Permit requirements for dexamphetamine and methylphenidate Information for medical practitioners

2012.2

This summary has been prepared by Drugs and Poisons Regulation (DPR) to assist medical practitioners in understanding complex permit requirements that might apply when prescribing the Schedule 8 poisons, dexamphetamine or methylphenidate. For full details, refer to the Drugs, Poisons and Controlled Substances Act 1981 & Regulations 2006 (at www.legislation.vic.gov.au) or the DPR website (http://www.health.vic.gov.au/dpcs/reqhealth.htm) for other summaries.

Note: Failure to comply with Victorian legislation renders a person liable to prosecution – regardless of whether (or not) a drug is prescribed as a Pharmaceutical Benefit.

Paediatricians & psychiatrists In recognition of the greater likelihood that paediatricians and psychiatrists will diagnose conditions for which they wish to prescribe dexamphetamine or methylphenidate, there are exceptions to permit requirements, which do not apply to other medical practitioners. To determine whether a permit is required, please refer to the following questions in the noted sequence. 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 permit before prescribing dexamphetamine or methylphenidate (section 34B) Are you treating a patient, less than 18 years of age, for childhood attention deficit hyperactivity disorder?  A permit is not required - provided DPR is notified of the proposed treatment; the permit application form should be submitted with section 3 completed. Are you intending to treat an older patient for attention deficit disorder? 

A permit is not required - provided the period of treatment does not exceed 8 weeks.

 A permit must be obtained before the period of treatment exceeds eight weeks - see below:

Clarifying “the 8-week rule” The 8-week period allows a paediatrician or psychiatrist to initiate treatment promptly - provided the patient is not a drug-dependent person. Note: The 8-week period relates to the duration of treatment and not the dates of consultations or dates on prescriptions. A single prescription, for sufficient medication to provide treatment for more than 8 weeks, would therefore require a permit. To address circumstances where a patient might be seeking treatment from multiple practitioners, the 8-week period also includes any preceding period of treatment by other medical practitioners.

Department of Health

Most medical practitioners (not paediatricians and psychiatrists) Requirements for medical practitioners who are not paediatricians or psychiatrists are quite simple; it is an offence to prescribe dexamphetamine or methylphenidate without a permit on any occasion - unless one of the following exceptions applies.

General exceptions – prisons, residential aged care services, in-patients 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 in-patient treatment in a hospital (not including day procedure centres).

Multi-practitioner clinics In recognition of the fact that more than one medical practitioner at a clinic might be involved in the management of some patients, 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. Note: To ensure compliance it is recommended that details of permits, including maximum dosage plus expiry or cancellation dates, are prominently displayed within patient records. ***

Permit applications by general practitioners Attention Deficit Hyperactivity Disorder The department takes the view that specialist involvement in treatment is necessary for ongoing management of all ADHD patients. General practitioners will generally be issued with stimulant permits only where there is evidence of a specialist diagnosis and at least yearly reviews by a specialist.

Narcolepsy The department has established a policy 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 a specialist has been consulted and endorses the treatment. The department considers that, once narcolepsy is diagnosed, ongoing treatment by a general practitioner is generally appropriate without further reference to a specialist, provided other risks to patient safety are not evident.

For further information Department of Health (DH) Drugs and Poisons Regulation, GPO Box 4541 Melbourne 3001 Tel: 1300 364 545 Fax: 1300 360 830 Web: www.health.vic.gov.au/dpcs

September 2010

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Department of Health