Changes to expiry dates of Schedule 8 permits in certain circumstances - from 1 October 2012The role of the Schedule 8 permit system is to prevent unsanctioned concurrent prescribing (“prescription shopping”) of Schedule 8 poisons to a patient and to minimise the risk of addiction to these substance(s).
The Department of Health has reviewed the requirements for prescribers who apply for Schedule 8 permits. Consequently, some Schedule 8 permits will be issued for up to a three-year period, which is a change from the maximum one-year period currently issued for all Schedule 8 permits.
Patients over 60 years of age requiring long-term treatment with an opioid at a dose under 100mg daily in morphine equivalentsThere may be situations where the clinical circumstances of a patient being treated with a Schedule 8 poison are unlikely to change. For instance, older patients with a chronic and stable set of clinical circumstances may require long-term use of a non-parenteral opioid medication for the treatment of chronic severe pain.
The following table (from Hunter New England NSW Health) provides the 100mg daily morphine equivalent doses (MED) for commonly prescribed opioids for chronic pain.
|Name of opioid||100mg daily MED|
|buprenorphine patch||40mcg/hr weekly|
|fentanyl patch||25mcg/hr every three days|
For information on the use of opioids in chronic non-cancer pain, recommendations on suggested opioid maximum daily doses and opioid dose equivalents, refer to the following best practice guidelines:
- NPS News 69: A planned approach to prescribing opioids, National Prescribing Service, 2010.
- Reconsidering opioid therapy, Hunter New England NSW Health, 2013.
Psychiatrists prescribing dexamphetamine or methylphenidate for adult ADHDPermits to treat a patient with dexamphetamine or methylphenidate for adult attention deficit hyperactivity disorder (ADHD) are generally only issued to psychiatrists (or to prescribers with supporting treatment advice from the patient's psychiatrist), as the department considers psychiatrists to be the most suitably qualified practitioners to monitor the safety and appropriateness of treatment with these Schedule 8 poisons for this condition.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) (Victoria Branch) was consulted on the proposal to extend the duration of permits issued to psychiatrists to treat patients with dexamphetamine or methylphenidate for up to three years where there were no concerns of misuse or abuse.
Respiratory or sleep physicians prescribing dexamphetamine or methylphenidate for narcolepsyPermits to treat a patient with dexamphetamine or methylphenidate for narcolepsy are generally only issued to respiratory or sleep physicians (or to prescribers where there is evidence of a specialist diagnosis), as the department considers respiratory and sleep physicians to be the most suitably qualified practitioners to monitor the safety and appropriateness of treatment with these Schedule 8 poisons for this condition.
It is important for prescribers to be aware that a permit issued by the department is not an endorsement of treatment. The responsibility for assessing the appropriateness of treatment of a patient rests with the prescriber in each particular case. It is crucial that prescribers continue undertaking regular reviews of a patient’s treatment to ensure not only that an ongoing therapeutic need exists but also that prescribing a Schedule 8 poison is an appropriate part of an overall treatment plan. Prescribers are also advised to follow relevant guidelines issued by the Medical Board of Australia and practice guidelines issued by specialty colleges when treating patients with a Schedule 8 poison.