ADHD Stimulant Prescribing Regulations & Authorities in Australia & New Zealand

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 contact 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!

Nurse Practitioners are also advised to check with their local State or Territory health departments as to whether they are authorised to initiate or co-prescribe stimulant medications.

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).

NSW Health Department Pharmaceutical Regulatory Unit

Prescribe a psychostimulant medication

As per the NSW Health website, an Authority from the NSW Ministry of Health is required to prescribe or supply dexamfetamine, lisdexamfetamine, or methylphenidate.

A pharmacist in NSW cannot dispense a prescription for psychostimulant medication unless the prescription shows an authority number issued by the NSW Ministry of Health, regardless of which state or territory a prescription is issued in.

Note: An Authority issued to a prescriber by the NSW Ministry of Health is separate to the authority required from Services Australia for a patient to receive a Commonwealth PBS subsidised medicine.

Who can prescribe a psychostimulant medication?

How to apply for an authority to prescribe a psychostimulant medication

Applications for an authority to prescribe or supply a psychostimulant medication should be submitted via SafeScript NSW or via submission of an Application for Approval to prescribe or supply a Schedule 8  psychostimulant.

Submitting applications via SafeScript NSW allows prescribers to monitor their application progress online and to receive real-time approval in many cases. Prescribers will be notified immediately if:

• an approval is required
• the application is automatically approved
• the application needs to be reviewed by NSW Health

Note: NSW Health is updating the terminology currently used from ‘authorities’ to ‘approvals.’ In SafeScript NSW an approval is a reference to an Authority issued under the Poisons and Therapeutic Goods Act 1966.

Prescribers can now use SafeScript NSW to:

• apply for certain approvals online
• receive approvals in real-time, in many cases
• easily view, monitor and track active approval applications for the last two years
• see their patient’s approval history including their current approvals.

Scheduled Substances Clinical Advisory Committee

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 as detailed in the Code of Practice Volume 1, Chapter 3 found here.

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 a 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 is required under age 4. Medication above 4 years at specialist discretion. In general, non-pharmacological treatment is 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.

QLD Health Department Monitored Medicines Unit

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.

Click to download the latest factsheet from Queensland Health Dept MMU as of December 2023

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 14 and 15 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

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.

SA Health Department Drugs of Dependence Unit

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.”

TAS Department of Pharmaceutical Services Branch

There are currently three Schedule 8 psychostimulants (dexamfetamine, methylphenidate and lisdexamfetamine) registered for use in Australia by the Therapeutic Goods Administration (TGA). Indications for use differ for each substance and include attention-deficit hyperactivity disorder (ADHD), binge-eating disorder, narcolepsy and other hypersomnias.

The Department of Health administers the Tasmanian Poisons Act 1971 and Poisons Regulations 2018. Under regulation 24 of the Poisons Regulations 2018 a medical practitioner is required to seek and obtain an authority from the Secretary of the Department of Health prior to issuing a prescription for a Schedule 8 psychostimulant for a patient. These authorities are issued pursuant to section 59E of the Poisons Act 1971. A medical practitioner must be present and practising in Tasmania to be authorised to prescribe Schedule 8 psychostimulants in Tasmania.

The below outlines the framework for prescribers to gain authorisation under section 59E of the Poisons Act 1971 to prescribe Schedule 8 psychostimulants in Tasmania.

Download relevant forms & guidelines for doctors below

• Application for authorisation to prescribe Schedule 8 medicines under section 59E of the Poisons Act 1971
• Process for assessing and granting authorities to prescribe psychostimulants
• Fact Sheet – Seeking Authorisation to Prescribe Schedule 8 Psychostimulants in Tasmania 

Diagnosis and Treatment Recommendations

Medical conditions which may benefit from treatment with Schedule 8 psychostimulants should be diagnosed by an appropriately qualified specialist medical practitioner. This includes psychiatrists, paediatricians, sleep physicians and neurologists. Assessment and diagnosis of medical conditions should occur using accepted diagnostic criteria and management approaches considered based on profession endorsed clinical guidelines and evidence-based resources.

