The Dental Quality Assurance Commission recently adopted a series of changes and new sections to existing rules that establish requirements and standards for prescribing opioids. The adopted rules are in response to the Legislature’s enactment of ESHB 1427 in 2017, which directed the five health care prescribing boards and commissions (medical, dental, nursing, osteopathic and podiatric) to adopt opioid prescribing rules by January 1, 2019.

The adopted rules go into effect January 26, 2019 and include several new requirements such as patient notification, Prescription Monitoring Program (PMP) queries, prescribing limits, and continuing education requirements. Here are some of the highlights.

Patient Notification

Per the adopted rules, upon initial prescriptions and each transition phase of treatment, dentists will need to provide patients with information regarding opioid risks, safe and secure storage, and proper disposal of unused medication. Dentists must document such notification in the patient record. This requirement may be satisfied by providing the following handouts from the Department of Health. 

• Chronic Pain Patient Handout
• Surgical Pain Patient Handout
• Acute Pain Patient Handout
• Sub-Acute Patient Handout

PMP Queries

When prescribing opioids, dentists will be required to query the PMP at the first opioid prescription refill or renewal for acute pain, each pain transition treatment phase (acute to subacute and subacute to chronic), and periodically for chronic pain patients based upon the patient’s risk assessment.

Dentists may delegate performance of required PMP queries to an authorized health care designee. An authorized healthcare designee is a current healthcare provider credentialed with the Washington State Department of Health (ex: dental hygienist, dental assistant, EFDA). Any healthcare provider credentialed with the state may be a designee to perform PMP queries.

Learn more about how to register and utilize the PMP. 

Prescribing Limits

The adopted rules establish prescribing limits for acute nonoperative pain and acute perioperative pain, subacute pain, as well as establish prescribing limits for youth. The rules limit opioid prescriptions to a 7-day supply for acute nonoperative pain and acute perioperative pain, and a 14-day supply for subacute pain. Additionally, for patients 24 years of age and under, the dentist may not prescribe more than 12 tablets. Dentists may only prescribe beyond these limits if they provide clinical documentation in the patient record to justify the need for such quantity. 

Continuing Education

Dentists who prescribe opioids must complete a one-time CE requirement regarding best practices in the prescribing of opioids and the adopted opioid rules. This CE must be at least three hours in length and can count toward license renewal requirements. 

This entire CE requirement can be satisfied at PNDC 2019 by taking the course “Opioid Prescribing Rules: How and Why to Comply” on June 21 from 1:00-4:00 PM.

WSDA members register at a deeply discounted member price! Learn more and register at wsda.org/pndc.

More Information

For more information regarding these rules, please visit the Department of Health website. 

Additional Resources

• Opioid Prescribing Webinar from DOH
• Dentist Practitioner Handout 
• Healthcare Provider FAQs
• Find a Medicine Take-Back Location - Take Back Your Meds
• Opioid Dose Calculator - Washington Agency Medical Directors Group
• Opioid Prescribing - Centers For Disease Control and Prevention
• Opioid Prescribing Guideline Implementation - BREE Collaborative
• Washington State Opioid Response Plan
• UW Practice Transformation Support Opioid Use
• Healthier Washington Practice Transformation Support Hub - Resource Portal - Opioids
• Medicaid Transformation
• Presentation: Implementation of Opioid Prevention and Treatment Initiatives 
• Opioid Crisis - American Dental Association
• Preventing Opioid Abuse - American Dental Association

Questions? 

Please contact WSDA Government Affairs Manager Sophie Doumit at sophied@wsda.org.