6 Crescent Road, Toronto, ON Canada M4W 1T1 T: 416.961.6555 F: 416.961.5814 Toll Free: 1.800.565.4591 www.rcdso.org PRACTICE ADVISORY SERVICE FAQ Information on Prescribing and Dispensing Drugs for Dentists CONTENTS Where do dentists get their authority to prescribe? 2 Do dentists have the authority to prescribe any drug for any individual? 2 Can dentists prescribe for themselves? 3 Can dentists prescribe for friends or family members? 3 Can dentists employ drugs to induce sedation or general anesthesia? 3 What information must be included with a prescription? 4 What are the acceptable forms of patient ID? 5 What are the rules concerning repeat/refill prescriptions? 6 Can dental office staff call in a verbal prescription for a patient on behalf of a dentist? 6 Who is responsible for confirming the authenticity of a prescription? 6 Can a prescription written by a dentist in Ontario be filled outside of Ontario? 6 Do dentists need to document prescriptions in patient records? 7 Can dentists order drugs for in-office use? 7 Can dentists dispense drugs from in-office supplies to patients for use at home? 8 Do dentists need to keep a register for in-office supplies of drugs? 9 How long should a drug register be kept? 9 What is the proper way to store drugs in a dental office? 10 Why should dentists be cautious about prescribing opioids and other monitored drugs? 10 What practical steps can dentists take to prevent problematic opioid use? 11 What was the rationale for Ontario’s Narcotics Strategy, which was introduced by the Ministry of Health and Long-Term Care? 12 What is a monitored drug? 12 Where can dentists find more information about Ontario’s Narcotics Strategy? 13 If opioids from a dentist’s office are expired or unusable, can the dentist destroy them? 13 Do dentists have to request permission for the destruction of benzodiazepines and other targeted substances? 13 How should dentists destroy expired or unusable controlled substances? 14 What should a dentist do if controlled substances, including opioids and other narcotics from their office supply have been lost or stolen? 14 How can dentists minimize the risk of forged/fraudulent prescriptions? 15 Where can dentists obtain further information on the use of opioids in the management of pain? 16
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Can dentists order drugs for in-office use? . . . . . . . . . . . . .7
Can dentists dispense drugs from in-office supplies to patients for use at home? . . . . . . . . . . . . . . . . . . . . . . . . 8
Do dentists need to keep a register for in-office supplies of drugs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
How long should a drug register be kept? . . . . . . . . . . . . . .9
What is the proper way to store drugs in a dental office? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Why should dentists be cautious about prescribing opioids and other monitored drugs? . . . . . . . . . . . . . . . . . 10
What practical steps can dentists take to prevent problematic opioid use? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
What was the rationale for Ontario’s Narcotics Strategy, which was introduced by the Ministry of Health and Long-Term Care? . . . . . . . . . . . . . . . . . . . . . . 12
Where can dentists find more information about Ontario’s Narcotics Strategy? . . . . . . . . . . . . . . . . . . . . . . . 13
If opioids from a dentist’s office are expired or unusable, can the dentist destroy them? . . . . . . . . . . . 13
Do dentists have to request permission for the destruction of benzodiazepines and other targeted substances? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Ho w should dentists destroy expired or unusable controlled substances? . . . . . . . . . . . . . . . . . . . . 14
What should a dentist do if controlled substances, including opioids and other narcotics from their office supply have been lost or stolen? . . . . . . . . . . . . . . . . . . . . 14
How can dentists minimize the risk of forged/fraudulent prescriptions? . . . . . . . . . . . . . . . . . . . . 15
Where can dentists obtain further information on the use of opioids in the management of pain? . . . . . . . . 16
InformatIon on PrescrIbIng and dIsPensIng drugs for dentIsts 2
InformatIon on PrescrIbIng and dIsPensIng drugs for dentIsts 11
What practical steps can dentists take to prevent problematic opioid use?
When prescribing opioids, dentists must be alert for behaviour that
suggests patients are experiencing problems with the appropriate use of
opioids or have an opioid use disorder. Dentists should:
• E nsure that the patient’s identity has been verified; for example, by
requesting two or three pieces of identification (e.g., health card,
driver’s licence, birth certificate).
• Verify the presenting complaint and observe for indicators of
problematic opioid use.
• Scr een for current and past alcohol and drug (prescription, non-
prescription, illicit) use.
• C onsider whether the patient may be experiencing problems with
opioid use or have an opioid use disorder if she/he:¡ requests a specific drug by name and/or states that alternatives
are either not effective or he/she is “allergic” to them;¡ refuses appropriate confirmatory tests (e.g., x-rays, etc.); ¡ indicates losing previous filled prescriptions or spillage of drugs.
• Ask to speak with the patient ’s primary family health care provider
and/or pharmacist.
• Ask if the patient has r eceived any opioids in the last 30 days from
another practitioner and look for any signs of evasiveness.
Under the Controlled Drugs and Substances Act, 1996, and its
regulations, a person who has received a prescription for a narcotic,
such as an opioid, shall not seek or receive another prescription or
narcotic from a different prescriber without telling that prescriber
about every prescription or narcotic that he or she has obtained within
the previous 30 days.
For more information:
Guidelines on the Role of Opioids in the Management of Acute
InformatIon on PrescrIbIng and dIsPensIng drugs for dentIsts 15
How can dentists minimize the risk of forged/fraudulent prescriptions?
When issuing prescriptions for opioids and other narcotics, controlled
drugs, benzodiazepines and targeted substances, dentists should
consider taking the following precautions:
• If using a paper prescription pad:¡ write the prescription in words and numbers;¡ draw lines through unused portions of the prescription;¡ keep blank prescription pads secure.
• If using desk-top prescription printing:¡ use security features, such as watermarks;¡ write a clear and unique signature.
• If faxing a prescription:¡ confirm destination and fax directly to the pharmacy,
ensuring confidentiality;¡ destroy paper copy or clearly mark it as a copy.
Trust is essential to the dentist-patient relationship. A dentist may wish
to terminate the relationship if they discover that a patient has altered
or forged a prescription.
In cases where a staff member has forged a prescription using a dentist’s
prescription pad, the College advises the dentist to document all
conversations with the staff member and obtain legal advice as to what
their obligations are with respect to employment-related issues. On the face
of it, forging a prescription may be grounds for dismissal for cause, but the
dentist must obtain their own legal counsel if they are contemplating this
type of action, as the College cannot provide legal advice.
Dentists may report the forgery to:
Compliance, Monitoring and Liaison Division
Office of Controlled Substances
Drug Strategy and Controlled Substances Program, Health Canada