Prescribers Eligible for Authorisation

Section 59E applications will be accepted from appropriately qualified specialist medical practitioners practising in Tasmania including psychiatrists, paediatricians, sleep physicians and neurologists.

Additionally, Tasmanian general practitioners may apply to be authorised to prescribe Schedule 8 psychostimulants where an assessment and diagnosis of the patient has been conducted by a relevant medical specialist in the condition being treated. Such applications should be accompanied by a comprehensive clinical report from the relevant medical specialist including diagnosis, management plan, and recommended treatment regimen.

The authorisation of medical practitioners under section 59E to prescribe Schedule 8 medicines is restricted to medical practitioners physically present and practising medicine in Tasmania. An interstate medical practitioner (e.g., practising telehealth interstate) cannot be authorised under section 59E. However, an appropriately qualified medical specialist interstate can support a Tasmanian-located general practitioner to make an application under section 59E.

General Process for Section 59E Application and Authorisation

An application for authority to prescribe Schedule 8 psychostimulants under Section 59E can be made using the form ‘Application for authorisation to prescribe Schedule 8 medicines under Section 59E of the Poisons Act 1971’ and can be submitted via email to pharmserv@health.tas.gov.au

Applications are then assessed by a pharmacist within the Department’s Pharmaceutical Services Branch (PSB) who is a delegate for the Secretary for purposes of section 59E. On assessment, the delegate may decide to refuse the application, issue an authority, or issue an authority with conditions.

Applications that do not include sufficient detail to allow an informed decision to be made by the delegate will not be assessed and will be referred to the applicant for further specific information. In some cases, the delegate may request further information to inform the assessment which could include the results of a urine drug screen, sleep study results, or occasionally a second supporting opinion from a specialist medical practitioner.

Authorities will generally be issued for a maximum of 24 months but may be issued for a shorter duration at the delegate’s discretion. Paediatricians making an application for a child may be issued an authorisation until the child turns 18 years old. Subsequent applications from a general practitioner to renew an expired authorisation should be accompanied by documentation indicating the patient has continued to engage in clinical review with a relevant medical specialist (at intervals as defined by the relevant medical specialist) with the patient’s current drug and dose regimen remaining appropriate.

A section 59E authority issued covers the named medical practitioner and any medical practitioner that works within the same medical practice.

Exceptional or Urgent Circumstances

In urgent or exceptional circumstances, a Tasmanian medical practitioner can telephone Pharmaceutical Services Branch and seek verbal authorisation under section 59E for short-term prescribing arrangements. In urgent and exceptional circumstances, the section 59E delegate still requires the medical practitioner to have undertaken appropriate clinical due diligence. Examples may include:

• Where the patient is a subject of a section 59E 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).
• Where the patient is treated with Schedule 8 psychostimulants interstate and during travel to Tasmania has insufficient dispensed medicine remaining.
• Where the patient is a subject of a section 59E authorisation for Schedule 8 psychostimulants, but there is an urgent need to vary the authorised regimen (e.g., when the usual medicine is unavailable due to stock shortages).

Regimen and Dosage

It is expected that in most cases the treatment of patients with Schedule 8 psychostimulants will be at doses within the TGA approved Product Information (PI) and profession endorsed clinical guidelines. Applications for doses exceeding those in the TGA approved PI should be accompanied by a detailed clinical rationale for the higher dose from the relevant medical specialist.

Authorities issued include specific psychostimulant(s) and maximum dosage, based on the requested regimen in the application. It is acknowledged that for some patients the prescriber may be titrating and adjusting psychostimulant treatment based on response, weight, or suitability. In clinical situations where the applicant believes it appropriate, after noting the clinical intention they may wish to include on their application:

• Multiple psychostimulant substances
• Multiple formulations of the same psychostimulant substance (i.e., immediate release and modified release)
• A maximum dose for upward titration

Patient Age

Prescribers should be familiar with current TGA approved PI regarding the use of methylphenidate, lisdexamfetamine, and dexamfetamine at different ages. It is expected that in most cases the treatment of patients with Schedule 8 psychostimulants will be within the age parameters of TGA approved PI and profession endorsed clinical guidelines. Applications for a patient not within the TGA PI range for a Schedule 8 psychostimulant should be accompanied by a detailed clinical rationale from the relevant specialist medical practitioner.

