Hydrocodone for a Spouse
Dr. Boone's spouse calls from home with 8/10 pain from a lower molar. Dr. Boone has not seen the spouse as a patient in two years, has no radiograph or pulp test, and is leaving for a conference. He calls a pharmacy and orders hydrocodone/acetaminophen 7.5/325 mg #20, plus amoxicillin 500 mg #21. The spouse takes clonazepam daily and has a history of alcohol use disorder. The pharmacist calls back because the prescription is written by Dr. Boone for a family member and because the PDMP shows two opioid prescriptions from another prescriber in the last 60 days. Dr. Boone says, 'It's fine, I'm a dentist.' He does not create a dental record.
1. Was Dr. Boone's prescribing to his spouse permissible under Montana law and Board rules? Explain.
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No. Montana's Board rules and the standard of care do not permit routine prescribing to an immediate family member without a bona fide dentist-patient relationship; absent a documented emergency, this is unprofessional conduct. Even in an emergency, the dentist must stay within scope, examine the patient or document why that was impossible, and keep a record. Dr. Boone had no examination, no radiograph, no pulp test, and no dental record. He also prescribed an opioid and an antibiotic without a diagnosis. The pharmacist's PDMP information-two opioids in 60 days-and the spouse's daily clonazepam make the combination especially dangerous. Saying 'I'm a dentist' does not create authority to prescribe for a family member outside an emergency. The proper course was to refer the spouse to another dentist or urgent care.
2. What should Dr. Boone have done before prescribing, including PDMP and risk assessment?
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Before any opioid, Dr. Boone should have: (1) established a dental record and examined or imaged the tooth; (2) queried the Montana PDMP as required and documented the query; (3) screened for opioid risk, including benzodiazepine and alcohol use; (4) considered non-opioid analgesia and definitive dental treatment; (5) if an opioid was truly indicated, used the lowest effective dose and shortest supply, discussed risks, and considered naloxone; and (6) avoided prescribing to a family member. The PDMP data would have required a conversation and likely a different plan. Antibiotics are not indicated for pain alone without evidence of infection.
3. What reporting or disciplinary exposure exists if the pharmacist reports him?
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The pharmacist's report can trigger a Board investigation for unprofessional conduct, prescribing outside the scope of a bona fide dentist-patient relationship, failure to keep records, and controlled-substance violations. DEA registration exposure also exists. Dr. Boone should not create a retroactive record or alter the prescription; he should document the pharmacy call and seek legal counsel. The Board may consider the family relationship, the missing examination, the PDMP red flags, and the benzodiazepine interaction as aggravating factors.