Prescribing, Controlled Substances, and Pain Management
What you must know
A dentist's prescribing authority is limited to the dentist's scope and to a patient for whom a documented evaluation and diagnosis exist. DEA registration plus California licensure is required for controlled substances. Before prescribing a Schedule II, III, or IV controlled substance for the first time, and at least once every six months thereafter while that therapy continues, the prescriber must consult CURES (the state prescription database) and document the review. Schedule II prescriptions may not be refilled; an oral Schedule II order in a genuine emergency must be followed by a written prescription within seven days. Tamper-resistant forms are required for controlled substances, and electronic prescribing of controlled substances is mandated in California subject to limited statutory exemptions.
Pain management expectations: lowest effective dose for the shortest appropriate duration, non-opioid multimodal therapy considered first, counseling on dependence, sedation, driving, storage, and disposal, and an offer of naloxone when risk factors are present (for example, concurrent benzodiazepines or high daily morphine milligram equivalents). Write drug, strength, quantity, directions, and refills clearly.
Traps
- Prescribing for someone you have not examined, or for a friend who is not a patient of record.
- Writing refills on a Schedule II drug or back-dating a prescription.
- Prescribing antibiotics to cover a procedure without a clinical indication.
- Assuming one CURES check satisfies the six-month rule.
Worked example
A patient calls after hours with pain following an extraction. Instead of phoning in a Schedule II, the dentist documents the reported symptoms, arranges an examination within a reasonable time, and if an opioid is truly indicated, checks CURES, prescribes a small quantity with no refills, and records the rationale.