Currently, all states and territories have different laws about stimulant prescribing which poses a problem for patients moving between jurisdictions and for doctors engaging in tele-psychiatry across jurisdictions. In addition, some states/territories do not honour prescriptions from other jurisdictions.

All states and territories have regulations on their Health Department websites ranging from well laid out, specific instructions, ready access to application forms and Expert Reference Stimulant Panels to increasingly vague information to contact the local S8/Drugs of Dependence Units with all enquiries.

Stimulant prescribers seeking permission to prescribe are advised to phone their state health department and speak to the department dealing with S8/controlled medicines or the pharmacy section. Get to know them well and stay onside!

Ideally, all states will provide clear guidelines for stimulant prescribing in both routine and non-routine situations (e.g. high dose, comorbidity/substance abuse) so that clinicians can efficiently provide appropriate treatment patients with ADHD. It is hoped that, over time, all jurisdictions reach greater uniformity reflecting best ADHD practice.

Specialists from any state or territory in Australia (paediatricians, psychiatrists, child and adolescent psychiatrists and neurologists) may apply to the NSW Ministry of Health for a general authority number (CNS number for paediatricians or S28c number for psychiatrists) to prescribe psychostimulant medication for the treatment of ADHD by submitting an Application to Prescribe Dexamfetamine, Lisdexamfetamine or Methylphenidate for the Treatment of ADHD.

An authority from the NSW Ministry of Health is required to prescribe or supply, Dexamfetamine, Lisdexamfetamine (Vyvanse®), or Methylphenidate (Concerta®, Ritalin®, Ritalin LA®).

A pharmacist in NSW cannot dispense a prescription for psychostimulant medication unless the prescription bears an authority number issued by the NSW Ministry of Health, regardless of which state or territory a prescription is issued in. Completed forms and supporting documentation should be faxed to Monitoring and Compliance section, Pharmaceutical Regulatory Unit on (02) 9424 5889.

A psychiatrist or neurologist (from anywhere in Australia) who has been issued with a ‘S28c’ authority number by Pharmaceutical Services Unit of the NSW Ministry of Health may prescribe psychostimulant medication without a prior authority provided that the patient has been diagnosed as suffering from ADHD and satisfies all of the criteria set out under “Criteria for Diagnosis”, the patient has been assessed as set out under “Assessment”.

Authorised specialist prescribers may not use their ‘S28c” authority number in the following circumstances:

• The daily dose prescribed is greater that 30mg dexamphetamine, 72mg methylphenidate, 70mg lisdexamfetamine, or
• The patient is aged more than 70 years, or
• The patient has a history of schizophrenia or other psychoses, or
• The patient suffers diagnosable anxiety, depression or other co-morbid condition requiring treatment in its own right, or
• The patient has a history of significant substance abuse or dependency, including past or present treatment for dependency (e.g. methadone, buprenorphine, naltrexone, acamprosate, etc.) and intravenous drug use at any time.

Note: Past history (but not in the last 3 months) of infrequent, non-parenteral illicit substance (including cannabis) abuse may be considered not significant.

Child Psychiatrists are Consultant Psychiatrists who are members (or eligible for membership) of the NSW Faculty of Child and Adolescent Psychiatry. Paediatricians and Child Psychiatrists may apply to the Ministry for a general authority number (CNS Number) to prescribe psychostimulants for patients without the need for an individual application.

For prescribing of dexamfetamine and methylphenidate patients must be aged 4 to 17 years (inclusive) and/or for prescribing of lisdexamfetamine patients must be aged 6 to 17 years (inclusive).

Prescribed doses must not exceed:

• 1mg/kg/day for dexamfetamine, up to a maximum of 50mg per day
• 2mg/kg/day for methylphenidate, up to a maximum of 108mg per day a maximum of 70mg lisdexamfetamine per day

Notification form submission after initial assessment
Notification form submission after initial assessment is normally not required (only if the guidelines for the general authority do not apply). 

Download the Application for Authority to Prescribe a Psychostimulant for ADHD in a Child or Adolescent and Application for Authority to Prescribe a Psychostimulant in a High Dose for the Treatment of ADHD in a Child or Adolescent to prescribe children doses greater than:

• 1mg/kg daily or 50mg daily of dexamfetamine
• 2mg/kg daily or 108mg daily of methylphenidate
• 70mg daily of lisdexamfetamine

Urine Drug Test – Not required

Specified Age Range
In NSW, paediatricians and child psychiatrists may treat between 4 – 19 years, and up to 25 years if the patient had treatment prior to 19. Treatment of any child between 2 – 4 requires special authority. Treatment below 2 years is not permitted. Treatment of any child less than 6 years with lisdexamphetamine is not permitted.

Adult specialists can routinely start treatment at 16, There is an upper limit of 70 yo, above which requires an individual application. Further notification to the health Department is only required if the upper dose or age restrictions need to be exceeded.

An application for authority to prescribe for an individual patient must be made where – a medical practitioner does not have an S28c authority issued by the NSW Ministry of Health, or – where the medical practitioner does have an S28c authority and the criteria are not met or any of the above exclusions apply.

In these cases, applications for authority to prescribe must be supported in writing by a detailed second opinion from an independent psychiatrist (e.g. from a different practice).

The initial application from the specialist psychiatrist must be made on Form 1AA. A comprehensive clinical report and management plan including history, assessment, diagnosis, current severity of symptoms, incidence of any co-morbidity and potential risks and benefits of psychostimulant therapy must also be submitted.