Non-TGA Registered Indications

Applications for authorisation to prescribe Schedule 8 psychostimulants for indications not registered by the TGA should be accompanied by a detailed clinical report from the relevant specialist medical practitioner outlining the rationale for use, recommended management plan, and account of other treatment options trialled.

Risk Evaluation and Mitigation Strategies (REMS)

The s59E application assessment process includes consideration of Risk Evaluation and Mitigation Strategies (REMS). A REMS approach can assist to:

• Ensure that patients who may be at increased risk of preventable harm when prescribed Schedule 8 psychostimulants are appropriately identified, the risks and benefits in the individual have been carefully considered, and that care is being provided with appropriate risk mitigation strategies and monitoring.
• Minimise preventable harms to the public from diversion of prescribed Schedule 8 psychostimulants into the community for illicit purposes.
• Ensure children receiving Schedule 8 psychostimulants are provided a supported framework to receive their prescribed medicines where risks in their care environment with respect to safekeeping of medicines have been identified.

Prior to making an application or recommendation for treatment with a Schedule 8 psychostimulant, it is expected that medical practitioners undertake a comprehensive clinical and psychosocial assessment to inform their management plan. This should include taking a comprehensive history of past or present illicit substance use and history of unsafe alcohol or substance use. The management plan should include an overall patient risk-benefit assessment for treatment and where appropriate detailed risk mitigation and monitoring strategies to support safe patient care.

Complex Applications

For applications where complex clinical issues are involved, a delegate may choose to seek advice from a Consultant Medical Officer (CMO) or a panel of two or more relevant specialist medical practitioners. Applications requiring CMO or panel advice comprise a very small percentage of all Schedule 8 psychostimulant applications. The CMO or panel will be experienced clinician(s) with appropriate background and training in the areas of paediatrics, addiction medicine or psychiatry. After seeking advice, the decision on the application remains with the delegate.

Review of a Decision

Formal review arrangements exist for authorities for Schedule 8 psychostimulants issued under section 59E. Where a delegate has included conditions on an authority or has refused to issue an authority, a medical practitioner, a patient, or their carer, may make application to request a review of the decision. Grounds for review may be clinical in nature or relate to other facts relevant to the application. A review is undertaken by a delegate not involved in the original decision. Information on this process and application form is available on the Department’s website.

VIC Health Department Medicines & Poisons Regulation

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).

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.

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.

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 Medsafe. See the Medsafe website for details.

Pursuant to regulation 22 of the Misuse of Drugs Regulations 1977, a medicine may be given consent to distribution, supply or use provided certain conditions are met. Conditions may relate to who can prescribe the medicine, or for what indication. The medicines listed below currently have conditions on supply and/or usage.

Note: the restrictions PHARMAC places on medicine subsidies (as listed in the Pharmaceutical Schedule) are independent of the conditions imposed under the Medicines Act or Misuse of Drugs Regulations.

Dexamfetamine (Dexamphetamine)

The following restrictions apply to all dexamphetamine products:

Prescribing
The following class of persons (“vocational medical practitioners”) may prescribe dexamphetamine products for a patient under his or her care for the corresponding conditions:

• Medical practitioners with a vocational scope of practice of paediatrics or psychiatry, registered with the Medical Council of New Zealand under the Health Practitioners Competence Assurance Act 2003, for the treatment of Attention Deficit and Hyperactivity Disorder (ADHD), or
• Medical practitioners with a vocational scope of practice of internal medicine, registered with the Medical Council of New Zealand under the Health Practitioners Competence Assurance Act 2003, for the treatment of narcolepsy.

