TDIC's informed consent form helps dentists follow law when prescribing opioids to minors

The Dentists Insurance Company has developed a resource to help prescribers follow a new requirement when prescribing Schedule II drugs to minors.

Beginning Jan. 1, 2019, before a prescriber issues the first prescription to a minor for a controlled substance containing an opioid, the prescriber must discuss specific information with the minor or the minor’s parent or guardian as required by Senate Bill 1109 signed into law last September. The new form from TDIC, “Consent to Prescribe an Opioid to a Minor,” covers the following required discussion items:

  • The risks of addiction and overdose associated with the use of opioids
  • The increased risk of opioid addiction to individuals who are suffering from both mental and substance-abuse disorders
  • The danger of taking an opioid with central-nervous-system depressants including alcohol and benzodiazepines

Available in English and Spanish, the downloadable consent form provides background on the new California law, a section for listed medications and doses, “facts for consideration” for the minor’s parent or guardian to read and sign, as well as a place for the prescriber to certify the discussion took place.

Most professional liability claims include an allegation of a lack of informed consent, according to TDIC Risk Management Analyst Taiba Solaiman.

“Patients argue they would have made a different treatment decision had they known of the possibility of a negative outcome,” Solaiman said, adding that informed consent is a discussion between the dentist and patient during which the dentist — not just staff — educates the patient about the diagnosis, nature of the treatment, alternative treatment options and the benefits, risks and consequences of each. “It is not just a form,” she said.

“By law, patients must be informed about their treatment, and obtaining written consent is the best way to protect the patient and the doctor,” Solaiman said.

The informed-consent discussion is not required in the following situations according to the law: when the minor’s treatment includes emergency services or is associated with an emergency surgery and when, in the prescriber’s professional judgement, the discussion would be detrimental to the minor’s health or safety or would violate the minor’s legal rights concerning confidentiality.

Covering addiction risks in mandatory C.E.

The new law also addresses continuing education for dentists, physicians, surgeons, nurse practitioners and pharmacists. Specifically for dentistry, SB 1109 allows the Dental Board of California to require C.E. that covers the risks of addiction associated with the use of Schedule II drugs. At its November meeting, the dental board voiced its support for additional C.E. and in the coming months will discuss what such a requirement would look like. CDA will work closely with the board and update members as more information becomes available.

Find the new form, “Consent to Prescribe an Opioid to a Minor,” on the TDIC website or at cda.org/practicesupport.

Related Items

Many bills were introduced over the past year to combat the opioid epidemic in California, as CDA previously reported. Here is an overview of CDA-supported legislation in the areas of e-prescribing, informed consent, interstate data sharing and prescription-pad requirements, that Gov. Jerry Brown signed into law in September and how these bills will affect the practice of dentistry.

Sometimes you read a research article and it hits you between the eyes like a sledgehammer. So it was when I read “Prescription Opioids in Adolescence and Future Opioid Misuse” published in the journal Pediatrics in 2015. It made me really reconsider the impact dentists can have on ameliorating the opioid crisis.