If substance abuse is current, the application or second opinion should be from a psychiatrist experienced in drug and alcohol issues. The patient may need to be detoxified prior to commencement with psychostimulants. Applications may be referred to the Medical Committee, established under Section 30 of the Poisons and Therapeutic Goods Act, for its advice.

Subsequent applications should be made on Form 1 and a full progress report must be attached if requested. The treating psychiatrist is required to submit and annual letter with a completed individual application for Authority

Download Application for Authority to Prescribe a Schedule 8 Drug – Psychostimulant.

Follow-up Interval – 6 Months
The assessment of ADHD in adults and initial prescribing of psychostimulants is limited to Psychiatrists. The patient should be reassessed at around 6 months after the commencement of treatment. For this reason authorisation to prescribe for the first six months is confined to the practitioner carrying out the assessment with the following exceptions:

• Where a patient has been treated with psychostimulant medication for ADHD prior to their 18th birthday and there has been a break in treatment of not more than two years, a Neurologist may continue treatment
• A Paediatrician who has diagnosed and treated a patient for ADHD prior to their 18th birthday may, in extenuating circumstances including an ongoing therapeutic TG190/4 Issue date: March 2015 Page 1 of 5 relationship, continue treatment with psychostimulants until age 25
• Provided that management is in accordance with the criteria and conditions outlined in this document, prescriptions may be endorsed with the CNS number and notified to the Ministry on a monthly basis using the latest version of the notification form provided for this purpose. Otherwise, an individual patient authority is required.

Maximal Doses Scheduled
Yes – as above

Co-Prescribing Details
Applications (on Form 1) may be accepted from the patient’s General Practitioner after a minimum of 6 months with the treating Psychiatrist or Neurologist and with their approval. A letter from the Psychiatrist or Neurologist, to this effect, must accompany the application. The referral to the GP is indefinite and does not require review by the specialist.

General practitioners may apply for authorisation to continue to prescribe a psychostimulant for a person aged 18 years or over by submitting an Application for Authority to Prescribe a Schedule 8 Drug – Psychostimulant.

Note: GPs seeking authorisation to prescribe psychostimulant medication for a patient must provide a supporting letter from the patient’s current specialist with their application.

In NSW, essentially the same form and same restrictions apply, however health.nsw.gov.au has limited information. The PRU are available to discuss a rational clinical reason to trial stimulant treatment if standard treatment has not helped. NB: they may require a second opinion.

Specialists (e.g. psychiatrists, neurologists, respiratory & sleep physicians, palliative care physicians) may apply for authorisation to prescribe psychostimulant medication for a person aged 18 years or over by submitting an Application for Authority to Prescribe a Schedule 8 Drug – Psychostimulant.

PRU advises to contact the Monitoring and Compliance section at Pharmaceutical Regulatory Unit during business hours on (02) 9424 5923 for further information if psychostimulant prescribing is required for a diagnosis other than ADHD, narcolepsy, treatment-resistant depression, or fatigue due to cancer.

Psychiatrists have permission to prescribe for treatment resistant depression (psychiatrists only), acquired brain injury / ‘brain damage’, and “other” (e.g. binge eating disorder). Other diagnosis: a second opinion from a specialist may be requested.

Sleep disorders
Initial authority to prescribe is usually only issued to the treating respiratory and sleep medicine specialist.

Diagnoses
(ICD-10) Narcolepsy Excessive, Somnolence, Other

Download Patient Fact Sheets – Managing Your ADHD and Useful Guidelines and ADHD References and visit the website for more information on prescribing stimulant medication.

If you have any questions, contact the Monitoring and Compliance section at Pharmaceutical Regulatory Unit during business hours on (02) 9424 5923. There is no specific contact however the clerical staff and senior pharmacists are very helpful.

Official Health Department (Mental Health) Policy on ADHD is not accessible via a website, and electronic copies of the documents are only available on the authority of the Deputy CEO of the Department. Monitoring of stimulant prescribing and issuing of Authority to prescribe is controlled through the Scheduled Substances Clinical Advisory Committee (CLAC) of the Medicines & Poisons Branch.

The Committee also reviews letters of application for doses exceeding the PBS guidelines. Membership of the Committee spans GPs, Addiction Specialists, Pain Specialists, Paediatricians, Psychiatrists, Pharmacists and the Chief Health Officer.

There is a specific stimulant application for form for Authority to Prescribe a Restricted S8 Psychostimulant Medication which covers all categories of primary prescribers (e.g. Neurologist, Psychiatrist) and those authorising co–prescribing with GPs or interstate specialists.

Authority is renewed every 2 years and GPs are limited in the number of patients they may prescribe stimulants for (currently 10), but may apply to the CLAC for an increased number. Specialists are limited to 200 patients for whom they can prescribe stimulants.

Notification form submission after initial assessment
Application for Authority to Prescribe is made following initial assessment. Paediatricians can initiate treatment immediately without waiting for approval. Officially, approval must be obtained by psychiatrists before writing the first prescription but in practice it doesn’t seem to be an issue writing one-month prescription and then reviewing the patient, by which time the approval has usually been granted.

Urine Drug Test 
Urine drug screen test is not required however it is likely to be mandated in the current revision of regulations.

Specified Age Range
2nd opinion required under age 4. Medication above 4 years at specialist discretion. In general, non-pharmacological treatment recommended below age 7. Paediatricians must stop treating their patients at age 18.

Further Notification
Further notification to the Health Department is required once every 2 years for review, or if the patient moves from a non-routine prescribing situation.

