expected to fulfill the CE requirement if the CE cycle ends on or after March 1, 2017, even if they have otherwise fulfilled their requisite CE credits.

  6. When does my CE cycle end?

    The CE cycle is the same as the *approval cycle, ending on the last day of your birth month. *See Continuing Education Requirements

  7. Are any licensees be exempt from the new CE requirement?

    Yes. Licensees who have not prescribed ANY controlled substances (opioid or non-opioid) since they last renewed are exempt from the requirement.

  8. I prescribe medications but I do not prescribe any controlled drugs. Do I have to comply with the requirement?

    No. Only licensees who prescribed controlled substances (including non-opioids) during their most recent CE cycle are subject to the requirement.

  9. I prescribe medications, including controlled substances (e.g. hormones, psychoactive medications, stimulants), but I do not prescribe ANY opioids. Do I have to comply with the requirement?

    Yes. The requirement applies to all prescribers who prescribed ANY controlled substances (including non-opioids) during their most recent CE cycle.

  10. How will licensees find CE courses that fulfill the requirement?

    It is not possible for the Board to maintain a current and complete list of available courses that meet the CS requirement. There are many existing online and in-person CE courses that meet the Continuing Education Requirements that covers “controlled substances prescribing practices, recognizing signs of the abuse or misuse of controlled substances, and controlled substance prescribing for chronic pain management,” as stated in NC Administrative Code 21 NCAC 36 .0807 and 21 NCAC 33 .0111.

    The NCBON is continually evaluating the Board Sponsored Offerings to meet the needs of nurses licensed in NC. Please see the following complementary CE offerings on the NCBON website that are designed for authorized APRN prescribers.

    1. Standards of Care for Opioid Prescribing (4 CH in controlled pharmacology)
    2. Nurse Practitioner Regulation (3 CH Discipline Specific/1 CH controlled substance pharmacology)
    3. Regulatory Intelligence: A Necessary Competency for Advanced Practice Nursing (2 CH Discipline Specific)
  11. What education topics must be covered for courses to count towards the new CE requirement?

    There are three topics that must be covered during each renewal cycle:
      1. Controlled substances prescribing practices
      2. Recognizing signs of the abuse or misuse of controlled substances
      3. Controlled substance prescribing for chronic pain management
  12. How will the Board communicate the CS requirements to licensees?

    NCBON will post regular updates and guidance on its website, in the quarterly licensee newsletter, the Bulletin and through direct email communication. NCBON will also email licensees who are seeking initial approval, annual renewal of approval or who apply for a change in supervising physicians to remind them of the new requirement. NCBON staff members are available to respond to emails or calls at aprnpractice@ncbon.com or 919-782-3211.

  13. I am a APRN who only orders or administers controlled substances to hospitalized patients, patients at an ambulatory care surgery or procedure center, or similar facility (e.g., NP/CNM working in hospitalist roles, out-patient procedural units, etc.), and I do not "prescribe" controlled substance by means of a written or electronic prescription. Am I required to obtain the required controlled substance continuing education (CE)?

    Yes. Licensees who prescribe, order, supply, administer, or otherwise provide controlled substances to patients under their care must complete the mandated CE. While there may be a semantic and possibly even practical distinction between prescribing to patients by writing a prescription and ordering medications to hospitalized patients, the Board has determined that hospital or institutional based licensees of this Board who order and/or administer any controlled substance to a patient using either their own DEA registration or by means of an institutional DEA registration, directly or indirectly, are required to obtain the CE.

  14. Why is NCBON implementing a controlled substances CE requirement?

    The mission of the North Carolina Board of Nursing is to protect the public by regulating the practice of nursing. Requiring CE in controlled substances prescribing and related topics 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. These requirements are respectively stipulated for the practice of nurse practitioners and certified nurse midwives in the NC Administrative Code 21 NCAC 36 .0807 and 21 NCAC 33 .0111.

  15. Who is subject to the controlled substance CE requirement?

    Every licensee who prescribe controlled substances

  16. What is the controlled substance reporting system (CSRS)?

    The North Carolina Controlled Substance Reporting System (NCCSRS), frequently truncated to CSRS, is a statewide reporting system was established by North Carolina law to improve the state’s ability to identify people who abuse and misuse prescription drugs classified as Schedule II-V controlled substances (Defined). It is also meant to assist clinicians in identifying and referring for treatment patients misusing controlled substances. The NC Commission for, and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services make rules and manage the program. (For more information, please visit the NC General Assembly website: http://www.ncleg.net for Chapter 90, Article 5 and Senate Bill 222).

