Do you know what authorities you need to issue prescriptions?
The Council receives many complaints about poor and/or unauthorised prescribing of Schedule 8 (S8) drugs.
In 2018, seven doctors from the same practice in a regional city prescribed large quantities of drugs of addiction to drug dependent patients without the required authorisation under NSW Poisons and Therapeutic Goods Act. In doing so, they risked suspension of their registration. At the Council hearings it became clear that ignorance of the law on prescribing was a major factor.
There are two types of authorities you may need to obtain before prescribing S8 medications:
1. The familiar PBS Authority which you obtain every day by calling 1800 888 333 or sending the script through the mail. This authority ensures your patient will get a PBS subsidy for the medication you have prescribed.
2. The less common NSW Ministry of Health Authority which is required when prescribing or supplying:
• Any S8 medicine for any period of time for someone you consider drug dependent.
• Alprazolam, Flunitrazepam, Buprenorphine (except transdermal), Hydromorphone, Methadone or any other injectable, intranasal or spray S8 medication for someone who has been taking the medicine for more than two months for someone you do not consider drug dependent. This means that before prescribing these drugs, you must consider whether the patient may be drug dependent abd whether you need a Ministry of Health Authority.
• Stimulants such as Dexamfetamine, Lisdexamfetmine (Vyvanse) or Methylphenidate (Ritalin, Ritalin LA and Concerta), or cannabis medicines including nabiximols, and any unregistered S8 medicine. You must write the NSW Authority Number on the prescription when prescribing any of these medicines.
A Ministry of Health Authority is also required when enrolling a patient in the NSW Opioid Treatment Program (aka the “Methadone program”). The people on the end of the PBS line do not have the authority to allow you to prescribe stimulants and S.8 medications. If you call them requesting a PBS Authority they will assume you have a NSW Ministry of Health Authority to prescribe that medication. A PBS Authority is not a defence if you get into trouble for prescribing these medications.
IMPORTANT: If a colleague may not prescribe these drugs, for example due to conditions imposed on their registration, you must ensure you see the patient before prescribing for them. In all cases, use your own judgement about whether the prescription and an authority is required, not someone else’s judgement.
A Regulation amendment to the Poisons and Therapeutic Goods Regulation 2008 on 30 September 2019 meant a NSW Health application to prescribe a Schedule 8 cannabis medicine is only required where:
- prescribing or supplying to a drug dependent person*, or
- prescribing or supplying for a clinical trial (if it is an unregistered cannabis medicine), or
- prescribing or supplying to treat a child (aged under 16 years).
Prescriptions for Schedule 8 cannabis medicines issued from 30 September 2019 do not require a NSW Authority number, other than in the above 3 listed circumstances.
A hard copy prescription is required to prescribe a S8 unregistered cannabis medicine. There is no provision under the Regulation to telephone, email or fax an order through to a pharmacist for dispensing.
The changes described above do not affect the requirement for a Commonwealth approval to prescribe an unregistered cannabis medicine.
The new requirements and how to apply to prescribe or supply a Schedule 8 cannabis medicine in NSW can be found here.
* A Schedule 8 cannabis medicine does not include an unregistered drug of addiction that is extemporaneously compounded, for more information about this can be found here.
More information? For Ministry of Health Authority and the forms you need to complete see: https://www.health.nsw.gov.au/pharmaceutical/doctors/Pages/default.aspx
TIP: Stay up to date with the latest news by regularly checking NSW Health’s what’s new page, and if you have questions around the criteria, call the Duty Pharmaceutical Officer at Pharmaceutical Services (NSW Ministry of Health) on 02 9391 9944.