Opioid prescribing – Know your state's Law, reduce your risk handout

ACT

Controlled Medicines in the ACT

In the ACT the Medicines, Poisons and Therapeutic Goods Act 2008 (ACT) (the Act) and Medicines, Poisons and Therapeutic Goods Regulation 2008 (ACT) (the Regulations) provide the regulatory framework for prescribing and supplying controlled drugs.

Under the Act and Regulations, approval from the ACT Chief Health Officer (CHO) is required to prescribe controlled drugs for drug-dependent patients or for treatment that is expected for more than two months. 

The Medicines Advisory Committee (MAC) is a statutory body established under the Act to provide advice to the CHO on complex clinical matters involving the prescription and supply of medicines.โ€ฏ 

The MAC provides advice on applications for approval to prescribe controlled medicines and applications for endorsement to treat drug dependency. The MAC may also consider applications for review of an unfavourable CHO decision on controlled medicine issues. 

Prescribers can apply to the Health Protection Service (HPS) to prescribe a controlled drug online using Smartform. Using Smartform, prescribers can apply directly via their practice management software or online through the HealthLink portal. Prescribers can also submit an application by fax to the HPS. 

The HPS can process an application within one to two working days providing further information is not required in support of the application. If treatment is urgent, prescribers should tick the 'Urgent' box on the application. When urgent, the HPS aims to assess the application within one working day.

All prescribers of controlled medicines do not have to seek approval from the CHO for: 

  • hospital inpatients; and 
  • for short term treatment for up to two months, provided the patient has not received a controlled medicine within the preceding two months and provided that they are not drug-dependant.

Prescribers can apply for either a Category Approval or an Approval by Drug. 

Category Approval  

Approval by category authorises the prescription of medicine within a therapeutic class up to a maximum dose to treat a certain condition(s).

A prescriber can apply for controlled medicine to treat a person with: 

  • Category 1: chronic (non-cancer) pain 
  • Category 2: pain attributed to malignancy or life-limiting disease; 
  • Category 3: drug-dependency 
  • Category 4: licensed indication or severe insomnia 
  • Category 5: Attention Deficit Hyperactivity Disorder, Binge Eating Disorder and Narcolepsy 
  • Category 6: cannabis products for specific medicinal purposes

Approval by Drug 

Authorises the prescription of a particular dose, form, strength and quantity of a medicine for a medical condition. A prescriber may request an 'Approval by Drug' due to their preference, or when the requested treatment does not meet the requirements of a Category Approval. 

https://health.act.gov.au/ 

https://health.act.gov.au/health-professionals/pharmaceutical-services 

NSW

Applicable legislation and other instruments

The following apply to the prescription of medicines and poisons in NSW:

General Notes on Prescribing Practices

  1. Who can prescribe?

Only medical practitioners, nurses, midwives and dentists registered (only in strict conditions for all bar medical practitioners) with ahpra.

  1. Minimum prescription requirements

Clause 80 of the Regulation

  1. Non-computer generated:

The prescriber in own handwriting must include:

  • the date on which the prescription is issued
  • the name and address of the patient, or if for an animal the name and address of the owner and the species of the animal
  • the name, strength, route for administration (if not apparent) and quantity of the medication to be dispensed (for a Schedule 8 medication the quantity to be dispensed must be handwritten in both words and figures)
  • the number of repeats to be dispensed (if any) and for certain medications the time interval between repeat dispensing
  • adequate directions for use
  • the prescriber's signature.
  1. Computer generated.

The system must print the following data fields on the prescription:

  • the date on which the prescription is issued
  • the name (including given name, or initial letter and appellation) and full residential address of the patient, or if for an animal the name and address of the owner and the species of the animal
  • the age of the patient when the patient is an infant or a child under the age of twelve
  • the name of the substance or the preparation containing it, including the strength when more than one strength is available
  • the quantity being prescribed in both words and figures (numerals)
  • adequate directions for use
  • the number of repeats authorised if the prescription is to be dispensed more than once and, if repeats are ordered, the time interval for repeats.
  • Written by dentists, must state “for dental treatment only”.
  1. Schedule 8 Medicines

Prohibition on prescribing drugs of addiction in certain cases

(1)  A medical practitioner or nurse practitioner must not, without the proper authority, prescribe for or supply to any person a type A drug of addiction.