Follow-Up Interval – 2 Years
Review with a Specialist is required every 2 years. Form submitted.

Patient Fact Sheets
Information for Patients on S8 Medicines

Maximal Doses Scheduled
There are no formal restrictions in the Regulations and application may be made to the CLAC to exceed PBS limits.

Co-Prescribing Details
The co-prescribing GP must refer the patient back to the original specialist for a review every 2 years. A new authority application is completed by the specialist and sent to the GP who then submits their application to the Medicine And Poisons Branch.

Read the Requirements for Prescriptions for Schedule 8 Substances (S8s) or get more information for Medical Practitioners and Schedule 8 Medicines plus information on Medicines & Poisons Control on the NT Government Health website which is very helpful.

If you are uncertain about the requirements for approval to treat a patient in the Northern Territory, contact the Medicines and Poisons Control department via email poisonscontrol@nt.gov.au or phone 08 8922 7341.

The department that manages restricted drugs in Queensland is now known as the Monitored Medicines Unit (MMU). Although ADHD comes under the Schedule 8 rules and regulations, it is generally treated in a more benign manner.  There are various regulatory requirements under the Health (Drugs and Poisons) Regulation 1996 regarding the prescribing of scheduled drugs of dependence (S8), including script requirements, and approvals/reports to the Chief Executive.

Diagnosis should only be made by an adult psychiatrist, particularly one with an interest or expertise in managing adult ADHD. A diagnosis of ADHD in adulthood should not be made in the absence of evidence of symptoms in childhood. This could include collateral history from a parent or school reports. In the absence of this, neuropsychological testing should be considered to determine if the patient’s cognitive profile is consistent with ADHD.

Diagnosis should be based on:

1. A full clinical and psychosocial assessment. Discuss behaviour and symptoms in the different domains and settings of the person’s everyday life,
2. A full developmental and psychiatric history,
3. Observer reports and an assessment of mental state.

Diagnosis should be made when symptoms of hyperactivity/impulsivity and/or inattention:

1. Meet the criteria in DSM-IV or ICD-10 (hyperkinetic disorder), and • are associated with at least moderate psychological, social and/or educational or occupational impairment based on interview and/or observation in multiple settings,
2. Are pervasive, occurring in at least two settings,
3. Are not better explained by another disorder such as depression, anxiety or a substance use disorder,
4. Corroborating evidence (if possible) is available of symptomatology in childhood.

As part of the diagnostic process, include an assessment of needs, coexisting conditions, social, familial, educational or occupational circumstances and physical health. Information on past and present substance use and whether a specialist (if completed by a GP) is involved in the treatment program should be included. Also include situations such as patients already taking stimulant medication, include if they are 18 years old and have yet to see an adult psychiatrist and/or are moving to Queensland from another states.

Adults (i.e 18 years and over), are treated by psychiatrists who must apply for a general authority to prescribe stimulants for all patients. This is known as a Patient Class Approval (PCA) for routine prescribing (ie maximum dose is not exceeded, no significant comorbidity).

The application form for the PCA is posted out after the applying psychiatrist contacts the Monitored Medicines Unit (MMU). The MMU then does some checks on the applying psychiatrist, and if all is clear the PCA is posted out to the applying psychiatrist and thereafter no specific forms are needed for individual patients, unless they are outside routine prescribing criteria.

A PCA is not required for patients under 18 years as the MMU is not particularly interested in paediatricians and child psychiatrists who prescribe stimulant medication, as long as it is routine. Even GPs can initiate treatment with stimulants for patients under 18, although it is not encouraged.

Urine Drug Test 
A urine drug test is not mandatory, but it is asked on the Report to the Chief Executive whether this has been undertaken. It would be a sensible approach unless compelling reasons why not. It is not an annual requirement; although if the patient has a history of drug misuse then random urine drug screens are advised to confirm the psychostimulant medication is being taken and that there is no continuing use of other drugs. Generally, drug misuse appears to be considered if active within the last 2 yrs.

Specified Age Range
18 is the cut-off from paediatric to adult treatment.

Further Notification to the Health Dept
No, not if routine case.

Follow-Up Interval
At the discretion of the clinician. Paediatricians can continue to prescribe beyond the age of 18, with no fixed upper limit, but beyond the age of 18 need approval from the MMU to do so.

Maximal Doses Scheduled
Dexamphetamine 40 mgs, Lisdexamphetamine/Vyvanse 70 mg and methylphenidate 80 mg. GPs are able to prescribe stimulant medication providing the diagnosis has been made by a specialist. No specific requirement for review by the specialist, but good practice would suggest a review every 1-3 years.

Co-Prescribing Details
GPs can prescribe without a QLD specialist review as long as this has been organised with an actual appointment date. It is though recommended in these situations that the GP should phone the MRQ beforehand.

The following table outlines the prescribing arrangements for medical practitioners in Queensland for psychostimulants.

You can also download the MMU’s Guidelines for the treatment of Adult ADHD with Psychostimulants and find more information on Queensland Regulatory Requirements and Resources regarding the treatment involving drugs of dependence.

If you are uncertain about the requirements for approval to treat a patient then contact MMU via email MMU@health.qld.gov.au or phone 13 S8INFO (13 78 46).

In South Australia, stimulants are grouped with all Schedule 8 drugs. The application form is general and only needs to be used if treatment with stimulants is expected to continue beyond 2 months. Download the Authority Application form here.

