Stimulants for ADHD or narcolepsy – permit requirements

A permit may be required before prescribing amphetamine, dexamphetamine, lisdexamfetamine, methylamphetamine or methylphenidate. This depends on 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.

Attention deficit hyperactivity disorder (ADHD)

While a permit is generally required before prescribing special Schedule 8 poisons, psychostimulants approved by the Therapeutic Goods Administration (TGA) for the treatment of ADHD may be prescribed without a permit in specified circumstances.

In recognition of their specialist expertise and key role of paediatricians, psychiatrists and ADHD practitioners in diagnosing and initiating treatment for patients for ADHD, the Secretary (of the Department of Health) has specified the circumstances under which a Schedule 8 poison may be prescribed, administered or supplied without first obtaining a permit, including where a medical practitioner or nurse practitioner is prescribing in accordance with a valid ADHD treatment instruction.

A special Schedule 8 permit to treat a patient with a psychostimulant drug approved by the TGA for the treatment of ADHD (dexamphetamine, lisdexamfetamine and methylphenidate) is not required where:

• the patient is not a drug-dependent person; and
• the prescriber is:
  • a paediatrician or psychiatrist; or
  • an ADHD practitioner and the patient is aged 6 years or older; or
  • a medical practitioner or nurse practitioner prescribing in accordance with a valid ADHD treatment instruction issued by a paediatrician, psychiatrist or ADHD practitioner.

For more information about the updated permit requirements for prescribing psychostimulants for ADHD, see Psychostimulants for ADHD – updated permit requirements.

PBS authorities or private (non-PBS) prescriptions

Authority prescriptions, approved under the Pharmaceutical Benefits Scheme, merely indicate that Medicare Australia will subsidise the cost of the medicine; medical practitioners must still comply with the requirements for a Schedule 8 treatment permit under Victorian legislation.

Similarly, in the case of a ‘private’ (non-PBS) prescription, medical practitioners must still obtain a Schedule 8 permit where required under Victorian legislation.

Other medical practitioners (not paediatricians, psychiatrists or ADHD practitioners)

Permit requirements for medical practitioners who are not paediatricians, psychiatrists or ADHD practitioners are clear; it is an offence to prescribe psychostimulants without a permit – even on one occasion – if not acting in accordance with a valid ADHD treatment instruction or 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 (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

Narcolepsy

The department’s policy is that 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.
• The department considers that, once narcolepsy has been 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 are unlikely to be issued in relation to amphetamine or methylamphetamine because these drugs are not registered for use in Australia.