Controlled Substances

​Prescribing Controlled Substances

Dentists licensed in Kentucky may ONLY administer and prescribe controlled substances:

1. For the evaluation or treatment for a condition of the oral cavity, maxillofacial area, or the adjacent and associated structures and their impact on the human body KRS 313.010(11); and
2. As outlined in the dental practices and prescription writing regulation 201 KAR 8:540.                         

KASPER is the Commonwealth's mandatory prescription monitoring program. It is designed to assist practitioners and pharmacists with patient care while also providing an investigative tool for law enforcement and regulatory agencies. Dentists authorized to administer and prescribe controlled substances in Kentucky must have a KASPER account and use it to query any patients being prescribed schedule II or III controlled substances. KASPER registration information and other program details are available on the Cabinet for Health and Family Services' KASPER page.

Opioid abuse is a serious public health issue. More than 83,000 drug overdose deaths occurred in the United States in the 12 months ending in June 2020, the highest number of overdose deaths ever recorded in a 12-month period, and an increase of over 21% compared to the previous year, according to recent provisional data from the Centers for Disease Control and Prevention (CDC).  Nearly half of all opioid overdose deaths involve a prescription opioid. Dentists should consider if non-pharmacologic and non-opioid therapy is preferred, especially if screening determines patient's increase of harm or misuse is greater than benefit (see examples below).

Substance use disorder - history of drug misuse, overdose, family history of SUD

Medical Conditions – sleep apnea, pregnancy, older age

Mental Health Conditions – depression, anxiety, schizophrenia

Other prescriptions (Use KASPER) – benzodiazepines, muscle relaxants, hypnotics or other narcotics 

All patients should be educated on safe use of medication, risk factors of use, appropriately storing medication, disposal methods and risks while operating heavy machinery.

Helpful Resources

Phone Numbers

DEA Louisville Office: 502-582-5905

DEA London Office: 571-362-7052

KY Board of Dentistry: 502-429-7280

KY Dental Association: 502-489-9121

KASPER/Drug Enforcement Branch/OIG: 502-564-7985

Documents

​Opioid Consent Form.pdf

White Paper - Opioid Prescribing.pdf

DEA Contact Information.pdf

DEA Registration Information.pdf

Opioid Risk Tool.pdf

Opioid Patient Counseling Guide.pdf

Websites

Law Enforcement Disposal Locations: https://odcp.ky.gov/Pages/Prescription-Drug-Disposal-Locations.aspx

DEA Take Back Day: https://takebackday.dea.gov/

DEA Drug Disposal Guidelines: https://www.deadiversion.us​doj.gov/drug_disposal/index.html

Find Help Now: https://findhelpnowky.org/

Behavioral Health Treatment Locator: https://findtreatment.samhsa.gov/

KY Drug and Alcohol Abuse Facility Locators: https://drugabuse.com/usa/drug-abuse/kentucky/

KY Office of Drug Control Policy Resource Page: https://odcp.ky.gov/​Resources/Pages/Treatment-and-Recovery-Resources.aspx​

Q: Why do I need to use KASPER?

A: Reviewing the report prior to administering or prescribing a controlled substance is important to prevent accidental or intentional misuse or diversion of prescribed medication. This process can assist with prevention and early treatment of substance use disorders. It is also required by law in certain instances. Refer to KRS 218A.172  and 201 KAR 8:540. 

Q: I have a DEA but rarely write for controlled substances. Am I still required to obtain a KASPER account? 
A: Yes. All Kentucky licensed dentists with an active Kentucky DEA registration must register and maintain a KASPER account regardless of whether you plan to use such authority. If you are unable to conform to the controlled substance prescribing regulation you may want to retire your DEA number by calling DEA Registration Support at 571-362-6905. 

Q: I am a Kentucky licensed dentist; however, I practice in Colorado and my DEA is registered to my office in Colorado. Do I need to maintain a KASPER account?

A: No. Only dentists who are licensed to practice in Kentucky and have a Kentucky DEA registration are required to maintain a KASPER account. Although a DEA registration is federal registration, it does not allow you to prescribe controlled substances anywhere in the United States. The authority granted under registration with a Kentucky address ends at our border. While you only need one DEA to prescribe (issue a prescription) from multiple office locations in Kentucky, you will need additional DEAs if you practice in other states. You will also need additional DEAs if you plan on procuring, storing, or administering controlled substances in more than one location in a state. Kentucky regulations prohibit dentists from dispensing (packaging and labeling medication for use by the patient outside the office setting) controlled substances. If you have additional questions, call DEA Registration Support at 571-362-6905.

Q: I'm a licensed Kentucky dentist, however I am in the military. Do I still need to register? 
A: Yes. If you have a Kentucky dental license and a Kentucky DEA registration, regardless of whether you are a military dentist, you should maintain a KASPER account.  

