Stimulants for ADHD or narcolepsy – permit requirements

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 special Schedule 8 poisons. However, in recognition of their specialist expertise and the greater likelihood that paediatricians and psychiatrists will diagnose and initiate treatment for patients for ADHD, the Secretary (of the Department of Health) has specified that medical condition and related circumstances under which a Schedule 8 poison may be prescribed, administered or supplied without first obtaining a permit.

Attention deficit hyperactivity disorder (patient is less than 18 years old)

A paediatrician or a psychiatrist is not required to obtain a special Schedule 8 treatment permit to treat a patient with a psychostimulant drug (approved by the TGA for the treatment of attention deficit hyperactivity disorder), provided:

• the patient is not a drug-dependent person; and
• the patient has not reached 18 years of age.

Attention deficit hyperactivity disorder (patient is 18 years or more)

A psychiatrist is not required to obtain a special Schedule 8 treatment permit to treat a patient with a psychostimulant drug (approved by the TGA for the treatment of attention deficit hyperactivity disorder), provided:

• the patient is not a drug-dependent person;

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 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 (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

The department’s policy is that 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 specialist review has taken place within a specified period.
  • Permits are unlikely to be issued in relation to amphetamine or methylamphetamine because these drugs are not registered for use in Australia.

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.