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ADHD Medication

ADHD Stimulant Prescribing Regulations & Authorities in Australia & New Zealand

By February 20, 2022June 17th, 2022No Comments
Last updated March 2022

All states and territories within Australia and New Zealand have their own laws about schedule 8 (ie dangerous drugs/poisons) which includes stimulants.

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 to patients with ADHD. It is hoped that, over time, all jurisdictions will reach greater uniformity reflecting best ADHD practices.

Note re Prescriptions:
a. computer-generated prescriptions also require confirmatory handwriting in NSW, VIC, TAS and ACT.
b. electronic prescribing of stimulant medication is allowed in all states and territories and NZ (modified version).

Real-Time Prescription Monitoring (RTPM)

Real-Time Prescription Monitoring (RTPM) is a nationally implemented system designed to monitor the prescribing and dispensing of controlled medicines to reduce their misuse in Australia.

From 2022, Real-Time Prescription Monitoring (RTPM) is available in all states and territories. RTPM is mandatory in Victoria and Queensland and voluntary elsewhere. It is a resource for prescribers to ensure that before they prescribe stimulant medication they check that there are no contraindications to stimulant prescribing e.g. that the patient is being prescribed other medications as part of a substance use treatment program.

The Commonwealth, state and territory agencies are working together to implement the RTPM system. However, each state or territory remains responsible for the management of controlled medicines in its jurisdiction. Please see the below links for specific state or territory information, including handling and protecting personal information.

Accessing Subsidies For ADHD Medications

In addition to the Prescribing Regulations, it is important to be aware of the process for accessing subsidies for ADHD medications within Australia and New Zealand.

1

In Australia

The Pharmaceutical Benefits Scheme (PBS) subsidises ADHD medications but has limitations based on both age and dosage. The PBS has no age restriction for subsidising dexamphetamine and methylphenidate, other than individual State and Territory regulations, however, there are variations for other medications dependent on age.

For children, the PBS subsidises:

  • for ages 6-18 inclusive, lisdexamphetamine, long-acting methylphenidate and atomoxetine,
  • for ages 6-17 inclusive, guanfacine.

For adults, the PBS only subsidises lisdexamphetamine and guanfacine if ADHD was diagnosed prior to turning 18 (19 for long-acting methylphenidate and atomoxetine).

The PBS also has restrictions based on dose. Upper dose subsidised limits vary–for example, methylphenidate is limited to no more than 60 mg/day but dexamphetamine has no upper limit other than what is determined by State and Territory Law. Long-acting preparations of both stimulants have their own limits mostly based on their Product Information.

It is worth noting that the Therapeutic Goods Administration (TGA) licenses dexamphetamine from age 3 onwards and methylphenidate from age 6 onwards.

2

In New Zealand

The subsidy process is more involved e.g. requiring forms to be submitted to Pharmaceutical Management Agency (Pharmac) which subsidises dexamphetamine, methylphenidate, atomoxetine, and long-acting preparations for all ages. Lisdexamphetamine/Vyvanse and guanfacine/Intuniv are not available in New Zealand. Relevant contact details are provided below with the general New Zealand information.
Adult ADHD State Regulations

Stimulant Prescribing Matrix

Australian & New Zealand Controlled Medicine Authorities

Contact Information

Australian Capital Territory

Chief Health Officer (CHO)

