Dispensing Sedation Meds: In-Office or Pharmacy?

Dispensing sedation medication from one's office is convenient and easy from the standpoint of the appointment, but can often be a headache of logbooks and secure storage areas and witnessed disposals. What's the best option?

A DOCS Education member inquires:

Our office currently dispenses sedation meds, but we are looking into having the patient get their OCS drugs from the pharmacy, and bringing them to their appointment. What is the recommended protocol? Also, if we have the patient bring their meds, and we have some left over, what is the protocol for the disposal of those, and who is responsible- the patient or our office?

Dr. Jerome Wellbrock, DOCS Education faculty member, responds:

I currently think there are several advantages from dispensing from the office:

  • The patient does not have to pick up the meds themselves.
  • They do not have access to excess meds that could result in improper dosing at home.
  • The patient does not have left-over drugs to accidentally take at home while sedated.
  • Patients may often question your fee for sedation when they purchase meds for a few dollars at the pharmacy and you charge several hundred dollars for sedation.

The average patient will not understand how all your time and responsibilities for a safe and effective sedation appointment influence the cost of the treatment. Is there a particular reason why you are considering switching?

The DOCS Education member adds:

We are looking into another option due to the following reasons:

  1. Dispensing meds here requires time and effort to track drugs, and with 2 doctors now doing sedation here, it could eliminate the headaches of log book errors, etc.
  2. We would not have to buy any sedation meds besides hydroxyzine, which is relatively inexpensive.

We have been dispensing meds here for sedation for years, but are interested if there is a better way.


Dr. Anthony S. Feck, DOCS Education Dean of Faculty, responds:

I totally agree with Dr Wellbrock regarding the dispensing of meds from the office versus prescribing from a pharmacy. Because you really don't know how much medication the patient will need when prescribing from a pharmacy, you intentionally write for more than the patient will end up taking. This will result in excess medication. What to do with this? Do you leave it in the hands of the patient? Drug-related emergencies are a big problem, and most of these problems occur with prescribed drugs not being used for their desired purpose. Do you take the medication from the patient? If so, then you now have the record-keeping issue that you say you don't want any more.

Your reasons for not wanting to dispense from the office are about convenience for you. But the reason you dispense from the office is safety for the patient. It's the doctor's call, but our official stance for patient safety is that you dispense from the office.

The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.