Q: I don't have a computer in my office, what do I do? 
A: It is required by law that each office must have one computer with internet capabilities to access the KASPER website and run KASPER reports.

Q: I have not had access to my KASPER account and I keep getting emails about needing to get a new KOG account. What is KOG?

A: KASPER moved to the cabinet's single sign-in security portal Kentucky Online Gateway (KOG) in May 2019. If you don't have a KOG account, you will need to create an account. Once you are logged in, search by the letter K for the Kentucky All Scheduled Prescription Electronic Reporting and click Enroll/Launch and you should see the Account Request Onboarding screen. You will be required to put in your old KASPER user name and password to link to your old account. Please contact the KASPER Help Desk at 502-564-2703 or email eKASPERHelp@ky.gov if you do not remember your original KASPER credentials. Do NOT click on the "Request a New KASPER account" unless you have never had a KASPER account.

Q: When am I required to run a KASPER?

A: Prior to the initial prescribing or administration of a schedule II or III controlled substance the dentist shall obtain and review a KASPER for the 12 months preceding the patient encounter. If the course of treatment extends beyond three months, and additional controlled substances are required, the dentist shall obtain a new KASPER report. You may review any exception to this rule in the Board of Dentistry's prescribing and dispensing regulation 201 KAR 8:540. Please note, providing a Schedule II or III after oral surgery is no longer an exemption listed in the updated regulation. A quick reference guide is as follows:

• Schedule II - KASPER query required before initial prescribing and at least every three months during treatment
  
• Schedule III – KASPER query required before initial prescribing and at least every three months during treatment
  
• Schedule IV – Not required
• Schedule V – Not required
  

Q: How often do I have to run a KASPER report to update a previous report? 

A: If the course of treatment extends beyond 3 months and additional controlled substances are required, the dentist shall obtain a new KASPER report.  

Q: Am I required to inform the patient that a KASPER report will be generated? 

A: No. 

Q: I don't have time to request KASPER reports, can someone else in my office do this for me?

A:  Yes. You may delegate office employees to request KASPER patient reports on your behalf by logging onto your KASPER account and clicking the Manage Delegate button in the Administration tab. You will be directed to your KOG profile where you can click the My Delegations tab and enter the name or email address under "Choose a user to invite" and click SEARCH.

It is strongly recommended that your delegate create his/her KOG account prior to the delegate invitation process. Once the delegate has activated their KOG account, search for the email address that the delegate provided. Searching by name may return multiple results, but searching by email will return a single result and help ensure you invite the intended person. The delegate should follow the instructions in the system generated email to obtain their own KASPER account. Do not share your KOG Log-in ID or password. Refer to section 4 of the KASPER-KOG User Guide for more information regarding delegate accounts.

Q: Am I required to complete any continuing education regarding controlled substances?
A: Dentists with controlled substance prescriptive authority are required to complete three hours of continuing education that relates to the use of the electronic monitoring system (KASPER), pain management or addiction disorders, or any combination of the three, during every two year license renewal cycle. 

Q: Can an associate dentist write a refill for a patient if the associate dentist that treated the patient is not present? 
A: Yes, provided the partner or associate performs an exam on the patient prior to prescribing the controlled substance. Additionally, if the KASPER is older than three months, an updated KASPER would need to be obtained.

Q: I heard there was a 3 day limit on pain pills now but my patient is in severe pain from major surgery and needs more. Should I just make the patient do without? 
A: In 2017, the General Assembly amended KRS 218A.205 to require the Board of Dentistry to establish regulations to limit prescribing to a three-day supply or less for pain as an acute medical condition with exceptions. If, in your professional judgement you believe more than a three-day supply of a Schedule II or III controlled substance is medically necessary, document the condition and lack of alternative treatment options in the patient's medical record. Refer to KBD prescribing and dispensing regulation 201 KAR 8:540 . 

Q: If I run a KASPER report on a patient and I feel that the patient may be abusing drugs, what should I do? 
A: Speak to the patient in private. Explain to them that you have concerns about their health and welfare as a result of the information that was generated on the KASPER. You have the right to refuse to prescribe them a controlled substance. If you feel threatened or believe they are doctor shopping, you may contact a local law enforcement agency or refer them to one of the many treatment and recovery resources.

Q: Can I KASPER potential employees to make sure they are not on drugs prior to hiring?

A: No. You may only query KASPER for the purpose of providing medical or pharmaceutical treatment to a bona fide current or prospective patient. There are penalties listed in (KRS 218A.202) for querying any other person. This is another reason why you should not share your username or password.  

Q: Can I share a KASPER report with another person?

A: Yes. You may provide a copy of the report to the patient or person authorized to act on the patient's behalf. You may also share the report with other practitioners in your office who are providing treatment to the patient. Note: There are penalties listed in the statute for sharing the report with unauthorized individuals. Another good reason why you should not share your user name or password. Refer to KRS 218.202 .

Q: Are dentists required to keep the KASPER report in the patient record?

