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North Carolina Workers’ Comp. Opioid Treatment Rules Approved

by User Not Found | May 01, 2018

North Carolina’s Rules Review Commission (RRC) recently approved the opioid treatment rules submitted by the North Carolina Industrial Commission. The new rules address requirements for the use of opioid analgesics, related prescriptions and pain management treatment for injured workers in both the acute and chronic phases. The rules (aside from provisions specifically addressing use of the state controlled substance reporting system) go into effect May 1, 2018.

Exception to the new rules
A majority of the prescribing guidelines/limits do not apply to claims in which the injured worker received a “targeted controlled substance” for more than twelve consecutive weeks immediately preceding May 1, 2018.  “Targeted controlled substance” refers to any controlled substance included in specified portions of the state’s controlled substance Schedule II and III lists.

Outlining the new rules

  • Guidelines for prescribing, including days’ supply and morphine milligram equivalent (MME) limits
    • ­The first prescription for a targeted controlled substance in an acute phase is not to exceed a five-day supply, or seven days for post-operative pain. 
    • ­Acute phase limits include the prescribing of only one targeted controlled substance at the time of the first prescription and prescribing the lowest effective dose, not to exceed 50 MMEs per day, using only short-acting opioids.  
  • Preauthorization requirements during treatment in the chronic phase
    • ­The rules identify medications not to be prescribed during an acute phase but which subsequently require preauthorization to prescribe in a chronic phase. These include transdermal fentanyl and carisoprodol, among others.
    • ­Preauthorization is required in a chronic phase for an MME dose higher than 90 mg per day.
  • Other sections address co-prescription of opioid antagonists under certain conditions, encouragement of non-pharmacological treatment and referrals for substance use disorder treatment

Review the approved rules

We applaud the Industrial Commission for seeking to address the issue of opioid use within the state workers’ comp. system and look forward to integrating these new guidelines into our processes. We encourage our clients to review the approved rules here: Please contact our Government Affairs team at with questions regarding this or other developing public policy matters.