Current through Register Vol. 35, No. 18, September 24, 2024
The following regulations shall be used by the board to
determine whether a dentist's prescriptive practices as consistent with the
appropriate treatment of pain.
A. The
treatment of pain with drugs or controlled substances is a legitimate dental
practice when accomplished in the usual course of professional practice. It
does not preclude treatment of patients with addicition, physical dependence or
tolerance who have legitimate pain. However, such patients do require very
close monitoring and precise documentation.
B. The prescribing, ordering, administering
or dispensing or controlled substances to meet the individual needs of the
patient for management of chronic pain is appropriate if prescribed, ordered,
administered or dispensed in compliance with the following.
(1) A dentist shall complete an evaluation.
The medical history shall include any previous history of significant pain,
past history of alternate treatments for pain, potential for substance abuse,
coexisting disease or medical conditions, and the presence of a medical
indication for or contra-indication against the use of controlled
substance.
(2) A dentist shall be
familiar with and employ screening tools as appropriate, as well as the
spectrum of available modalities, in the evaluation and management of pain. The
dentist shall consider an integrative approach to pain management.
(3) A written treatment plan shall be
developed and tailored to the individual needs of the patient, taking age,
gender, culture, and ethnicity into consideration, with stated objectives by
which treatment can be evaluated, e.g. by degree of pain relief, improved
physical and psychological function, or other accepted measure. Such a plan
shall include a statement of the need for further testing, consultation,
referral or use of other treatment modalities.
(4) The dentist shall discuss the risks and
benefits of using controlled substances with the patient or surrogate or
guardian, and shall document this discussion in the record.
(5) Complete and accurate records of care
provided and drugs or controlled substances prescribed shall be maintained.
When controlled substances are prescribed, the name of the drug, quantity,
prescribed dosage and number of refills authorized shall be recorded.
Prescriptions for controlled substances shall include indications for
use.
(6) The management of patients
needing chronic pain control requires monitoring by the dentist. The dentist
shall periodically review the course of treatment for chronic pain, the
patient's state of health, and any new information about the etiology of the
chronic pain at least every six months. Chronic pain patients shall receive all
chronic pain management prescriptions from one dentist and one pharmacy
whenever possible.
(7) In addition,
a dentist shall consult, when indicated by the patient's condition, with health
care professionals who are experienced in the area of chronic pain control;
such professionals need not be those who specilize in pain control.
(8) If, in a dentist's opinion, a patient is
seeking pain medication for reasons that are not medically justified, the
dentist is not required to prescribe controlled substances for the
patient.
(9) A dentist who
prescribes, distributes or dispenses an opioid analgesic for the first time to
a patient shall advise the patient on the risks of overdose and inform the
patient of the availability of an opioid antagonist. With respect to a patient
to whom an opioid analgesic has previously been prescribed, distributed or
dispensed by the dentist, the dentist shall advise the patient on the risks of
overdose and inform the patient of the availability of an opioid antagonist on
the first occasion that the dentist prescribes, distributes or dispenses an
opioid analgesic each calendar year.
(10) A dentist who prescribes an opioid
analgesic for a patient shall co-prescribe an opioid antagonist if the amount
of opioid analgesic being prescribed is at least a five-day supply. The
prescription for the opioid antagonist shall be accompanied by written
information regarding the temporary effects of the opioid antagonist and
techniques for administering the opioid antagonist. That written information
shall contain a warning that a person administering the opioid antagonist
should call 911 immediately after administering the opioid
antagonist.
C. The board
will evaluate the quality of care on the following basis: appropriate diagnosis
and evaluation; appropriate indication for the treatment prescribed; documented
change or persistance of the recognized indication; and, follow-up evaluation
with appropriate continuity of care. The board will judge the validity of
prescribing based on the dentist's treatment of the patient and on available
documentation, rather than on the quantity and chronicity of prescribing. The
goal is to control the patient's pain for its duration while effectively
addressing other aspects of the patient's functioning, including physical,
psychological, social, and work-related factors.
D. The board will review both
over-prescription and under-prescription of pain medications using the same
standard of patient protection.
E.
A dentist who appropirately prescribes controlled substances and who follows
this section would be considered to be in compliance with this rule and not be
subject to discipline by the board, unless there is some violation of the
Dental Health Care Act or board rules.