02 6205 0998
02 6205 0997
Click to email
Website

Locked Bag 5005
Weston Creek ACT 2611

ACT Regulations

New South Wales

Pharmaceutical Regulatory Unit

  02 9424 5923
  02 9424 5889
Click to email
Website

Locked Mail Bag 961
North Sydney NSW 2059

NSW Regulations

Northern Territory

Medicines & Poisons
NT Health Department

08 8922 7341
08 8922 7200
Click to email
Website

Lv 2, Casuarina Plaza
258 Trower Road
Casuarina NT 0810

NT Regulations

Queensland

Monitored Medicines Unit

13 78 46
07 3708 5431
Click to email
Website

Locked Bag 21
Fortitude Valley BC 4006

QLD Regulations

South Australia

DDU Drugs of Dependence Unit

1300 652 584
1300 658 447
Click to email
Website

PO Box 6, Rundle Mall
Adelaide SA 5000

SA Regulations

Tasmania

Public Health Services Department of Health

03 6166 0400
03 6173 0820
Click to email
Website

GPO Box 125
Hobart TAS 7001

TAS Regulations

Victoria

Safer Prescribing Team

1300 364 545
1300 360 830
Click to email
Website

Health Services
50 Lonsdale Street
Melbourne Victoria 3000

VIC Regulations

Western Australia

Medicines and Poisons

08 9222 2483
08 9222 2463
Click to email
Website

Level 3, C Block
189 Royal Street
East Perth WA 6004

WA Regulations

New Zealand

Medicines Control Unit

(04) 496 2000
(04) 496 2340
click to email
Website

Ministry of Health
PO Box 5013
Wellington 6140

NZ Regulations
ACT Stimulant Prescribing Regulations

ACT Chief Health Officer

There is no general authority to prescribe Controlled Medicines in the ACT and approval from the Chief Health Officer (CHO) must be requested in order to prescribe controlled medicine for a drug-dependent patient, or for ongoing treatment of more than 2 months in the ACT.  Although it is not clearly outlined, there is a requirement to wait for CHO approval before proceeding to prescribe stimulants. Specialists may however prescribe in the first 2 months without approval, and submit an application to prescribe stimulants if treatment is expected to continue beyond 2 months.

Routine Initial Assessment

Once and initial psychiatric assessment has established a diagnosis of ADHD, complete the Application For Approval To Prescribe Controlled Medicines and fax to HPS via 02 6205 0997 or online through the HealthLink portal using a Smartform. Applications are usually processed within one to two working days if no further information is required. Prescribers may tick the URGENT box on the application if an urgent approval is required and the HPS can consider urgent applications within one working day.

Urine Drug Test – Not mandated

Specified Age Range
No treatment under age 4

CHO approval is for 3 years and then another application must be made. No further forms are required to be submitted unless treatment becomes non-routine, or a GP takes over prescribing in which case a review is required every 3 years with the GP submitting an application confirming the specialist review.

Prescribing For Non-ADHD Conditions
Yes, on the same application form, but on the right-hand side of the form.

Non-Routine Initial Assessment

An additional authority form is available (Controlled medicine approval by drug) if patients have substance abuse or prescribing above maximal quantities or prescribing for a condition not licensed with the Australian Register of Therapeutic Goods. No specific mention of comorbidities other than substance abuse.

Follow-up Interval – 3 Years
Patients need to be reviewed by a psychiatrist every 3 years for treatment to continue.

Maximal Doses Scheduled
As per the ACT Controlled Medicines Prescribing Standards, for 4 – 18 years who have been initiated or reviewed within the previous 2 years, and for 19 years or over who have been initiated or reviewed within the previous 3 years, the max daily dosage is:

  • 40mg daily of dexamphetamine 
  • 70mg daily of lisdexamphetamine
  • 72mg daily of controlled release methylphenidate
  • 60mg daily of conventional methylphenidate 

Co-Prescribing Details
Once the therapeutic dose (daily dose) is established, patients can be referred back to their GP with a letter from the psychiatrist for continuation of treatment and care. GP is able to obtain CHO approval for a duration of 3 years provided there is no change in the dose.

More Information

Other helpful resources and application forms for specific approval to prescribe controlled medicine in ACT are below for reference:

If you have any questions, contact the Chief Health Officer during business hours via phone 02 6205 0998, email hps@act.gov.au or visit the website for more information.

NSW Stimulant Prescribing Regulations

NSW Health Department Pharmaceutical Regulatory Unit (PRU)

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.

Routine Initial Assessment (Adults 16 - 70 Years)

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.

Routine Initial Assessment (Children & Adolescents)

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.

Non-Routine Initial Assessment

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.

Prescribing Stimulants For Non-ADHD/Narcolepsy

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

More Information

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.

Northern Territory Government - Department of Health
NT Stimulant Prescribing Regulations

Scheduled Substances Clinical Advisory Committee (CLAC)

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.

Routine Initial Assessment

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.

More Information

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.

QLD Government Health Dept
QLD Stimulant Prescribing Regulations

QLD Health Department Monitored Medicines Unit (MMU)

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.

Routine Initial Assessment

Prior to September 2021, a Patient Class Approval was required to be in place for paediatricians and psychiatrists to prescribe stimulants. After September 2021,  it was easier for paediatricians to prescribe stimulants to children and psychiatrists to adults, as no approval or permit is needed.

This is explained clearly on pages 15 and 16 of the document entitled “Compliance, Monitoring and Enforcement” available to read here.

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 
An initial urine drug test is not mandatory but 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.

Prescribing Arrangements

The new Medicines and Poisons Act 2019 (MPA) and the Medicines and Poisons (Medicines) Regulation, 2021 (MPMR) commenced on Monday 27 September 2021. The Medicines and Poisons (Medicines) Regulation 2021 sets out the requirements for written and computer-generated prescriptions.

A psychiatrist is authorised to prescribe amfetamine or methylphenidate for a child of any age for the treatment of brain damage or ADHD (Part 2 Division 16).