Schedule 8 drugs may only be prescribed by any medical practitioner for up to two months. If stimulant prescribing is expected to continue beyond 2 months, approval must be applied for by submitting an Authority Application form. Ensure there are no complicating factors such as a history of schizophrenia (or other psychosis) or significant substance abuse. In this case, another opinion from a 2nd psychiatrist is required.

The Drugs of Dependence Unit of the SA Department of Health is the entity which issues such Authorities. A supporting written opinion from the relevant specialist (paediatrician or child psychiatrist for minors, or psychiatrist for adults) must be provided with the generic application form if a GP is applying for the Authority.  A psychiatrist may simply submit the application form and doesn’t usually have to provide an additional letter.

Second opinions from another psychiatrist are no longer required for doses above 30 mg dexamphetamine, 60 mg methylphenidate or their equivalent slow-release formulations, but a second opinion may be demanded by the DDU on a case by case basis, e.g. if the dose requested is ‘unusually high’, or in cases of significant past or recent/current substance and/or alcohol use disorder.  Second opinions may be required for patients with a history of psychosis, especially if this has been an adverse sequelae to stimulant medication in the past, but a second opinion is not necessarily mandatory in such cases.

Urine Drug Test 
Not mandated but may be of help before initiating treatment to ensure substance-abuse is not present. The DDU do not routinely require urine drug screens and only require them as an additional condition of Authority in select cases of comorbid or past significant substance use disorders/addictions, unusually high doses of stimulants or past history of a tendency to overuse or misuse their stimulants, forgery of scripts, presenting to their pharmacy too soon for repeat dispensing etc.

Patients who are also attending another doctor/clinic for opiate substitution therapy (such as Suboxone) are usually also required to have urine drug screens by both prescribers, and prescribers are required to maintain communication with each other.

Specified Age Range
Paediatrician may continue pre-existing regular treatment up to the age of 25 provided the patient is in at least “half-time” study and do not necessitate review by a psychiatrist. Otherwise, beyond the age of 19, all patients require a review by psychiatrist. Approvals to treat are granted for variable periods, depending on the clinical situation but no more than 5 years.

Further Notification To Health Department
Yes, at review, which may be up to 5 years.

Stimulant prescribing for non-ADHD conditions
Yes, apply on the usual form for conditions such as depression. Each case assessed individually by the DDU.

2nd opinions are required when there is a history of schizophrenia (or other psychosis) or significant substance abuse.

Follow-Up Interval
All prescriptions should be limited initially to no more than 3 month supply. Subsequently, it is acceptable to provide six month scripts (i.e. monthly supply with 5 repeats) in straightforward cases with no significant comorbidities to be managed.

Maximal Doses Scheduled
Not mandated, but doses are reviewed and feedback given if considered excessive. Most patients should respond to daily dosages of 6 tablets per day or less, up to 75 mg per day of extended-release methylphenidate.

Co-Prescribing Details
Amended November 2018 to encourage more rapid GP involvement for follow-up treatment, thus encouraging psychiatrists to be more available for new cases. Psychiatrists can refer patients to GPs soon after their diagnostic process without waiting for 6 months or so to stabilise medication dosages (even immediately if a case can be made for difficulty accessing follow-up e.g. remote location). Also, annual psychiatric review is not routinely required, and authorities for GPs to prescribe may be up to 5 years. All of this is for low-risk, stable patients.

Maintenance and Continued Prescribing
A GP will not usually be granted an authority to prescribe schedule 8 stimulants without the explicit written support of a relevant specialist medical practitioner and, diagnosis and treatment stability has been established, and/or for individual patients with special needs (including those living in regional areas) where a specialist retains clinical oversight of the patient’s care.

Below is an excerpt from the DDU regarding Schedule 8 stimulants

“Schedule 8 stimulant medicines including dexamphetamine, lisdexamfetamine and methylphenidate have legitimate therapeutic uses, but also the potential for addiction or abuse. Stimulant medicines stimulate the central nervous system by increasing the activity of certain chemicals in the brain and are used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy (a sleep disorder) and less often to treat depression or acquired brain injury”.

Diagnosis
Diagnosis and initial application for authority to prescribe Schedule 8 stimulants should be made by a relevant AHPRA recognised specialist medical practitioner (eg. paediatrician, psychiatrist, neurologist or respiratory physician).

Dose
Determining the severity of ADHD is a matter for clinical judgement, taking into account the severity of impairment, pervasiveness, individual factors and familial and social context. Stimulant dose should be titrated against the patient’s clinical need and treatment should be part of a comprehensive program addressing psychological, behavioural and educational or occupational needs.

Misuse
Stimulant treatment for people who misuse other substances should be carefully monitored. Substance misuse may include current or past IV drug use, illicit amphetamine use or drug or alcohol dependence. The risk of misuse and diversion of prescribed stimulants may be increased for patients with a history of substance abuse and the decision to use stimulants requires an individual risk-benefit assessment.

Specific consideration should be given to:

• drug screen urinalysis to determine what (if any) other drugs are being used,
• referral to an Addiction Medicine specialist or Drug and Alcohol Services, and
• liaison between health professionals involved in the patient’s care where a patient is receiving treatment for opioid drug dependence.”

For more information, download the Criteria for grant of Authority under the Controlled Substances Act 1984 (SA) or visit the SA Government Health website for more information regarding all Schedule 8 drugs (not just stimulants) in South Australia.

If you are uncertain about the requirements for approval to treat a patient, contact the Duty Pharmacist in the Drugs of Dependence Unit (DDU), via email healthdrugsofdependenceunit@sa.gov.au or phone 1300 652 584.

