Drug Use in the Dental Practice
Dental practices must have a number of controlled substances on hand in order to perform various levels of treatment, from oral surgery to local anesthesia. It is important to note the detailed controls over the presence of particular drugs in dental practices set by the Board of Registration in Dentistry and the Department of Public Health, and to prevent the abuse of drugs by any individual having to do with the practice.
The Drug Enforcement Administration (DEA) of the U.S. Department of Justice has numerous controls over the registration of dentists to allow them a DEA license to handle controlled substances, and also there are federal and state laws regarding storage of these drugs. Drugs are assigned Schedule numbers from I though VI depending on the strength and effects of their use and possible abuse, and those used by dental offices from schedules II through V must be kept in locked up and inventoried regularly. Prescription drugs are labeled Schedule VI, and the Massachusetts Department of Public Health often requires those drugs to be locked as well.
Dental practices hiring dentists or other employees who may have access to controlled drugs should make sure no felony convictions regarding controlled substances exist in the employee’s background check, and that the dentist’s DEA registration is current and has not been revoked or suspended. The criminal act of a theft of drugs from a dental practice can result in revocation of a DEA license and negatively impact a practice. The false accusation of theft of drugs and drug use, though, can often be a basis for a slander or defamation action by an accused party. It is best to recognize HIPAA requirements if any protected health information must be revealed to the authorities in any investigation, for detailed rules in that statute and other privacy laws exist covering this type of situation.
With regard to the handling of employees suspected of having a drug problem, the Family and Medical Leave Act can provide some protections to employees needing to take unpaid leave to seek treatment for drug abuse. Illegal use of drugs is not considered a disability under the ADA, however, unless drug use has been completely halted and a supervised rehabilitation program has been successfully completed or is being regularly attended.
The addiction of a dentist or other dental provider to drugs is a very serious issue, given the possibility of the misuse of prescribing capabilities of dentists. Noting the suspicion of drug use in private discussions with the employee, without the publication of the information until more evidence is collected is suggested, and referral to treatment programs can be done at this stage. The ADA Dentist Health and Wellness program and several state programs are available as rehabilitation resources. The DEA publishes a brochure on how to recognize drug problems or abuse among health care employees called “Drug Addiction in Health Care Professionals” (which can be found at www.deadiversion.usdoj.gov/pubs/brochures/drug_hc.htm)
There are detailed requirements set by the DEA for reporting any discrepancies in the amounts of controlled substances present in the dental office. Inventory logs must be maintained and regularly updated by a specific assigned employee.
The requirements of locking up controlled substances are important to follow when independent contractors such as cleaning services are used, and contracts with such companies should note the penalties for any tampering with supplies and that the practice will ensure such criminal wrongdoing by third parties will be prosecuted to the fullest extent of the law
The Massachusetts Dental Regulations have detailed parts dealing with what drugs are required to be kept by the practice doing specific types of procedures or using various types of anesthesia. Many of these drugs are controlled substances and special care must be taken to make sure proper supervision requirements of the regulations are met with these procedures, and that access to controlled substances only to those with proper credentials is allowed.