Maximum A psychiatrist can prescribe for an adult patient for the treatment of ADHD up to the following limits without a prescribing approval;

  • Dexamfetamine up to 40mg per day
  • Lisdexamfetamine up to 70mg per day
  • Methylphenidate up to 80mg per day

A psychiatrist will require a prescribing approval for any other condition(s), or when prescribing doses higher than the maximum limits. Download the prescribing approval application form here.

All Schedule 8 medicines and a range of Schedule 4 medicines are now monitored medicines and subject to the new real-time reporting system, QScript. Prescribers are now required to look up QScript before they prescribe any monitored medicines.

GP Prescribing

Updated March 2022

The parameters for medical practitioners prescribing psychostimulants can be found in the Medicines and Poisons (Medicines) Regulation 2021, Schedule 6:

A medical practitioner can prescribe amfetamine or methylphenidate for the treatment of narcolepsy for a patient of any age, or for the treatment of brain damage or attention deficit disorder of a child patient who is at least 4 years old (Part 1 Division 5).

A GP requires prescribing approval for anything that is outside the above limits including prescribing for adult ADD. It is also an expectation that the GP will have the support of a psychiatrist when prescribing for adult ADHD, and they must name the supporting specialist in their application.

For children transitioning into adulthood, their specialist care should also be transitioned from a paediatrician to an adult psychiatrist, so a GP naming a paediatrician as the supporting specialist will generally be given an approval with an additional condition requiring them to refer their patient to a psychiatrist within 12 months.

With the introduction of the new real-time prescription monitoring system, QScript, it is now a mandatory requirement for a GP to look up a patient’s prescribing and dispensing history before prescribing, so it was decided there was no need for these approvals to be issued.

Queensland Health cannot provide approvals for prescribing activities that take place outside of Queensland and currently only provide access to QScript to doctors who are located in Queensland. Prescribers located outside of Queensland may wish to consider a shared care arrangement with a Queensland-based GP for any patients located in Queensland.

Find more information on complying with the provisions of the Monitored Medicines Standard and registering for and using QScript here.

More Information

Download the Monitored Medicines Standard Companion Document and prescribing approval application form. A number of factsheets are also available to assist in understanding the new scheme with factsheets of particular interest below:

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).

SA Stimulant Prescribing Regulations

SA Health Department Drugs of Dependence Unit (DDU)

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 at the bottom of this page.

Routine Initial Assessment

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 that 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.

Non-Routine Initial Assessment

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.”

More Information

For more information, 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.

Tasmania Health and Human Services logo
TAS Stimulant Prescribing Regulations

TAS Department of Pharmaceutical Services Branch

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.

Routine Initial Assessment

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”.

Non-Routine Initial Assessment

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 Arrangements

Updated April 2022

Effective 1 April 2022 the Department will no longer issue s59E psychostimulant authorities with a co-prescriber included on the authority.

The Department’s position remains that either the relevant specialist medical practitioner or the general practitioner may take on the role of ongoing Schedule 8 psychostimulant prescribing, but both parties should not be prescribing concurrently.

Applications for new patients

  • If the relevant specialist medical practitioner making the diagnosis, documenting the risk-benefit assessment, and formulating the treatment plan will be undertaking the role of ongoing prescribing, they will make an application using the approved s59e psychostimulant application form; OR
  • If the general practitioner will be undertaking the role of ongoing prescribing, they must make an application under s59E using the approved psychostimulant form and accompany the application with a recent letter from a relevant specialist medical practitioner which provides a diagnosis, documents the risk-benefit assessment, and recommends a Schedule 8 psychostimulant treatment including dosage.

Renewal of existing authorisation on expiry

  • If the relevant specialist medical practitioner reviewing the diagnosis and treatment plan will continue the role of ongoing prescribing, they will make an application using the approved s59e application form on expiry of the current authority; OR
  • If the general practitioner will continue the role of ongoing prescribing, they must make an application under s59E using the approved form and accompany the application with a recent letter from the relevant specialist medical practitioner which confirms they have conducted a clinical review of the patient and that treatment with a Schedule 8 psychostimulant remains indicated, safe, and the regimen is supported.

Exceptional Circumstances
As is currently the case, where the patient is a subject of a s59E authorisation for Schedule 8 psychostimulants, but a different non-authorised medical practitioner wishes to prescribe the Schedule 8 psychostimulant due to exceptional circumstances (e.g. transfer in treating medical practitioner, unable to secure necessary specialist medical appointment) the medical practitioner may contact the Branch to discuss short-term prescribing arrangements.

Click here for more information on changes in approach to authorising co-prescribers

More Information

Visit the Tasmanian Dept of Health and Human Services website to access guidelines for health professionals relating to Schedule 8 and Schedule 4D prescribing and dispensing, application forms and other resources.

