Important changes to expiry dates for Schedule 8 permits in certain circumstances - from 1 February 2014
The purpose of issuing Schedule 8 permits is to prevent unsanctioned concurrent prescribing (“prescription shopping”) of Schedule 8 poisons to individual patients and to minimise the risk of addiction to these substances.
The Department of Health has reviewed the requirements for Schedule 8 permits. From 1 February 2014 , some Schedule 8 permits will be issued without a nominated expiry date. This is a change from the standard 12 month period currently issued for most Schedule 8 permits.
Patients being prescribed an opioid at a dose under 100mg daily in morphine equivalence
Current evidence-based guidelines, such as the National Prescribing Service’s Opioids - a planned approach to prescribing opioids for persistent non-cancer pain1 recommend daily doses of opioids should not exceed 100mg in morphine equivalence without specialist advice.
The following table provides the 100mg daily morphine equivalent doses (MED) for commonly prescribed opioids for chronic pain.
Table 1: 100mg daily morphine equivalent dose (MED)2
|Name of opioid||100mg daily MED|
|buprenorphine patch||40mcg/hr weekly|
|fentanyl patch||25mcg/hr every three days|
A further change from 1 February 2014 is that Schedule 8 permits issued under these circumstances will allow for the prescribing of any combination of the listed opioids in Table 1, provided the cumulative daily dose does not exceed 100mg daily in morphine equivalent dose (MED). A MED calculator is available here.
Permits may be amended, suspended or revoked by the Secretary at any time if a notification of drug dependency or aberrant drug-related behaviour has been reported to the Department of Health. For example, permits issued may be amended to specify an expiry date and include the advice that a review by a specialist will be necessary to affirm ongoing treatment is appropriate for the management of the patientís condition by the expiration of the permit.
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, lisdexamfetamine or methylphenidate for adult ADHD
Permits to treat a patient with dexamphetamine, lisdexamfetamine 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, lisdexamfetamine 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.