Prescription and Controlled Substance Regulations
Authority and limits
Prescribing is an element of the practice of dentistry, limited to drugs and devices connected to the practice and to the dentist's scope. A dentist may not prescribe for a person who is not a patient - no prescribing for self, family, or friends absent a documented patient relationship and legitimate dental purpose. Know the registration tiers: a federal controlled-substance registration is separate from the state license, and both must be current. Traps: assuming a state license authorizes controlled substances (it does not); assuming a DEA registration permits any schedule (it lists the schedules authorized).
Prescription requirements
Valid prescriptions require prescriber identification, patient identification, drug, strength, quantity, directions, date, and signature; controlled substances carry additional requirements, including schedule-specific limits on refills (Schedule II generally no refills), quantity limits, and in many jurisdictions mandatory electronic prescribing and prescription monitoring program checks. Know the rules for emergency oral orders and the time frame for follow-up written documentation.
Opioids and monitoring
Many jurisdictions impose specific duties: query the prescription monitoring program before prescribing beyond a threshold, provide opioid counseling, co-prescribe naloxone in defined circumstances, and limit initial supply for acute pain. These are high-yield. Traps: assuming a monitoring query is optional; assuming refills may be authorized for a Schedule II drug; assuming a prescriber may delegate the decision to prescribe.
Recordkeeping and security
Controlled substances require inventory, secure storage, and records of administration and dispensing. Loss or theft must be reported. Prescribing to oneself or obtaining drugs by fraud is a ground for discipline.
Worked example
A patient calls after hours requesting a refill of a Schedule II analgesic for a toothache. Rule of thumb: Schedule II prescriptions generally cannot be refilled; the dentist must evaluate the patient and issue a new prescription, not authorize a refill.