(2)  A medical practitioner or nurse practitioner must not, without the proper authority, prescribe or supply a type B drug of addiction:

  • for continuous therapeutic use by a person for a period exceeding 2 months, or
  • for a period that, together with any other period for which that drug or any other type B drug of addiction has been prescribed or supplied by the medical practitioner or nurse practitioner or has, to the medical practitioner’s or nurse practitioner’s knowledge, been prescribed or supplied by any other medical practitioner or nurse practitioner, would result in that drug, or that drug together with any other such drug, being prescribed or supplied for continuous therapeutic use for a period exceeding 2 months.

(3)  A medical practitioner or nurse practitioner must not, without the proper authority, prescribe for or supply to a person who, in the opinion of the medical practitioner or nurse practitioner, is a drug dependent person a type C drug of addiction.

(4)  For the purposes of this section, the proper authority means an authority under section 29 that authorises the medical practitioner or nurse practitioner to prescribe or supply the drug of addiction to the person concerned.

(5)  A drug of addiction may be prescribed for or supplied to a person by a medical practitioner or nurse practitioner without the proper authority if the medical practitioner or nurse practitioner is authorised by the regulations to prescribe or supply the drug without an authority under section 29.

  1. ID Verification

QLD

Applicable legislation and other instruments
The following apply to the prescription of medicines and poisons in QLD:

General Notes on Prescribing Practices

  1. Who can prescribe?

Doctors, endorsed midwives and nurse practitioners, as well as physician’s assistants under supervision, are endorsed to prescribe controlled (Schedule 8) and restricted (Schedule 4) drugs.  A dentist is authorised to prescribe a restricted drug and not more than 3 days supply of codeine or pentazocine. 

  1. Minimum prescription requirements
  • S8 prescriptions must provide:
    • full name, professional qualifications and address of the prescriber
    • full name, address and date of birth of the patient
    • date
  • S8 prescriptions must also provide and, for computer generated S8 paper prescriptions, be written in the doctor's own handwriting:
    • the description and quantity (in words and figures) of the medicines to be dispensed
    • adequate directions for use
    • dose
    • number of repeats (if any) and intervals at which they may be dispensed
    • signature of the prescriber
  • S8 prescriptions are valid for 6 months
  • Only one S8 medication can be written on a prescription, except where multiple items are different forms of the same drug
  • No other prescription medication can be written on an S8 prescription
  • S8 prescriptions must not be written by a prescriber for self-administration
  • Pharmacists can dispense an interstate S8 script as long as it fulfils these requirements
  1. Approvals

Approval must be sought from Chief Executive prior to prescribing a controlled drug or restricted drug of dependency (including codeine) to a ‘drug dependent person’.  A ‘drug dependent person’ is a person who, as a result of repeated administration of controlled or restricted drugs, demonstrates impaired control or exhibits drug-seeking behaviour suggestive of impaired control over the continued use of controlled or restricted drugs, and who, when administration ceases, suffers or is likely to suffer mental or physical distress or disorder.

  1. ID Verification

ID verification is not required.  However, if a pharmacist reasonably believes a prescription is false, they must make reasonable inquiries to establish the name and address of the person who gave it to them.  Albeit not a legal requirement, it may be reasonable for a prescriber to request ID in exceptional circumstances.   

SA

Applicable legislation and other instruments

In South Australia the prescription, supply, administration, possession, storage, and handling of S8 opioids is subject to the provisions of three main legislative instruments:

General Notes on Prescribing Practices

  • Who can prescribe?

Healthcare professionals registered under the Health Practitioner Regulation National Law (South Australia) 2010 [section 4]. Practitioners must obtain authority from Minister for Mental Health and Substance Abuse when prescribing an S8 poison to a patient who has been treated with drugs of dependence by any prescriber for > 2 months; or before prescribing an S8 poison for drug-dependent patients.

  • Minimum prescription requirements

The Controlled Substances (Poisons) Regulations 1996 (SA) specifies requirements for written prescriptions for S8 opioids. Prescriptions must be written legibly in ink, or printed, with the following information included:

  • Prescriptions for S4 & S8 drugs must be legible, written in ink and include the**
  • Name, address and telephone number of the prescriber,
  • The date the prescription was written,
  • Full name and address of the patient,
  • Name of the drug and if necessary, the strength and form of the drug,
  • Dosage instructions for the safe use of the drug,
  • Quantity to be dispensed,
  • Number of repeats if applicable
  • the total amount of the drug to be supplied each time the prescription is dispensed
  • Prescriber’s personal signature.

