PURPOSE: This rule provides for regulation of prescriptions for opioid pain medication.

1. (1) Dentists shall consider non-opioid medications and therapies for treatment of mild to moderate acute dental pain prior to prescribing an opioid controlled substance. Options for non-opioid treatments shall be discussed with the patient and the patient advised of the risks associated with opioid related treatments and the discussion documented in the patient’s dental record.
2. (2) Before prescribing an opioid controlled substance to a patient experiencing dental pain, a dentist shall assess the patient for potential opioid use disorder. At a minimum, this should include collecting and maintaining a thorough medical history of the patient from the patient or their guardian including any history of substance abuse disorders, mental health conditions, or sleep-disordered breathing. Dentists shall thoroughly discuss with the patient or their guardian and document in the patient’s record any medications the patient or their guardian discloses to the dentist they have received from any other healthcare providers.
3. (3) A dentist shall not issue an initial prescription for more than a seven- (7-) day supply of an initial prescription of an opioid controlled substance for treatment of a patient’s acute pain. A dentist may not issue any renewal, refill, or new prescription for an opioid controlled substance for treatment of the same acute pain without first conducting 20 CSR 2110-2

a consultation with the patient to determine the need and appropriateness of the renewal, refill, or new prescription. For the purposes of this rule, a consultation shall include all of the requirements outlined in section (2) of this rule. Any appropriate renewals, refills, or new prescriptions of opioids for treatment of the same acute pain shall also be limited to a seven- (7-) day supply and shall be in compliance with the general provisions of Chapters 195 and 579, RSMo. If, in the professional judgment of the dentist, more than a seven- (7-) day supply is appropriate for the initial prescription or any renewals, refills, or new prescriptions of opioids to treat the patient's acute pain, the dentist may issue a prescription for the quantity needed to treat the patient, provided that the dentist shall document in the patient's dental record the reason for the necessity for more than a seven- (7-) day supply and that a nonopioid alternative was not appropriate to address the patient's condition.

AUTHORITY: section 332.031, RSMo 2016.* Emergency rule filed Nov. 7, 2018, effective Nov. 17, 2018, expired May 15, 2019. Original rule filed Nov. 7, 2018, effective May 30, 2019.

*Original authority: 332.031, RSMo 1969, amended 1981, 1993, 1995.