  17. I do not prescribe controlled substances, am I required to enroll in the controlled reporting system (CSRS)?

    Yes. Statute § 90-113.74A stipulates that within 30 days after obtaining an initial or renewal license that confers the authority to prescribe a controlled substance for the purpose of providing medical care for a patient, the licensee shall demonstrate to the satisfaction of the licensing board that he or she is registered for access to the controlled substances reporting system. A violation of this section may constitute cause for the licensing board having jurisdiction over the licensee to suspend or revoke the license. (2016-94, s. 12F.7(c). See Controlled Substances Reporting System (CSRS)

  18. How does the Board notify licensees of the requirement for the CSRS?

    NCBON will post regular updates and guidance on its website, in the quarterly licensee newsletter, the Bulletin and through direct email communication. NCBON will also email licensees who are seeking initial approval, annual renewal of approval or who apply for a change in supervising physicians to remind them of the new requirement. NCBON staff members are available to respond to emails or calls at aprnpractice@ncbon.com or 919-782-3211.

  19. I work in a federal healthcare system, am I required to enroll and utilize the CSRS?

    Yes. Federal health systems i.e. the Veteran’s Administration, utilize the CSRS using a unique institutional/provider suffix for monitoring. Licensees enrolled in federal systems are directed to check with their administration regarding their unique suffix.

  20. Who is authorized to access the CSRS?

    The prescriber or dispenser. Only the person with that log on, not their nurse, not their office manager, not another prescriber. Each practitioner in the office has to have their own login.
    The CSRS began allowing delegate accounts in 2014 where an already approved user may delegate the task of running queries to someone else in the office. This delegate will apply online and be given their own individual username and password. Never share your username and password with anyone.
  21. Can I use the CSRS to monitor patient prescriptions across state/jurisdictional boarders?

    No. At this time the CSRS is a statewide reporting system that does not cross state/jurisdictional borders.

  22. Are APRN prescribers authorized to prescribe Medically Assisted Therapy (MAT)?

    Yes. The APRN roles that have prescriptive authority in NC includes the CNM and the NP roles. APRNs who have prescriptive authority in NC and have met the following requirements, s/he are authorized to prescribe MAT.
    1. Completed the required waiver requirements for MAT(see educational opportunities for meeting the requirements to apply for a medication assisted therapy waiver)
    2. Has a valid DEA Registration
    3. Has a primary supervising physician with the same level of DEA registration/MAT Waiver
    4. MAT is included in the CPA
    5. Register with the North Carolina Department of Health and Human Services Drug Control Unit
    Educational opportunities for meeting the requirements to apply for a medication assisted therapy waiver
  23. What is the STOP Act?

    Session Law 2107-74, Strengthen Opioid Misuse Prevention (STOP ACT) H243/S175 was signed into law on June 29, 2017 in order to combat the nationwide opioid epidemic that has had a severe impact in North Carolina. The objective of this law is to reduce or eliminate inappropriate opioid prescribing. Several provisions apply to Advanced Practice Registered Nurse (APRN) prescribers (Nurse Practitioners [NPs] and Certified Nurse Midwives [CNMs]) who prescribe targeted controlled substances.

  24. Is the goal of the STOP Act to get clinicians with prescriptive authority to stop treating chronic pain?

    No. The objective of the STOP Act is to ensure opioid prescribing is safe and appropriate. The rate of patient deaths due to opioid overdose has increased significantly over the past several years, to the point where the state of North Carolina considers it to be a public health crisis. Through the mission of public protection by regulating the practice of nursing, NCBON stands with other regulatory boards and policy thought leaders in the recognition that chronic pain is a legitimate health issue requiring appropriate, evidence-based care.

  25. What medications does the STOP Act impact?

    Provisions of the STOP Act only apply to “targeted controlled substances” which includes all schedule II and III opioids as listed in listed in G.S. 90-90(1) & (2) and G.S. 90-91(d).

  26. When does the Personal consultation with the supervising physician for Schedule II and III Opioids go into effect?

    Effective July 1, 2017 APRN prescribers shall personally consult with the supervising physician as established in the collaborative practice agreement and document said consultation in the client’s health record prior to prescribing a targeted controlled substance when all of the following conditions apply:

    • The patient is being treated by a facility that primarily engages in the treatment of pain by prescribing narcotic medications or advertises in any medium for any type of pain management services.
    • The therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days.
  27. Does the STOP Act apply to APRN prescribers who do not work in pain management settings?

    Yes. The NCBON expects every licensee prescribing opioids for the treatment of pain to provide diagnoses, treatments, and health record documentation consistent with the standard of care in North Carolina. When a targeted controlled substance is continuously prescribed to the same patient, the APRN prescriber shall consult with the supervising physician at least once every 90 days to verify that the prescription remains medically appropriate for the patient. The consultation shall be documented in the patient’s health record. APRN prescribers prescribing targeted controlled substances in settings that do not specialize or advertise for the treatment of pain by prescribing narcotic medications or any type of pain management services (including but not limited to primary care and sub-specialty practices) shall utilize the Policy for the Use of Opiates for the Treatment of Pain and practice within the prescriptive authority established in NC law and administrative code 21 NCAC 36 .0809 Nurse Practitioners and § 90-178.3.(b) Regulation of Midwifery.