In Tasmania, for initial assessment, routine prescribing, a specific form is to be filled out and co-prescriber nominated. The form is an application and no prescribing can be done until the Pharmaceutical Services Branch gives approval. In practice, best to ring at the time of the initial assessment and can be given the go-ahead over the phone if there are no concerns about drug abuse.

The Tasmanian health Department is particularly sensitive to any drug abuse, even up to 10 years ago, and requires the applicant to check with the Health Department drug register (DORA) for any evidence of drug abuse.

Urine Drug Test 
Only if substance abuse is an issue. If drug abuse is a problem, a urine drug screen must be done and be clear, before approval is given. And more urine drug screens may be required. The cases are reviewed by a Stimulant Advisory Committee.

Specified Age Range
A new application is required when a patient turns 18 and must be transferred from a paediatrician to a psychiatrist, and then authorisation on a 12 monthly basis in line with adult authorisations. In practice, paediatricians can continue to prescribe beyond 18 while a patient is trying to engage with and adult psychiatrist.

Child specialists can treat from 3 to 18, or when they cease schooling, or whichever is the earliest. Children aged between 2 and 3 require a second specialist opinion. Prescribing less than 2 years is not approved. Prescribing over 70 is outside routine prescribing and needs special application.

Notification form submission after initial assessment
To be submitted as soon as possible.

Further notification to the Health Department required
Annually for routine.

Stimulant prescribing for non-ADHD conditions
Some flexibility for prescribing stimulants for non-ADHD patients e.g depression, brain injury.

Local Prescriber

“Actually you can prescribe stimulants for treatment resistant depression in Tasmania but it is not commonly known. There is a category ‘Other’ that can be ticked for the condition being treated. The application along with clinical notes will be sent to Pharmaceutical Services and be considered by the Chief Medical Officer. It is usually an augmentation strategy and you have to demonstrate that other treatments have failed to get the patient into remission”.

Exceeding maximal doses (see below), patient age more than 70, history of schizophrenia or other psychoses, diagnosable anxiety, depression or other comorbid condition, history of substance abuse or dependency.

A special application forms required in this situation. Past history (but not in the last 3 months) of casual cannabis abuse may be considered not significant. Some flexibility for prescribing stimulants for non-ADHD patients e.g. depression, brain injury.

Follow-Up Interval
The patient should be reassessed at around 3 months after the commencement of treatment. This will be the initial authorisation period. Ongoing authorisations will be for 12 – 24 months.

Maximal Doses Scheduled
Yes. The dose limits for children in Tasmania: 0.9mg/kg/day for dexamphetamine and 1.8mg/kg/day for methylphenidate. Overall,limits are Dexamphetamine 30mg, methylphenidate 60mg, Vyvanse 70mg.

Co-Prescribing Details
A specialist may request a patient’s GP to take over prescribing, but must have specialist approval to increase the dose or change the drug.

Access guidelines for health professionals relating to Schedule 8 and Schedule 4D prescribing and dispensing, on the Tasmanian Dept of Health and Human Services website including ADHD Criteria for Children and Adolescents 2008 and Adult Psycho stimulant guidelines 2008.

You can also contact the Chief Pharmacist (Peter Boyles) via email pharmserv@health.tas.gov.au or phone (03) 6166 0400. Or phone the Department of Pharmaceutical Services Branch, Department of Health and Human Services on either (03) 6233 2064 or (03) 6233 3906.

In most circumstances, a medical practitioner in Victoria must obtain a permit before prescribing methadone (Physeptone®), nabiximols (Sativex®), amphetamine, dexamphetamine, lisdexamfetamine (Vyvanse®), methylamphetamine or methylphenidate (Ritalin®, Concerta®).

A permit is not required to initiate treatment of a person (who is not drug-dependent) with any other Schedule 8 medicine, but they must obtain a permit to prescribe treatment for a continuous period of more than 8 weeks. Note: the 8-week period relates to the duration of prescribed treatment and not the dates of consultations.

After 8 weeks, clinicians treating adults (18 years or older) are required to have submitted a permit application and have received back a permit from the Medicines and Poisons Regulation (MPR).

Paediatricians or psychiatrists treating patients under 18 for ADHD are not required to obtain a permit, but they will need to notify the department about the treatment (i.e. treatment can continue uninterrupted) using the same permit application form but only filling out the details halfway down on the form. That is, paediatricians and child psychiatrists are notifying, not permit applying, and will receive correspondence back from the health Department acknowledging their notification.

If patients are drug dependent, treatment with stimulant medication must wait for a permit.

General authority to prescribe stimulants
Only specialist paediatricians and psychiatrists have this general authority to initiate treatment and then must apply for a permit (or if under 18 notify of intent to continue treatment, as above) from the MPR if they wish to continue stimulant prescribing beyond 8 weeks.

On occasion, a specialist may do an initial assessment and then immediately transfer the ongoing ADHD management to a GP who would then need to do the permit application, with the specialist letter attached, and the health department will reply to the GP with a permit approval.

If a patient has come from another specialist who already has a permit to prescribe stimulant medication, the new specialist must contact the old specialist to get them to cancel their permit, and then the MPR will notify the new specialist that they can proceed with a new permit.

Get more information on Schedule 8 Permits & Notifications in Victoria.

From April 2020: Note that where a patient is considered to be drug-dependent, a permit must still be obtained regardless of whether Safescript is checked before prescribing. The following exceptions apply for drug-dependent patients.

