Kentucky Board of Dentistry Clarifies Requirements for Controlled Substance Prescribing, Including EPCS and KASPER Mandates

What this means for your practice

For dental practices operating in Kentucky, particularly those considering or engaging in telehealth, this guidance underscores the critical need for robust compliance infrastructure. Strict adherence to state-specific mandates like the Kentucky All Schedule Prescription Electronic Reporting (KASPER) program and the Electronic Prescribing of Controlled Substances (EPCS) is non-negotiable. Furthermore, any prescribing must fall squarely within the dental scope of practice, and practitioners should prioritize patient safety by considering non-opioid alternatives and educating patients on medication use and disposal. Practices must ensure their Electronic Health Record systems are EPCS certified or seek appropriate waivers when exceptional circumstances arise, and all prescribing dentists must have an active KASPER account accessed via the Kentucky Online Gateway (KOG).

The Kentucky Board of Dentistry has provided clarifying guidance on the requirements for licensed dentists administering and prescribing controlled substances within the Commonwealth. This information emphasizes strict adherence to both state and federal regulations, with particular attention to electronic prescribing mandates and prescription monitoring programs.

Core Requirements for Prescribing Controlled Substances

Before any dentist can administer or prescribe controlled substances in Kentucky, several prerequisites must be met:

• Active Kentucky Dental License: Possession of a current and valid dental license issued by the state of Kentucky.
• DEA Registration Number: An active registration number from the Drug Enforcement Administration (DEA) specific to Kentucky. Practitioners operating in multiple states or administering controlled substances in various locations within Kentucky may require additional DEA numbers.
• Active KASPER Account: Registration and active status with the Kentucky All Schedule Prescription Electronic Reporting (KASPER) program.

Scope of Practice for Dentists

Kentucky-licensed dentists are permitted to administer and prescribe controlled substances exclusively for specific conditions and as outlined in state regulations:

• Condition of Oral Cavity, Maxillofacial Area, or Associated Structures: Prescribing must be for the evaluation or treatment of conditions related to the oral cavity, maxillofacial area, or the adjacent and associated structures, and their impact on the human body, as defined by KRS 313.010(11).
• Dental Practices and Prescription Writing Regulation: All prescribing must conform to the guidelines set forth in the dental practices and prescription writing administrative regulation, 201 KAR 8:540.

Managing State and Federal Requirements

Practitioners in Kentucky are obligated to comply with all state and federal rules governing controlled substance prescribing. This includes, for licensed dentists, the federal Controlled Substances Act, the Kentucky Controlled Substances Act, and the Board of Dentistry's administrative regulation. It is explicitly stated as the practitioner's responsibility to be fully aware of and adhere to these statutory and regulatory requirements.

Electronic Prescribing of Controlled Substances (EPCS)

Kentucky has its own mandate for the electronic prescribing of controlled substances:

• State Mandate: KRS 218A.182, which mandates e-prescribing for controlled substances in Kentucky, took effect on January 1, 2021.
• Federal Alignment: This state requirement is similar to the federal mandate, which has an effective date of January 1, 2022.
• Waiver Process: Practitioners unable to comply with EPCS due to exceptional circumstances may petition for a temporary waiver.
• EHR System Compliance: Dentists whose Electronic Health Record (EHR) systems are not EPCS certified are advised to contact their vendors promptly to implement the necessary certification.

Kentucky All Schedule Prescription Electronic Reporting (KASPER)

KASPER serves as Kentucky's mandatory prescription monitoring program, designed to support patient care while also serving as an investigative tool for law enforcement and regulatory agencies.

• Mandatory Use: Dentists authorized to administer and prescribe controlled substances in Kentucky must maintain an active KASPER account.
• Patient Query Requirement: Practitioners are required to use KASPER to query patients who are being prescribed Schedule II or III controlled substances.

Kentucky Online Gateway (KOG)

To ensure compliance with current regulations, all prescribers in Kentucky must access their KASPER accounts via the Kentucky Online Gateway (KOG).

• Consolidated Security Portal: KOG is the Commonwealth's unified security portal.
• Mandatory Registration: Any prescribing dentist not yet registered with KOG should establish an account as soon as possible.

Dentists' Critical Role in Addressing Opioid Abuse

The Board acknowledges the serious public health issue of opioid abuse, citing alarming statistics on overdose deaths. Dentists are encouraged to play a critical role in addressing this crisis by:

• Considering Alternatives: Evaluating whether non-pharmacologic and non-opioid therapies are preferable, especially when patient screenings indicate a higher risk of harm or misuse compared to potential benefit.
• Risk Factors: Recognizing patient risk factors such as a history of substance use disorder, certain medical conditions (e.g., sleep apnea, pregnancy, older age), mental health conditions (e.g., depression, anxiety), and concurrent prescriptions (e.g., benzodiazepines, muscle relaxants).
• Patient Education: Educating all patients on the safe use and storage of medication, appropriate disposal methods, and risks associated with operating heavy machinery while on medication.

Key Facts

| Detail | Value | |---|---| | Kentucky EPCS Effective Date | January 1, 2021 (KRS 218A.182) | | Federal EPCS Effective Date | January 1, 2022 | | Scope of Practice Statute | KRS 313.010(11) | | Administrative Regulation | 201 KAR 8:540 | | Required Registrations | Active Kentucky dental license, DEA registration, KASPER account, KOG account | | KASPER Query Requirement | Mandatory for Schedule II and III controlled substances |

Frequently Asked Questions

What are the essential requirements for a Kentucky dentist to prescribe controlled substances?

A Kentucky dentist must hold an active Kentucky dental license, possess a DEA registration number specific for Kentucky, and have an active KASPER account before administering or prescribing controlled substances.

What is the scope of practice for dentists prescribing controlled substances in Kentucky?

Dentists may only administer and prescribe controlled substances for the evaluation or treatment of conditions of the oral cavity, maxillofacial area, or the adjacent and associated structures and their impact on the human body, as outlined in KRS 313.010(11) and 201 KAR 8:540.

When did electronic prescribing of controlled substances (EPCS) become mandatory in Kentucky?

KRS 218A.182, which mandates e-prescribing for controlled substances in Kentucky, took effect on January 1, 2021. The similar federal requirement has a January 1, 2022 effective date.

What is KASPER, and how do I access it?

KASPER is the Commonwealth's mandatory prescription monitoring program. Dentists authorized to administer and prescribe controlled substances must have a KASPER account and use it to query patients being prescribed Schedule II or III controlled substances. Access to KASPER accounts is via the Kentucky Online Gateway (KOG).

Can a dentist obtain a waiver for the EPCS requirement in Kentucky?

Yes, a practitioner who is unable to comply with EPCS may petition for a temporary waiver based on exceptional circumstances.

Source: dentistry.ky.gov — Additional State EPCS Requirements for Telehealth Prescribing of Schedule II Stimulants