** This does not apply to a medical practitioner who writes a medication chart prescription for an S4 medicine that may be supplied under the Medication Charts Program when that Program comes into operation. Refer to the National Health (Residential Medication Chart) Determination.

  • Prescriptions for S4 and S8 drugs are valid for a period of 12 and 6 months, respectively, from the date of prescribing.
  • Prescriptions may be written by a computer or other aid but must include the personal signature of the prescriber.

In addition to the above, Medication Assisted Treatment for Opioid Dependence (MATOD) prescriptions should also include the:

  • dose in milligrams, and for methadone, millilitres as well to minimise error,
  • doses to be administered under supervision
  • number of take away doses that may be provided each week
  • expiry date of the prescription. This date is the date after which no more drug can be supplied and should coincide with the date that the patient is to be reviewed
  • name of the pharmacy that can dispense the prescription
  • Schedule 8 Medicines

For Schedule 8 drugs, prescriptions must also include:

  • The date of birth of the patient,
  • The quantity in words and numerals, and
  • The words –
    1. "For dental treatment only" if the prescriber is a dentist; or
    2. “For podiatric treatment only” if the prescriber is a podiatrist.

Dronabinol (delta-9-tetrahydrocannabinol): prescribers must be authorised by the Secretary of the Commonwealth Department of Health and Wellbeing to prescribe or order dronabinol (Section 19, Therapeutic Goods Act 1989 Cth).

Authority to prescribe will not be granted by the South Australian Minister for Mental Health and Substance Abuse unless the applying prescriber can demonstrate he or she is in possession of a Commonwealth authority. [SECTION 18A]

  • ID Verification

A pharmacist must not supply an S8 drug unless:

  • satisfied the person ordering is lawfully authorised to possess the drug, (this includes medical practitioners, dentists, veterinary surgeons and licence holders)
  • if not known to the pharmacist, provides satisfactory identification
  • unless a receipt is provided.

Prescriptions for schedule 8 medicines written by prescribers in another state or territory can be dispensed in South Australia provided the pharmacist dispensing the prescription:

  • knows the person for whom the medication has been prescribed, OR
  • recognises the signature of the prescriber on the prescription, OR
  • has verified the prescription by contacting the prescriber1
1 Regulation 35(8)(a) Controlled Substances (Poisons) Regulations 2011

TAS

Applicable legislation and other instruments 

The following apply to the prescription of medicines and poisons in Tasmania: 

General Notes on Prescribing Practices 

  1. Who can prescribe?

    Under Poisons Regulations 2018: 

    Section 20(2): A medical practitioner, veterinary surgeon, authorised health professional or dentist, subject to this regulation, is authorised to write or issue a prescription for a narcotic substance.  

    Section 20 (3) An authorised nurse practitioner may write or issue a prescription for a narcotic substance in such circumstances, subject to such conditions and in relation to such substances or classes of substances as may be specified in an authorisation issued by the Secretary.  

    Section 20 (4) A person must not write or issue a prescription for the purpose of procuring a narcotic substance for administration to himself or herself. Penalties apply. 

  2. Minimum prescription requirements 

    Under Poisons Regulations 2018: 

    • Section 20 (5): A person must not write or issue a prescription for a narcotic substance unless the prescription includes (otherwise than in handwriting) the name of the person writing or issuing the prescription and the address of the person's place of residence or of the place at which the person carries on practice. Penalties apply. 
    • Sub regulation 5: does not apply in the case of an emergency when the means of complying with that sub regulation are not readily available to the person writing or issuing the prescription.
    • Section 20 (7): Prescriptions for a narcotic substance must comply with the following condition
      • the date on which it is written or issued; and 
      • the name, including initials, date of birth and address, of the patient or, in the case of an animal, the name, date of birth and address of the owner; and
      • hand-written legibly in ink, the name of the narcotic substance, the dosage and quantity to be dispensed; and
      • subject to sub regulation (10), the number of times that the dispensing of the prescription may be repeated and the interval between each dispensing of the prescription; and 
      • adequate directions for use
    • and sign the prescription with his or her usual signature;
    • he or she is not to include in that prescription more than one preparation which is or includes a narcotic substance; 
    • he or she is not to include in that prescription a preparation other than the preparation which is or includes the narcotic substance; 
    • if a medical practitioner, he or she is not to write or issue a prescription for the supply of a narcotic substance for any purpose other than in the course of medical treatment; 
    • if a dentist, he or she is not to write or issue a prescription for the supply of a narcotic substance for any purpose other than in the course of dental treatment and is to include in a prescription which he or she issues the words "For dental treatment only" 
    • if an authorised health professional, he or she is not to write or issue a prescription for the supply of a narcotic substance for any purpose other than in the lawful practice of his or her profession.
  3. Schedule 8 Medicines 
    Authority approval from Tasmanian Secretary for Health and Human Services (for > 2 months of treatment) before prescribing certain medicines including dexamphetamine, methylphenidate and fentanyl (for a complete list, refer to Poisons Regulations 2008, reg 19); or before prescribing S8 medications to patients who are drug dependent, or who have a history of or are currently exhibiting drug-seeking behaviour. 
    • Opioids, flunitrazepam and alprazolam: The Medical Practitioner must be present and practising in Tasmania.
      • Repeats allowed R.20(7)(a)(iv) 
      • Interval must be endorsed 1 R.27(4)-(6)
      • Repeats to be retained where first dispensed 2 R.27(2) 
      • Authority required from the Department of Health before supply of items listed under R.24
    • Opioids, flunitrazepam and alprazolam: The Dental Practitioner must be present and practicing in Tasmania
      • No repeat allowed R.15(9) 
      • No repeat allowed R.20(10)
      • Cannot prescribe drugs listed under regulation R.24  
  4. ID Verification 