SafeScript exceptions (for patients who are not drug-dependent persons)
A medical practitioner or nurse practitioner who checks SafeScript in relation to a patient, on each occasion, before prescribing a Schedule 8 poison for that patient will not be subject to certain permit and notification requirements.

Note: In subsequent information within this document, SafeScript exceptions will be shown in red text beneath the requirement that will apply to practitioners who do not check SafeScript.

Paediatricians and psychiatrists (ONLY)

Attention deficit hyperactivity disorder (where the patient is less than 18 years old):
A paediatrician or a psychiatrist is not required to obtain a 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; and
• the duration of treatment does not exceed a continuous period greater than 8 weeks; and
• the prescriber submits a permit application form (after completing the relevant section of the form) to notify the department about that treatment

Note: A paediatrician or a psychiatrist who checks a patient’s information on SafeScript, on each occasion before prescribing, is not required to give written notice to the department

Attention deficit hyperactivity disorder (where the patient is 18 years or more):
A psychiatrist is not required to obtain a 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 duration of the period of treatment does not exceed 8 weeks

Note: To prescribe for a period greater than 8 weeks, a psychiatrist must obtain a permit. A psychiatrist who checks a patient’s information on SafeScript on each occasion before prescribing the Schedule 8 poison, is not required to obtain.

Urine Drug Test 
Not mandatory in Victoria.

Specified Age Range
Not specified. At “clinicians discretion”.

Notification form submission after initial assessment
In practice, forms are submitted after the initial assessment as it is very likely stimulant prescribing will continue beyond 8 weeks, and to avoid a delay in getting a permit, the sooner the permit application form is submitted the better.

Further notification to the Health Department  
No.

Stimulant prescribing for non-ADHD conditions
Psychiatrists, neurologists and paeds can prescribe for ADHD (if no comorbid SUD) for up to 8 weeks before getting Permit. Everything else needs permit first: ADHD+SUD, Depression, Binge eating. Same Application forms are used.

Follow-Up Interval
Only specified if patients are being co-managed with the GP, and in this case, the GP must ask for a specialist review at least every 2 years

Maximal Doses Scheduled
No maximum doses scheduled in Victoria. Doses are written on the notification form, and high doses will be queried.

Co-Prescribing Details
Strictly speaking, Victoria does not allow the specialist and GP to both have permits to prescribe at the same time but will allow co-managing which means that the permit to prescribe is transferred from the specialist to the GP, and the GP can keep prescribing stimulants (after the permit has been approved) for up to 2 years before a specialist review is required to allow this to continue.

For more information on SafeScript visit the SafeScript website here. For more information including the required forms to manage routine stimulant prescribing and dispensing of Schedule 8 medications, visit the Stimulant Prescribing section of the medicines and poisons website.

If you are uncertain about the requirements for approval to treat a patient, please contact Safer Prescribing Team | Medicines and Poisons Regulation via email dpcs@dhhs.vic.gov.au or phone 1300 364 545.

For many years, the WA Health Department has had clear guidelines devoted to stimulant prescribing. From time to time, these are updated. Originally, they were based on the NSW guidelines but have gradually evolved to be probably one of the most clear and comprehensive of all state guidelines.
There is a particular subsection of the WA Health Department Medicines and Poisons Regulation Branch devoted to Stimulants.

In WA, special stimulant medication forms are required, not just general schedule 8 forms. There are forms to do with applying for general authority to prescribe stimulants before patients are seen, and then specific individual patient notification forms.

There are further forms on this website to use if the patient meets non-routine standard criteria (e.g. comorbid stimulant psychosis,psychosis or bipolar disorder, comorbid substance abuse, prescribing beyond the set maximum dose range, prescribing below the minimal age – usually 4, but 6 for prescribing lisdexamphetamine).

These special authority forms are submitted to a Stimulant Assessment Panel (a mix of paediatricians, psychiatrists and Health Department officials) which meets monthly and adjudicates on cases outside the routine standard criteria.

Specialists intending to prescribe stimulants need to apply the WA Health Department for a Stimulant Prescriber Number (SPN). To apply for approval a prescriber must complete the Application for Prescriber Authorisation: Stimulant medicines form.

Once the SPN is obtained (and it may take a few weeks), specialists can start seeing individual patients and if prescribing stimulants is planned, notify the WA Health Department of each individual patient after the assessment interview (by clicking on the heading “Notification of treatment: Stimulant medicines form) and then immediately proceed to prescribe stimulants without delay.

• For ADHD, only psychiatrists, paediatricians and neurologists are authorised.
• For acquired brain injury, only neurologists and rehabilitation physicians are authorised.
• For narcolepsy, only neurologists and sleep physicians are authorised.
• For depression, only psychiatrists are authorised.

Specific stimulant notification form filled out or more general Schedule 8 notification form? In WA, there is a specific stimulant notification form completed at the 1st assessment (as above) and submitted to the Health Department. (Some jurisdictions just use the general Schedule 8 forms, just including stimulants with other restricted medications).

To assist in completing the specific stimulant notification form, from the main website link go to the link headed “Stimulant Prescribing Code Overview – Healthy WA” which walks the novice specialist through the details of how to fill in the notification form for newly diagnosed patients requiring stimulant medication.

Urine Drug Test 
Yes. In WA, a urine drug screen (in accordance with ANZ standard 4308) should be undertaken by all patients 13 years and older before treatment with a stimulant is commenced. Further testing is recommended annually and as indicated.