A: It is not a requirement, however, it is recommended for documentation purposes. Alternatively, you may choose to record the KASPER request number located on the top right-hand side of the report, and document in your records that you reviewed the report.  

Q: Where do I find information and additional resources to comply with controlled substance laws?

A: The Kentucky Dental Board collaborated with the Drug Enforcement and Professional Practice Branch and created a page on their public web site under the DENTIST tab called Controlled Substance Prescribing. You will find dental regulations, KASPER FAQs and resources to help you comply with controlled substance laws. DEPPB staff are available to help you with additional questions or problems you encounter at 502-564-7985. You can also find additional information at CHFS-OIG Drug Enforcement Website.

Q: What is a Reverse KASPER?

A: This report, located in your Account Maintenance screen, helps to ensure that only your patients' prescriptions are associated with your DEA Number. A review of your prescribing report (reverse KASPER) can also help identify fraudulent controlled substance prescriptions filled under your DEA Number. If you suspect an individual is diverting controlled substances, please report this to law enforcement authorities. If you are unsure how to proceed, please contact DEPPB for assistance at 502-564-7985. For information on how to obtain your Reverse KASPER, view the Reverse KASPER Tip. Note: DEPPB recommends circling your name at the top of the Rx if there are multiple dentists' names listed to help pharmacists select the correct prescriber.

Q: How can I view my Prescriber Report Card?

A: A practitioner with an active KASPER account can access their quarterly and annual KASPER Prescriber Report Cards (PRC) under the Account Maintenance tab in KASPER, which includes metrics based on the prescriber DEA number(s), area of work, and specialty designated in the prescriber master account holder's KASPER personal account information. In 2019 the PRCs were updated to compare dentists and peers in the following specialties: endodontics, general, pediatric, oral and maxillofacial surgery, orthodontics, periodontics and prosthodontics. For more information on obtaining and reviewing your PRC, access the Prescriber Report Card User Guide.   

Q: What is KOG? 

A: All secure applications utilize a security portal to restrict access to authorized users. These portals also serve as the access control or application login method. The Cabinet for Health and Family Services utilizes a security portal called the Kentucky Online Gateway (KOG) to control access to KASPER and other restricted services. 

Q: Who needs to register for a KOG account? 

A: All KASPER users, regardless of whether they are a master account holder or delegate account holder, must register with KOG in order to continue to access KASPER. 

Q: How do I access KOG to set up a KASPER account? 

A: Go to the KOG homepage where you can create a citizen or business partner account. Once you have completed the KOG registration process, you will be directed to the KASPER–KOG onboarding page, where you should select Request a KASPER Account at the bottom of the screen. If you previously had a KASPER account you should not create a new account! Instead, enter your old KASPER user name and password to onboard your existing account to KOG. If you don’t remember your old KASPER user name or password, you can call the Help Desk at 502-564-2703 for assistance. 

Q: What is a unique email address and why do I need one? Can I use the same email address as other staff where I work? 

A: A unique email address means you are the only one who uses that email address and it is not shared among office personnel. KOG uses your email as your login ID; therefore, a unique email address is required for each KOG account (KASPER user). You may use the same email address for KOG and KASPER as long as it is unique to you. 

Q: If I am not a U.S. citizen, business partner or state employee, what should I select on the KOG “I am a” section? 

A: Unless you are a Kentucky state employee, you should select Citizen or Business Partner to continue. 

Q: Why is KOG telling me my email address is already in use? 

A: If you already use a state application, such as the Electronic Death Registration System (EDRS) or the KASPER Prescription Upload Program (KPUP), or if you access state programs like Benefind or Child Support, you may already have a KOG account. If so, you may use your existing account to access KASPER. Please verify whether you have an existing KOG account with the KOG Help Desk at 502-564-0104 extension 2 or KOGhelpdesk@ky.gov. 

Q: What address should I use when I register for KOG? 

A: Please use your home address for KOG registration. 

Q: I have finished registering for KOG, so why is KASPER not showing up in My Apps? 

A: If you log into KOG and do not see the KASPER launch button, log out and go to https://ekasper.chfs.ky.gov. This will notify KOG that your are trying to onboard to KASPER. 

Q: I am a KASPER master account holder. Do my delegates need to have KOG accounts as well? 

A: All KASPER users, including master account holders and delegate account holders, are required to have a KOG account. You can use KOG to issue invitations to those you would like to have as delegates under your master account. You can access the delegate function in KOG by clicking on the Welcome button at the top of the KOG home page, then selecting My Delegations. You may also access the KOG delegate function from KASPER by going to Account Maintenance, then Manage Delegates.

Q: Why am I unable to click on the link in the mobile notification I received after registering for KOG? 

A: For assistance, you will need to contact the KOG Help Desk at 502-564-0104 extension 2 or KOGhelpdesk@ky.gov.

Updated 4/22/2021