    R.28(2). Authenticate validity. If unable to authenticate the validity of the prescription a pharmacist may provide 2 days' supply only until validity can be confirmed 

    Specific reference is also made toโ€ฏthe: 

    Poisons Act 1971 Part VA - Notification and authorisation in relation to certain restricted substances and narcotic substances S59A- 59E. 

    TOPPโ€ฏ (Tasmanian Opioid Pharmacotherapy Program – Policy and Clinical Practice Standards) is listed to refer to https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0018/112527/2012_TOPP_Document.pdf 

VIC

Applicable legislation and other instruments

In Victoria, the prescription, supply, administration, possession, storage, and handling of S8 opioids is subject to the provisions of two main legislative instruments. The regulations complement the Act by authorising actions that would otherwise be unlawful and define the outcomes required of lawful actions.

General Notes on Prescribing Practices

  • Who can prescribe?

Only medical practitioners registered with AHPRA may obtain authority to prescribe a compounded S8 medicine. Other practitioners cannot prescribe them in Victoria.

  • Minimum prescription requirements

Regulation 24 specifies the required form of a prescription for Schedule 4 and Schedule 8 medicines; required components, which must all be in the prescriber’s own handwriting, include:

  • full details of the prescriber (i.e. name, address and contact phone number)
  • the name and address of the patient
    • Note: The patient’s date of birth must also be included on each prescription when a Schedule 8 poison or a Schedule 4 monitored poison is prescribed
  • unambiguous details of the medicine
  • the quantity to be supplied
  • precise directions for use except:
    • where complex directions are provided separately, in writing, or the medicine is to be administered by a registered health practitioner (e.g. injection to be administered by a nurse or medical practitioner)
    • where a variable dosage regimen is directed, in which case a statement specifying a maximum frequency of administration is to be included;
  • the signature of the prescriber and date of prescribing
  • In Victoria practitioners must also check Safe Script before writing any s8 or high risk s4 prescription
  • s30F -must take all reasonable steps to check the monitored poisons database
  • Schedule 8 Medicines

In addition to the requirements for a prescription for a Schedule 4 poison, regulation 24 requires the following details on a prescription for a Schedule 8 poison:

  • a statement of the quantity to be supplied, written in both words and figures; and
  • a statement that:
    • there is to be no repeat supply, specified in words and not just figures; or
    • the number of times that the prescribed quantity may be supplied or repeated (written in words and figures).
  • ID Verification

Practitioners are required to take ‘all reasonable steps’ to ascertain the identity of a person when a drug of dependence is to be prescribed, supplied or administered by them. If that person is not already known to the practitioner, all reasonable steps might include examining photo identification, such as a Driver's Licence, and confirming the patient’s date-of-birth.

If a prescription is issued for a Schedule 8 medicine (or another monitored supply medicine), the prescriber must also include the patient’s date of birth on the prescription.

  • If a practitioner issues a prescription with the incorrect date-of-birth or an incorrectly spelt patient’s name; details of the prescription might not be accurately recorded on the SafeScript database.
  • Some prescription-shoppers deliberately provide false names or inaccurate details in an attempt to deceive; so it is important for prescribers to seek photo identification (e.g. Driver's Licence) and confirm the date-of-birth of any new or unfamiliar patients.