Specified Age Range
Yes. In WA, paediatricians and child psychiatrists may treat between 4 – 19, and up to 25 if the patient had treatment prior to 19. Treatment of any child between 2-4 requires special authority. Treatment below 2 is not permitted. Treatment of any child less than 6 with lisdexamphetamine is not permitted. Adult specialists can routinely start treatment at 17, but can also treat 15-16 with special authority. There is no upper limit.

Notification form submission after initial assessment
The notification form is submitted after the initial assessment and prescribing of stimulant medication can proceed.(Some jurisdictions have to submit their notification forms and then wait for approval from the health departments before proceeding to prescribe stimulants.
Some jurisdictions allow stimulant prescribing to proceed after the initial assessment and only require notification form submission after 8 weeks/2 months following this “treatment trial”).

Further notification to the Health Department required
No. The only reason for further notifications to the Health Department are if patients change their name or date of birth, move to non-routine prescribing criteria, or the specialist decides to co-prescribe with a general practitioner (GP).

Stimulant prescribing for non-ADHD conditions
Yes, as above, stimulants are allowed for acquired brain injury, narcolepsy and depression, under the same prescribing regulations.

If the patients fall outside the criteria of the Schedule 8 medicines prescribing Code (Part 4) due to ADHD comorbidity (co-morbid substance abuse/misuse within the last 5 years, psychosis or bipolar disorder,stimulant-induced psychosis), prescribing stimulants for ADHD beyond the set maximum doses and/or below the minimal age (usually 4, but 6 for lisdexamfetamine), or using stimulants for binge eating disorder, then prior authorisation is required before prescribing stimulant medicines to these patients.

The completed “Application Form For Authorisation’ has to be submitted for each patient, along with a detailed clinical report addressing all the points on the checklist for each co-morbidity and a urine drug screen.

Note: The above authorities are separate to the PBS authority number that is required from Medicare on PBS prescriptions for stimulant medicines, phone 1800 888 333.

Follow-Up Interval
Yes.In WA, all patients are reviewed on at least an annual basis for the continuation of appropriate stimulant treatment.

Maximal Doses Scheduled
Yes. Under 18, limits are:

• 1 mg per kg per day dexamphetamin
• 2 mg per kg per day methylphenidate
• 70 mg per day lisdexamphetamine.

Overall maximum doses are no more than:

• 12 tablets daily of dexamphetamine
• 5 mg tablets or methylphenidate
• 10 mg tablets, or a combination of the 2 stimulants.

Vyvanse is converted:

• Vyvanse 30 mg equals dexamphetamine 10 mg
• Vyvanse 50 mg equals dexamphetamine 20 mg
• Vyvanse 70 mg equals dexamphetamine 30 mg.

NB: Some jurisdictions do not have specific regulations on maximum doses of psychostimulants that can be prescribed.

Co-Prescribing Details
Yes. GPs are allowed to prescribe, as long as the specialist provides a review at least annually. In practice, for stable patients this means the patient has a medical review 6 monthly, alternating between the specialist and the GP.

All prescribing must be in accordance with the Schedule 8 Medicines Prescribing Code (the Code). This contains details of all a number of prescribing issues including co-prescribing, maximal doses, etc. In particular, co-prescribing with general practitioners is allowed for all ages, at the discretion of the specialist.

Visit the WA Dept of Health website to download all of the forms required in the management of stimulant prescribing for ADHD, acquired brain injury, narcolepsy and depression. The Prescribing Stimulant Medicines Guide also provides a summary of the requirements for prescribing stimulant medicines in Western Australia and the Medicines and Poisons Regulation Branch Patient Fact Sheet provide patients with more information.

If you are uncertain about the requirements for approval to treat a patient, please contact Alpa Dodhia, Senior Pharmacist via email alpa.dodhia@health.wa.gov.au or phone 08 9222 2483.

In New Zealand, specialist paediatricians and psychiatrists have a general authority to prescribe stimulants for ADHD by virtue of their specialist qualification under the auspices of Medicines Control.

Other medical practitioners have to apply for ‘authority to prescribe’ before prescribing, or GPs can prescribe under the authority number of the specialist. If specialist paediatricians and psychiatrists want to provide stimulants for conditions other than ADHD (e.g. depression), they must apply to Medicines Control, which is a team within Medsafe which is the regulatory authority for the supply chain of medicines within the Ministry of Health (amongst other functions). Medsafe is probably best described as similar to the TGA in Australia.

There is no special authority form for these non-routine ADHD cases (although there may be soon), and the clinician should simply provide the usual clinical background of the patient in an email or letter to the Medicines Control office, and wait for an approval to be given. Once approval is given, application to Pharmac for a subsidy is made in the usual way (as below).

In order for medications to be funded by the government, the specialist clinician must apply to Pharmac (Pharmaceutical Management Agency) which is the funding organisation within the Ministry of Health (similar to the Australian Pharmaceutical Benefits Scheme/PBS).

There are special forms for each of the 3 medications available in New Zealand that must be filled out:

1. Dexamphetamine > form SA1149 – Dexamfetamine Sulfate
2. Methylphenidate  > form SA1150 – Methylphenidate Hydrochloride (Rubifen; Rubifen SR; Ritalin; Ritalin SR)
3. Methylphenidate (extended release) > form SA1151 – Methylphenidate Hydrochloride Extended Release (Concerta; Ritalin LA; Methylphenidate ER – Teva)

Note: visit the Pharmac website for all available Special Authority Application forms in addition to the above three medication forms.

