Do you want to see how easy it is to register for the E-FORCSE database? Watch FDA President Dr. Jolene Paramore complete her registration in the video below.
E-forcse Registration Video from Florida Dental Association on Vimeo.
For technical assistance, please call 877.719.3120. If you have questions specific to state policy, you may contact E-FORCSE 850.245.4797 or firstname.lastname@example.org.
On July 1, new laws and rules go into effect for the prescribing and dispensing of controlled substances in Florida. Below is a snapshot of the changes and how they will affect you.
Limits Prescribing of Controlled Substances for Acute Pain
- Three-day limit prescription for acute pain
- Acute pain: the normal, predicted, physiological and time-limited response to an adverse chemical, thermal or mechanical stimulus associated with surgery, trauma or acute illness.
- Exceptions for acute pain includes cancer, a terminal condition, palliative care and traumatic injury.
- Exception to three-day limit is a seven-day limit prescription for acute pain (dentists can write a seven-day prescription using their professional judgement that their patient needs more than a three-day limit). Must write on prescription “acute pain exception” and document in patient’s record their acute medical condition and lack of alternative treatment.
- For treatment of pain other than acute pain, a prescriber must indicate “non-acute pain” on a prescription for an opioid drug listed as a Schedule II controlled substance.
Dispensing Limits on Practitioners
- Dispensing controlled substances listed in Schedule II, for the treatment of acute pain, may not exceed a three-day supply, or a seven-day supply based on the same parameters listed above for prescribers.
- Dispensing controlled substances listed in Schedule III, for the treatment of acute pain, may not exceed a 14-day supply.
- Verifying the identity of an individual must be done prior to dispensing a controlled substance, if not already known to the dentist.
Mandatory Two-hour CE Training on Controlled Substances
- All health care providers who are authorized to prescribe controlled substances and are registered with the United States Drug Enforcement Agency (DEA) to prescribe controlled substances must complete a board-approved two-hour continuing education (CE) course by Jan. 31, 2019, and at each subsequent licensure renewal. Failure to take the two-hour CE course could impact licensure renewal.
- The new law limits approved providers authorized to offer the two-hour CE course to include only statewide professional associations of physicians in Florida that are accredited to provide such educational courses (some collaborative efforts have been granted, but are limited, and must have approval from appropriate health care boards). The ONLY approved CE providers are: the Florida Medical Association, Florida Osteopathic Medical Association, Florida Academy of Family Physicians and Florida College of Emergency Physicians.
- This two-hour CE course is now available online. To access the course, please click here.
Mandates Checking the Prescription Drug Monitoring Program (PDMP) Database
- Florida’s PDMP database is known as E-FORCSE (Electronic-Florida Online Reporting of Controlled Substance Evaluation Program), which is administered through the Department of Health. To register, please click here. For step-by-step instructions on how to register, please click here.
- Providers must check the PDMP database (E-FORCSE) before prescribing or dispensing Schedules II, III, IV and V controlled substances for patients 16 years old or older starting on July 1, 2018. For a list of controlled substances, please click here. For step-by-step instructions on how to search for a patient in the PDMP, please click here. For step-by-step instructions on how to search for multiple patients at once, please click here.
- Providers are exempted from checking the PDMP database for “non-opioid” Schedule V controlled substances (does not contain any amount of a substance listed as an opioid).
- Health care providers are authorized to designate multiple staff members to check the PDMP on their behalf. For more information on designate/delegate management, please click here.
- Failure to check the PDMP database prior to the prescribing of a controlled substance could be subject to a non-disciplinary citation from the appropriate licensing board.
For more information, please visit flhealthsource.gov/FloridaTakeControl or floridadental.org/e-forcse.
By Dr. John Paul, FDA Editor
How many of your patients complain when you prescribe their prophylactic antibiotics? In my practice, it’s all of them. No one complains about the drugs they think will make them feel better, but when they perceive no problem, they want no cure.
“It’s four big old horse pills that make me gag, I can never remember them and I read that it’s bad to take too many antibiotics. Why do I have to take them every time I come to the dentist?”
“Mrs. Gruntbuns, you’re right, it’s bad to take medicines you don’t need and it is four large pills. If it’s just the pills and remembering, we can get you a liquid (but it costs more and won’t last on the shelf) and we can call to remind you. If you need the medicine though, it might just be the difference between life and death, or at least between a relatively comfortable life and misery.
“Not as many people need or are prescribed an antibiotic before dental care today as when I started practice. Science has shown us some situations aren’t a risk while others remain. If you are likely to get an infection in your heart or on an artificial piece of equipment, then you should have an antibiotic before we do any procedure that may cause bleeding and let germs enter your blood stream.
“Remember, you have that artificial valve in your heart — that’s a place where bacteria can land and live, and since the artificial valve doesn’t have a blood supply, giving you antibiotics to kill the bugs that start living there is no easy matter. It won’t just be a couple of pills, but days in the hospital. I like you too much to risk you going to the hospital just because you had your teeth cleaned.”
Have a question you have a tough time answering? Send it to Dr. Paul at email@example.com.
By Bob Macdonald, Florida PDMP Foundation Executive Director
As a licensed dentist, have you registered to use the Prescription Drug Monitoring Program (PDMP) database yet? Florida’s version of the nationwide program is called the Electronic-Florida Online Reporting of Controlled Substances Evaluation, better known as E-FORCSE. The database allows dentists to:
- review complex prescribing for the elderly.
- guarantee new prescriptions will not negatively interact with existing prescriptions from other prescribers.
- confirm that patients do not need additional medicines or increased dosages to prevent unknown over-prescribing.
- prevent unknown over-prescribing, which will reduce excess prescription drugs in medicine cabinets — the highest source of prescription drug diversion.
- detect doctor-shopping, which may stop potential addiction and selling of drugs.
The state’s PDMP went into effect in 2009. Under the law establishing the program, all dispensers of Scheduled II-V drugs must enter prescription information in the database within seven days or it is a misdemeanor. The majority of dispensers under the law are pharmacists, although there are still some dispensing practitioners operating in Florida. Besides pharmacists, the law also allows for all licensed medical doctors, osteopathic physicians, dentists, podiatric physicians, ARNPs, physician assistants and optometrists to access the database for free to review patient information before prescribing any controlled substances for pain management. Law enforcement agencies also may access the database when investigating an active case of drug abuse or diversion.
Of a potential of 148,000 licensed Florida practitioners, about 30,000 have registered to use the database. Only about 700 dentists are signed up to access E-FORCSE, which is about 6 percent of all licensed dentists.
To date, the database has collected more than 130 million prescription records and is receiving about three million a month. E-FORCSE users have made more than 12 million queries for information. Of this total, dentists have made more than 12,000 contacts for records.
If you have a DEA license and regularly prescribe pain medication to patients, you should consider using the PDMP as part of your practice management office policy. To register to use the database, visit the program’s website under the Department of Health at www.e-forcse.com.