Any other medical practitioner registered with the Medical Council of New Zealand (“registered medical practitioner”) or nurse practitioner registered with the Nursing Council of New Zealand practising within their area of practice (“nurse practitioner”), may only prescribe dexamphetamine products when acting on the written recommendation of one of the vocational medical practitioners described above, for the conditions specified.

Supply
The following class of persons may supply dexamphetamine products in the following circumstances:

• Any pharmacist registered with the Pharmacy Council of New Zealand under the Health Practitioners Competence Assurance Act 2003, in the course of his or her employment as a pharmacist, may supply dexamphetamine products pursuant to a prescription issued by:
  • A registered medical practitioner with a vocational scope of practice of paediatrics, psychiatry, or internal medicine, when prescribing for the conditions specified above, or
  • Any other registered medical practitioner or nurse practitioner, when acting on the written recommendation of one of the vocational medical practitioners specified above, with the recommendation endorsed on the prescription.

Administration
Any person who is caring for a patient, for whom a dexamphetamine product has been prescribed by any of the medical practitioners or nurse practitioners described above, may administer the product to that patient in accordance with the prescribed directions for use.

Methylphenidate

The following restrictions apply to all methylphenidate products:

Prescribing
The following class of persons (“vocational medical practitioners”) may prescribe methylphenidate products for a patient under his or her care for the corresponding conditions:

• Medical practitioners with a vocational scope of practice of paediatrics or psychiatry, registered with the Medical Council of New Zealand under the Health Practitioners Competence Assurance Act 2003, for the treatment of Attention Deficit and Hyperactivity Disorder (ADHD), or
• Medical practitioners with a vocational scope of practice of internal medicine, registered with the Medical Council of New Zealand under the Health Practitioners Competence Assurance Act 2003, for the treatment of narcolepsy, or
• Medical practitioners with a vocational scope of palliative medicine registered with the Medical Council of New Zealand under the Health Practitioners Competence Assurance Act 2003, for use in palliative care treatment.

Any other medical practitioner registered with the Medical Council of New Zealand (“registered medical practitioner”) or nurse practitioner registered with the Nursing Council of New Zealand practising within their area of practice (“nurse practitioner”), may only prescribe methylphenidate products when acting on the written recommendation of one of the vocational medical practitioners described above, for the conditions specified.

Supply
The following class of persons may supply methylphenidate products in the following circumstances:

• Any pharmacist, registered with the Pharmacy Council of New Zealand under the Health Practitioners Competence Assurance Act 2003, in the course of his or her employment as a pharmacist, may supply methylphenidate products pursuant to a prescription issued by:
  • A registered medical practitioner with a vocational scope of practice of paediatrics, psychiatry, internal medicine, or palliative medicine, when prescribing for the conditions specified above, or
  • Any other registered medical practitioner or nurse practitioner, when acting on the written recommendation of one of the vocational medical practitioners specified above, with the recommendation endorsed on the prescription.

Administration
Any person who is caring for a patient, for whom a methylphenidate product has been prescribed by any of the medical practitioners or nurse practitioners described above, may administer the product to that patient in accordance with the prescribed directions for use.

Other Medical Practitioners 

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 that 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 approval to be given. Once approval is given, an application to Pharmac for a subsidy is made in the usual way (as below).

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 SA1964 – Methylphenidate Hydrochloride (Rubifen; Rubifen SR; Ritalin; Ritalin SR; Methylphenidate ER – Teva)
3. Methylphenidate: Form SA2305- Methylphenidate Hydrochloride Extended-Release (Concerta; Ritalin LA)

Note: visit the Pharmac website for more Special Authority Application 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.

For 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 of 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 the Ministry of Health, Private Bag 3015, Wanganui, or 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.

Lisdexamphetamine/Vyvanse was launched and made available in New Zealand in June 2023 as a private, non-Pharmac subsidised medicine. Guanfacine/Intuniv remains unavailable 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.

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 Regulations 1977 (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 still requires 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.

For 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 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.