Patients without a National Health Index/NHI number (similar to the Australian Medicare number), such as overseas students, are not eligible for the subsidy scheme and the clinician should write “private, NSS” on the prescription to make it clear to the pharmacist that it is not subsidised.

To quote Medicines Control:

“By way of background, Medicines Control is a team within Medsafe. Medsafe is the regulatory authority for the supply chain of medicines within the Ministry of Health (amongst other functions). Probably best described as similar to the TGA in Australia”.

For the want of a better description, there is a “blanket approval” in place to enable psychiatrists and paediatricians to prescribe methylphenidate and dexamphetamine for the treatment of ADHD (and doctors working under their written recommendation).

That is the legal part for prescribing, funding is separate and is completely under the control of Pharmac. Visit the Pharmac website for details of funding applications and the timing for these. For these medicines, an approval number or “CHEM” number would be applied for, to show the patient has been accepted for funding of this medicine.”

Any psychiatrist or paediatrician can initiate stimulant prescriptions which may be then continued by the person’s General Practitioner. Methylphenidate and dexamphetamine are written on special triplicate prescription forms which are obtained from the MOH (free and delivered by courier, and signed for – Form H572).

All three pages go to the pharmacist who keeps the top page and sends the other two to the Ministry. One is labelled Sector Services copy, the other Medicines Control copy. Each prescription form has a seven digit number, so the Ministry can track the prescription back to the prescriber.

In addition, each patient must have a Pharmac Special Authority (SA) number for that particular drug if they want to receive stimulant medication at a subsidised price. Applications may be posted to Ministry of Health, Private Bag 3015, Wanganui, faxed to 0800 100 131.

Application forms may also be submitted online using Electronic Special Authority. This system requires a secure telephone line and broadband internet access via a Digital Certificate issued by the Ministry of Health. It is hard to install but they provide technicians who will help. This number needs to be written on each prescription. The authority lasts for 2 years and then needs Renewal which is on the reverse side of the same application form.

Whilst there is no charges to use this system, there are charges to establish a Health Intranet approved network available through Telecom or HealthLink as well as the cost for the Digital Certificate of about $100 per year. Contact the Ministry of Health Sector Services Helpdesk on 0800 243 666 or email: sectorservices@moh.govt.nz with any questions or technical assistance required to set up the online process.

There are lots of formulations of methylphenidate but only short acting dexamphetamine 5mg tablets. There is a separate Special Authority Application form and number for long acting methylphenidate (Concerta and Ritalin LA). For patients on a mixture say Concerta and immediate release MP, two numbers will need to be included on the prescription form.

Note: Guanfacine/Intuniv and Lisdexamphetamine/Vyvanse are not available in New Zealand.

The Special Authority Application requires the applicant to state that the diagnosis has been made using DSM or ICD criteria.

Atomoxetine is a bit different; it can be started by any physician, is written on a normal prescription form but does require an SA number for funding; it lasts only for six months.

The applicant must state why it is necessary (several conditions to choose between are given on the form – diagnosed with ADHD, can be dosed once a day, side effects from stimulants, worsening substance abuse, poor clinical response, and will not be using it with a stimulant except when transitioning).

To prescribe the more expensive Concerta and Ritalin LA, the applicant must state on the form that compliance and abuse issues are of concern, and therefore the patient must move from short acting to long acting Ritalin.

All specialist paediatricians and psychiatrists have general authority and no need to notify the health Department of individual patients. And that authority can be transferred to GPs.

Urine Drug Test 
No. This could cost the patient $120 if ordered by a specialist. May be free if ordered by the GP or District Health Board/DHB.

Specified Age Range
The only specification is that a Paediatrician or Child Psychiatrist should prescribe under the age of 6. Otherwise nothing specified. Indeed, some flexibility may be allowed for both paediatricians and adult psychiatrists to prescribe for all ages where appropriate.

Notification form submission after initial assessment
Not required.

Further notification to the Health Department 
At renewal every 2 years.

Stimulant prescribing for non-ADHD conditions
Yes, individual applications can be made for such conditions as depression, and may be funded.

For ADHD complicated by comorbidity, including substance abuse, it is up to the clinician to decide if it is still indicated to prescribe stimulants, and if so they apply in the usual way. In practice, most clinicians are wary of prescribing stimulants in the presence of significant substance abuse.

Follow-Up Interval 
2 years via the SA number mechanism

Maximal Doses Scheduled
No.

Co-Prescribing Details
GPs can continue prescribing indefinitely but an annual review with the specialist is recommended- does not have to be face-to-face and can be “directed” by the specialist.

Find additional information regarding restrictions on certain controlled drugs, together with more details on psycho stimulant prescribing on the Health NZ website. You can also download the New Zealand Guidelines for the Assessment and Treatment of ADHD or visit the MedSafe website which contains many helpful patient fact sheets.

Visit the Pharmac website to access the subsidised stimulant medication forms. Please note the approval process takes approximately one week. If you have any questions or need further assistance, phone Pharmac on 0800 660 050 (9am to 5pm weekdays) or email enquiry@pharmac.govt.nz.

For initial and ongoing stimulant prescribing queries, contact the Medicines Control Unit (within the Ministry of Health) via email: medicinescontrol@health.govt.nz or phone Sue Wiltshire in the Medicines Control Team on 04 496 2436. The duty officer on the Medicines Control Team can also be contacted via the MOH switchboard on 04 496 2000 (ask for the Medicines Control Team).