9.2 Opioids for Minors, Scope Limits on Prescribing, and Prescription Requirements

Opioids and minors (K1182)

Health and Safety Code § 11158.1, amended by SB 607 effective January 1, 2025, requires a prescriber, before directly dispensing or issuing the first prescription in a single course of treatment for a controlled substance containing an opioid, to discuss:

1. The risks of addiction and overdose associated with opioids.
2. The increased risk of addiction for a person with both mental health and substance use disorders.
3. The danger of combining an opioid with a benzodiazepine, alcohol, or another CNS depressant.
4. Any other information required by law.

Who hears it: the patient, or if the patient is a minor, the minor and the minor's parent or guardian, or another adult authorized to consent to the minor's care. Document the discussion in the chart.

Exceptions: emergency services and care; emergency surgery; hospice; substance use disorder treatment; and cases where, in the prescriber's professional judgment, the discussion would harm the patient's health or safety or violate their confidentiality rights (for example, a minor lawfully consenting to confidential care). Failing to comply is not a crime (§ 11158.1(c)), but it can still be treated as a practice violation.

For a teenager having third molars removed, the dentist should talk with both the teen and the parent before the first opioid prescription, prefer NSAIDs combined with acetaminophen, prescribe the smallest effective quantity with no refills if an opioid is needed, and explain safe storage and disposal.

The naloxone offer (B&P § 741)

When prescribing an opioid or benzodiazepine, the prescriber must offer a naloxone prescription (or another FDA-approved reversal drug) if any of these apply:

• The opioid dose is 90 or more morphine milligram equivalents (MME) per day.
• An opioid is prescribed within a year of a benzodiazepine being dispensed to the patient.
• The patient has an increased overdose risk, such as a history of overdose or opioid use disorder, or a risk of returning to a high dose after losing tolerance.

The prescriber must also educate the patient, and one or more people the patient designates (for a minor, the parent or guardian), on overdose prevention and naloxone use. The education may be skipped if the patient declines it or received it in the past 24 months. The rule does not apply to drugs administered in an inpatient or outpatient setting, to terminally ill patients, or to patients under corrections jurisdiction.

Scope limits on prescribing (K1183)

Because B&P § 1625 limits dentistry to the teeth, jaws, and associated structures, a dentist's prescriptions must relate to dental diagnosis and treatment. Prescribing hydrocodone for a spouse's back pain, a sleep aid for a patient's insomnia, or weight-loss drugs is outside the scope of dentistry and violates §§ 11154 and 11210 even if the dentist holds a DEA registration. Prescribing antibiotics or analgesics for a dental infection or post-operative pain is within scope.

Prescription format requirements

Electronic prescribing (B&P § 688)

Since January 1, 2022, a prescription "shall be issued as an electronic data transmission prescription." Exceptions include:

• A temporary technological or electrical failure.
• A prescription for a pharmacy outside California.
• Terminally ill patients under Health and Safety Code § 11159.2.
• Certain emergency department or urgent care situations.
• Volunteer prescribers at free clinics.
• The prescriber and dispenser being the same entity.
• Situations where the prescriber reasonably determines electronic prescribing would be impractical and cause a delay that harms the patient.

Electronic controlled substance prescriptions must meet DEA electronic prescribing rules (21 CFR Part 1311), including two-factor authentication.

Paper controlled substance prescriptions

When an exception allows paper, a Schedule II–V prescription must be written on a California security prescription form from a DOJ-approved printer (§ 11162.1). Its required features include:

• A uniquely serialized number, required since AB 149.
• The "California Security Prescription" watermark and a "void" pattern that appears when copied.
• Thermochromic ink and chemical-void protection.
• Quantity check-off boxes (1–24, 25–49, 50–74, 75–100, 101–150, 151 and over).
• The prescriber's preprinted name, license category and number, DEA number, and address.

The prescription must be signed and dated in ink and include the prescriber's address and phone, the patient's name and address, refill information, and the drug name, strength, quantity, and directions (§ 11164). Schedule III–V drugs may also be prescribed orally or electronically. Federal law prohibits refills of Schedule II prescriptions.

Federal requirements

A dentist needs a DEA registration to prescribe controlled substances. Since June 27, 2023, new and renewing DEA registrants must attest to completing eight hours of one-time training on substance use disorders (the MATE Act). California separately requires two CE units on Schedule II opioid prescribing each renewal (16 CCR § 1017(a)(4)).