Key messages

  • Most medical practitioners must obtain a permit before prescribing amphetamine, dexamphetamine, lisdexamfetamine, methylamphetamine or methylphenidate.
  • Some exceptions apply for paediatricians and psychiatrists.
  • Pharmaceutical Benefits Scheme (PBS) authority prescriptions for these medicines merely indicate that Medicare Australia will subsidise the cost of the medication; medical practitioners must still obtain a Schedule 8 permit if required under Victorian legislation. 
     

A permit may be required before prescribing amphetamine, dexamphetamine, lisdexamfetamine, methylamphetamine or methylphenidate. This depends on the type of medical practitioner and the particular circumstances.

The requirements for prescribing these types of medicines are complex, so it is important that medical practitioners understand their responsibilities under the legislation.

Paediatricians and psychiatrists

Most medical practitioners must obtain a permit before prescribing amphetamine, dexamphetamine, lisdexamfetamine, methylamphetamine or methylphenidate. However, in recognition of their specialist expertise and the greater likelihood that paediatricians and psychiatrists will wish to initiate treatment for ADHD (without first obtaining a permit) and to continue treating the patient (without the administrative burden associated with renewing or amending permits), there are exceptions to permit requirements that do not apply to other medical practitioners.

To determine whether a permit is required, paediatricians and psychiatrists should address the following four questions in the noted sequence.

1. Is the patient a drug-dependent person?

If you have reason to believe a patient is a drug-dependent person, you must obtain a Schedule 8 treatment permit before prescribing any of the noted drugs.

2. Are you initiating treatment of a patient diagnosed with attention deficit hyperactivity disorder?

A permit is not required to initiate treatment with the noted drugs but a permit must be obtained (or a notification submitted by submitting the permit application form with section 3 completed) if the prescribed quantity of medication represents treatment for a continuous period longer than eight weeks.

Note: A single prescription with repeats might represent treatment for a period longer than eight weeks.

3. Do you intend to prescribe dexamphetamine, lisdexamfetamine or methylphenidate for a patient (under 18 years of age) for childhood ADHD for longer than eight weeks?

A permit is not required provided DPR is notified of the proposed treatment by submitting the permit application form with section 3 completed.

4. Do you intend to prescribe any of the noted drugs for a patient (18 years or older) for ADHD for a period longer than eight weeks?

A permit must be obtained before the period of treatment of an adult exceeds eight weeks.

Note:

  • Permits are unlikely to be issued in relation to amphetamine or methylamphetamine because these drugs are not registered for use in Australia.
  • In the case of an inherited patient, an application for a permit or notification form must be submitted immediately if there is reason to believe that the intended prescribing will contribute to a patient being treated for a continuous period greater than eight weeks (including any preceding period of treatment by any prescriber). 

Private prescriptions

Pharmaceutical Benefits Scheme (PBS) authority prescriptions for Schedule 8 poisons merely indicate that Medicare Australia will subsidise the cost of the medication; medical practitioners must still obtain a Schedule 8 permit if required under Victorian legislation.

Other medical practitioners (not paediatricians and psychiatrists)

Permit requirements for medical practitioners who are not paediatricians or psychiatrists are clear; it is an offence to prescribe amphetamine, dexamphetamine, lisdexamfetamine, methylamphetamine or methylphenidate without a permit – even on one occasion – unless one of the following exceptions applies.

General exceptions – prisons, residential aged care services, hospital inpatients

In circumstances where patients are confined and not personally managing their medications, the risk of concurrent prescribing is significantly reduced. Accordingly, a permit is not required to prescribe Schedule 8 poisons for prisoners being treated in a prison, residents being treated in a residential aged care service and patients receiving inpatient treatment in a hospital (not including day procedure centres).

Multi-practitioner clinics

At multi-practitioner clinics, more than one medical practitioner might be involved in the management of some patients. For this reason, each practitioner is not required to obtain a permit, provided a valid permit is held by one practitioner at the clinic and the prescribing is consistent with and does not exceed the permit limits or conditions.

Note: To ensure compliance, details of permits, including maximum dosage plus expiry or cancellation dates, should be prominently displayed within patient records.

Permit applications by general practitioners

Attention deficit hyperactivity disorder

Specialist involvement is necessary for the diagnosis and ongoing management of all ADHD patients. General practitioners will generally only be issued with permits to prescribe dexamphetamine, lisdexamfetamine or methylphenidate where there is evidence of a specialist diagnosis and that a review with a specialist has taken place within the last 12 months.

Permits will not be issued in relation to amphetamine or methylamphetamine because these drugs are not registered for use in Australia.

Narcolepsy

An initial diagnosis of narcolepsy must involve a respiratory physician or a specialist in sleep disorders. A general practitioner will generally not be issued with a permit unless the application indicates that the physician or specialist has been consulted and endorses the treatment.

Once narcolepsy is diagnosed, ongoing treatment by a general practitioner is generally appropriate without further reference to the physician or specialist, provided other risks to patient safety are not evident.

Permits will not be issued in relation to amphetamine or methylamphetamine because these drugs are not registered for use in Australia.

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