The Department is planning to release an updated guidance document on the overall process for authorisation of Schedule 8 psychostimulants in Tasmania under s59E. Professional representative organisations will be invited to provide feedback on the document prior to finalisation.

For more information contact the Pharmaceutical Services Branch, Department of Health via phone (03) 6166 0400 or email pharmserv@health.tas.gov.au

Victoria Health and Human Services Department
VIC Stimulant Prescribing Regulations

VIC Health Department Medicines and Poisons Regulation (MPR)

From 2021, the S8 permit system was scrapped making it much easier to prescribe S8 medications in Victoria. The SafeScript system is being introduced throughout Australia and was introduced in Victoria in April 2020 as a mandatory check-in system to ensure that patients are not drug-dependent. If they are not, specialist paediatricians and psychiatrists can then prescribe stimulant medication without needing a Permit as was the case.

SafeScript Prescribing

  • SafeScript is a clinical tool that provides access to a patient’s prescription history for high-risk medicines to enable safer clinical decisions.
  • SafeScript is quick and easy to use and can be integrated with prescribing and dispensing software.
  • From April 2020 it has been mandatory to check SafeScript prior to writing or dispensing a prescription for any medicines monitored through the system (these include stimulant medications, but also benzodiazepines, painkillers, quetiapine, et al).

Updated May 2022

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 (not 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.

General Information

Urine Drug Test 
Not mandatory in Victoria.

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

Stimulant prescribing for non-ADHD conditions
Psychiatrists, neurologists and paediatricians 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.

More Information

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.

Western Australia Department of Health
WA Stimulant Prescribing Regulations

WA Health Department Medicines and Poisons

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.

General Authority to prescribe Stimulants

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.

Routine Initial Assessment

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.

Non-Routine Initial Assessment

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 dexamphetamine
  • 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
  • Methylphenidate, 10 mg tablets
  • Or a combination of 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.

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.

More Information

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.

New Zealand Ministry of Health
NZ Stimulant Prescribing Regulations

NZ Medicines and Medical Devices Safety Authority

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.”

General Authority to Prescribe Stimulants

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 regular prescription form and no longer needs a Special Authority number for the patient to access government funding.

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.

Updated March 2022 

Dexamfetamine and methylphenidate are classified as Class A and B controlled drugs respectively in New Zealand and are therefore regulated by the Misuse of Drugs Act 1975 (the Act) and the Misuse of Drugs Regulations1977 (the Regulations).

Section 29 ‘General requirements in relation to prescriptions’ of the Regulations covers the form of a controlled drug prescription in New Zealand;

  • Subsection (1) specifies the form of the prescription (paper form approved by the director general or on paper that is eletronically generated from an approved system).

Drawing particular attention to subsection (4)(a) which specifies that every prescription for a controlled drug must –

  1. be signed physically by the controlled drug prescriber in his or her own handwriting

This means that even if a controlled drug prescription is electronically generated it still needs to be printed off and physically signed by the prescriber and sent to the pharmacy at which the prescription was dispensed.

Controlled drugs (dexamfetamine and methylphenidate) can be prescribed electronically (using an approved system), however, the prescription still needs to be printed and physically signed by the prescriber as is a requirement of the current legislation.

New Zealand now allows electronic prescriptions in both forms, computer-generated or e-scripts.

It also still allows the old hand-written triplicate prescription system, pharmacies still accept this, but they also accept the modern system.

The computer-generated prescriptions are printed out, signed, scanned to either the pharmacy or the patient, with the original needing a hand-written (colloquially known as “wet ink”) signature on the printed-out prescription, and that then needs to officially arrive within 48 hours at the pharmacy, but often a week is allowed.

Or the prescriber can use the NZ form of e-scripts which are electronically signed and emailed (not sms) to the patient or the pharmacy, with the pharmacy reading the barcode encrypted within the email and providing the medication. The curious NZ twist on e-scripts is still to require some non-electronic, paper activity: the electronic prescription also needs to be printed out and the signature handwritten (“wet ink”), and that is sent to the pharmacy, again officially within 48 hours but up to a week is allowed. That curious twist requirement may well be removed in new legislation later this year or early next year.

Any queries, contact Daniel Harris, advisor, Medicines Control, Medsafe, Ministry of Health, phone: +64 20 4107 7737.

Routine Initial Assessment

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.

From an ADHD Clinician 

It might be said that we never use formal second opinions in New Zealand when considering ultrahigh dose regimes of stimulants as it can be difficult to get ‘first opinions’ from a psychiatrist in NZ, in either the public or private sectors. If concerned, we would discuss it with our peer review groups, or a colleague, and make a note of that. It is not feasible to do any more.

Non-Routine Initial Assessment

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.

More Information

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).