Frequently Asked Questions - Prescribing and Dispensing Drugs

Dentists can only prescribe or dispense drugs for the purpose of diagnosing, treating or preventing conditions of the oral-facial complex for patients that they are treating.

Before prescribing any drug, a dentist must have current knowledge of the patient’s health status and clinical condition, acquired by obtaining a medical history and conducting an appropriate clinical examination to make a diagnosis or differential diagnosis, or otherwise establishing a clinical indication for the use of a drug. There must be a logical connection between the drug prescribed and the diagnosis or clinical indication.

It is inappropriate for a dentist to self-prescribe any drugs. Dentists can prescribe drugs for friends and family members who are their patients of record, provided these prescriptions are for the purpose of treating conditions within the scope of practice of dentistry. It is inappropriate for a dentist to prescribe drugs for a non- dental purpose.

Dentists who wish to employ any modality of sedation or general anesthesia must apply to the College and have their training reviewed and approved by the College.

Dentists must provide the following information with a prescription:

• name of the patient;
• full date (day, month and year);
• name of the drug, drug strength and quantity or duration of therapy;
• full instructions for use of the drug;
• refill instructions, if applicable;
• printed name of the prescriber;
• address and telephone number of the dental office where the patient’s records are kept;
• signature of the prescriber or, in the case of electronically produced prescriptions, a clear  and  unique identifier, which signifies to the dispenser that the prescriber has authorized the individual prescription.

If the prescription is for a monitored drug, as defined in the Narcotics Safety and Awareness Act, 2010, dentists must also provide:

• their RCDSO registration number;
• an identification number for the patient and the type  of identification used.

The Ministry of Health and Long-Term Care publishes a list of approved forms of identification.

The College strongly recommends that dentists select the Ontario Health Card or other health card issued by a Province or Territory in Canada as the preferred form of patient ID.

For opioids and other narcotics, refills are NOT permitted.

For some controlled drugs, refills are permitted for written and verbal prescriptions, while for others, refills require a written prescription. For all controlled drugs, the prescription must also specify the intervals between refills.

For benzodiazepines and other targeted substances, refills are permitted for written and verbal prescriptions. The prescription (with any refills) is valid for only one year from the date it was issued.

The use of intermediaries (e.g. office staff) is a prominent source of medication error. The prescribing dentist is responsible for ensuring accurate information is transmitted to the pharmacy. It is recommended that dentists communicate verbal prescriptions themselves. If this is not possible, the dentist should consider asking a staff person who has an understanding of the drug and indication to communicate the prescription information, unless the prescription is a refill.

Pharmacists are responsible for confirming the authenticity of each prescription, which may require direct confirmation with the prescriber before the prescription is filled.

Dentists who practise in Ontario may prescribe for any of their patients, including those who live outside of Ontario. However, whether the prescription will be accepted and filled by a pharmacist outside of Ontario depends on the jurisdictional requirements of that province or country.

Dentists are required to document details of their prescriptions in the patient’s chart, including the name of the drug, drug strength and quantity, and instructions for use.

Dentists are able to order drugs for office use, including antimicrobials, analgesics, sedatives and medical emergency drugs. Drugs ordered for in-office use will be determined by the scope of a particular dentist’s practice and the conditions for which they have the expertise and competence to manage.

There is no provision for dentists or their staff to access in-office supplies of drugs that normally require a prescription for their own use or by their family members. Dentists should take reasonable precautions to prevent the unauthorized use of in-office supplies of drugs by staff and other individuals with access to the office.

This is usually done if a drug is necessary for the immediate treatment of a patient, in an emergency or where the services of a pharmacist are not readily available. In most cases, dentists should dispense no more than a three-day supply of a drug. Normally, the drug is dispensed at no charge. If the dentist charges the patient, the fee must be the actual cost of the drug.

A drug should be dispensed in a CSA-approved child-resistant package that is labelled with the following information:

• the name of the drug;
• the drug strength and quantity;
• the date the drug is dispensed;
• the name and address of the prescriber;
• the name of the person for whom it is prescribed;
• the directions for use.

In addition, an entry should be made in the patient’s chart, noting that the drug was dispensed to the patient.

Dentists must maintain a drug register. The register must record and account for all opioids and other narcotics, controlled drugs, benzodiazepines and targeted substances that are kept on-site.

Dentists must take adequate steps to protect opioids and other narcotics, controlled drugs, benzodiazepines and targeted substances in their possession from loss or theft. Drugs stored in a dentist’s office be should kept in a locked cabinet and out of sight.

Dentists should avoid storing drugs in any other location, including their homes, and never leave drug containers unattended or in plain view.

These drugs are highly susceptible to misuse, abuse and/or diversion, and may result in harm. If there are no appropriate or reasonably available alternatives, the benefits of prescribing an opioid must be weighed against its potential risks, especially when used long-term.

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 are responsible for protecting and accounting for all controlled substances in their possession, including expired, damaged and unusable drugs.

Most pharmacies offer take-back programs for the safe disposal of expired/unusable drugs. Dentists should contact the pharmacy to determine if it will accept the returns.

A request to destroy unusable benzodiazepines and other targeted substances listed in the Benzodiazepines and Other Targeted Substances Regulations made under the Controlled Drugs and Substances Act is NOT required.

All drugs should be destroyed through a waste disposal service that accepts biohazardous waste.

Drugs should never be thrown into the regular garbage; flushing medications down the toilet is discouraged for environmental reasons.

Prior to destruction, the dentist must record the name, strength and quantity of the drugs to be destroyed. The destruction must be witnessed by another dentist, pharmacist or another practitioner able to prescribe. The date of the destruction must be recorded and, immediately after the destruction has taken place, the dentist and witness must sign and print their names on a joint statement.

Dentists are required to report within 10 days of discovery the loss or theft from their office of controlled substances, including opioids and other narcotics, to the Office of Controlled Substances, Federal Minister of Health. Loss and theft report forms are available from the Office.

Dentists should consider the following precautions when issuing prescriptions for opioids and other narcotics, controlled drugs, benzodiazepines and targeted substances.

• 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.

A dentist may wish to terminate the relationship if a patient alters or forges a prescription.

In cases where a staff member has forged a prescription, the dentist should document all conversations with the staff member and obtain legal advice about their 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.

Dentists may report the forgery to:
Compliance, Monitoring and Liaison Division
Office of Controlled Substances
Drug Strategy and Controlled Substances Program, Health Canada
Address Locator: 3502 B, Ottawa, ON K1A 1B9
phone: 613-954-1541
fax: 613-957-0110