WA

Overview

  1. This document summarises the prescribing regimes in Western

Regime

Applicable legislation and other instruments

  1. The following apply to the prescription of medicines and poisons in WA:
    1. Medicines and Poisons Act 2014 (WA);
    2. Medicines and Poisons Regulations 2016 (WA);
    3. Health Services Act 2016;
    4. Schedule 8 Medicines Prescribing Code;
    5. Public Health Policy Framework; and
    6. Medicine Handling Policy (MP 0139/20) and its related document Risk based requirements for medicines handling.
  1. The Medicines and Poisons Act 2014 (WA) (Act) is the broad framework which addresses the handling of medicines and poisons in The Medicines and Poisons Regulations 2016 (WA) (Regulations) is subsidiary legislation that supports the framework established under the Act. Both are legally binding on both the public and private sector.
  1. Under section 132 of the Act, the Regulations may adopt codes. The Schedule 8 Medicines Prescribing Code (Code) is one such code adopted by the
  1. Additionally, under section 26 of the Health Services Act 2016 (WA) the Department of Health may issue binding policy frameworks and has done so with the Medicine Handling Policy (Policy) established under the Public Health Policy Framework, which is mandatory for all health service
  1. Further guidance on prescribing practices in WA may be obtained in the explanatory notes to the Policy at this link.

General Notes on Prescribing Practices

Who can prescribe?

  1. Only health professionals authorised under the Health Practitioner Regulation National Law, acting in the lawful practice of their profession, can prescribe medicines: Act, s 25 and Regulations, Part
  1. Prescribers must prescribe within their scope of practice and comply with both the Act and the Regulations, otherwise they may be guilty of an
  1. The Act creates a number of offences for the unlawful manufacture, supply and prescription of For example, it is an offence to manufacture, supply, prescribe or possess a Schedule 4 or Schedule 8 poison unless it is in accordance with their license or authority and is in accordance with the Regulations: Act, s 14.

Minimum prescription requirements

  1. Generally, prescriptions must include the following information:
    1. name, address and telephone number of the prescriber;
    2. date on which the prescription was issued
    3. name and address of the patient (or if for veterinary use, the species of the animal and name and address of the animal’s carer);
    4. a description and the quantity, dose, strength and form of each medicine to be supplied;
    5. precise directions for use (dosage and frequency)
    6. number of repeats permitted (if any): Regulations, s 10(1).
  1. A prescription for a Schedule 8 medicine cannot include any Schedule 4 medicines: Regulations, s 10(2).
  1. A prescription may be in the form of any of the following:
    1. an electronic document issues by the prescriber by means of an approved electronic prescribing system; or
    2. a printed form that is generated by means of an appropriate computer system and is signed by the prescriber; or
    3. a document which includes the information at [9] of this memo written in ink, which is signed by the prescriber: Regulations, s 11(1).
  1. Note, only authorised prescribers can write prescriptions for Schedule 4 and Schedule 8 medicines. Authorised prescribers include:
    1. Medical practitioners;
    2. Nurse practitioners;
    3. Dentists; and
    4. Endorsed midwives, podiatrists and

Schedule 8 Medicines

  1. In addition to the standard requirements, when prescribing a Schedule 8 medicine authorised prescribers must include:
    1. a minimum repeat dispensing interval; and
    2. the patient’s verified date of
  1. Further requirements for the prescription of Schedule 8 medicines are in the Code, which must be complied
  1. The Code recommends that a prescriber, prior to prescribing an S8 medicine:
    1. take an accurate medication history;
    2. have a clear diagnosis and indication for treatment;
    3. consider appropriate medicine selection; and
    4. enter into a treatment contract with the patient where the prescribing may continue beyond 30
  1. Prescribers should maintain and exercise appropriate practices that:
    1. monitor medicine usage and adherence;
    2. have frequent treatment review;
    3. identify and respond to warning flags;
    4. use urine and other drug screening tests; and
    5. prescribe to first time
  1. Schedule 8 medicines should not be prescribed to any new or unknown patient without first contacting the Department of Health Schedule 8 Prescriber Information Service on (08) 9222 Their identity should be recorded, and verified against photo ID if possible.

ID Verification

  1. Prescriptions will be reviewed by a pharmacist to confirm the genuineness of the prescription, including checking the:
    1. identity and authority of the prescriber;
    2. identity of the person presenting the prescription; and
    3. authenticity of the prescription

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