The MDS Dental Practice and Benefits Committee reminds all dentists who write prescriptions that you must register for the Massachusetts Prescription Awareness Tool (MassPAT)—our state’s official prescription monitoring program (PMP). Massachusetts state law requires that you query the MassPAT database prior to issuing a prescription to a patient for a Schedule II or III narcotic drug and prior to the first time prescribing a benzodiazepine to a patient.
 
Here is how to do this:
 
(1)   Use this link to register for MassPAT (Massachusetts Prescription Awareness Tool): Register for Massachusetts Prescription Awareness Tool (MassPAT) | Mass.gov. Here is a video to walk you through the registration process: MassPAT Tutorial #1: Prescriber Account Registration (youtube.com).

(2)   Use this link to look up a patient’s history every time you prescribe a Schedule II or III narcotic and prior to the first time prescribing a benzodiazepine:
Login - MassPAT (pmpaware.net). Every time you query the MassPAT, download the report and attach it to your patient record.
 
If you or an assigned delegate in your office are not performing this lookup as required, you are not following the law and putting yourself and your practice at risk. (For reference, the two specific state laws requiring dentist prescribers to use MassPAT are MGL Ch. 94C, Sec 24A General Law - Part I, Title XV, Chapter 94C, Section 24A (malegislature.gov)and Ch. 208 of the Acts of 2018 PMP Utilization for Benzodiazepines | Mass.gov.

The MDS expects the Board of Registration in Dentistry (BORID) to take disciplinary action against dentists who do not comply. You are also putting your patients and community at risk by potentially exposing known high-risk individuals to addictive drugs and potentially allowing such drugs to be diverted in the community.
 
In general, the MDS Dental Practice and Benefits Committee recommends that Massachusetts dentists take a careful, evidence-based approach to decisions about prescribing scheduled drugs. Our professional duties to beneficence and non-maleficence compel us to meet the needs of the Massachusetts public through effective management of pain and anxiety, and scheduled drugs can be an indicated modality in some cases.
 
When writing such prescriptions, avoid ordering a large number of tablets/pills. It is safer to prescribe fewer and to renew the prescription as needed. To further minimize risks, consider the reasonable alternatives to scheduled drug prescriptions whenever possible. For example, the broad clinical consensus is that NSAID-acetaminophen combinations are the most effective pharmacologic treatment for most dental pain.
 
Collaborate with your dispensing pharmacists by informing them of the dental indication for prescriptions. Discuss medical and psychiatric risks with the patient’s primary care physician to determine the most effective strategies for management of pain, anxiety, etc. Detailed documentation of these discussions in your clinical records further reduces your liability risk. If a case requires an unusual prescription, a referral to an appropriate dental specialist or physician may be indicated.
 
What should you do when a MassPAT query reveals a suspicious prescription history? The immediate action is not to prescribe a scheduled drug. Protect the patient and other providers by reporting your finding to the patient’s primary care physician. Dentists are in an important position to help people with possible substance use disorders. One simple tool we can use is an evidence-based protocol called SBIRT (Screening, Brief Intervention, Referral to Treatment). To learn how to use this protocol, visit this link of SAMHSA (the National Substance Abuse and Mental Health Services Administration): Screening, Brief Intervention, and Referral to Treatment (SBIRT) | SAMHSA.