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Handling drug dependent patients

A patient has presented to the surgery requesting for OxyContin but I think he may be drug-dependent. Can I supply it?

Opioids such as OxyContin and MS Contin, which are indicated for the management of moderate to severe pain, are subject to misuse or abuse by some individuals. If a person is suspected of being drug-dependent, it is illegal to prescribe OxyContin, MS Contin or any other Schedule 8 drug without prior written approval from the NSW Ministry of Health.

You should politely but firmly decline the request. You could refer the person to a community Drug and Alcohol Unit – contact the Alcohol and Drug Information Service on (02) 9361 8000 or 1800 422 599 (toll free).

Alcohol and drug information can be accessed online via the Australian Drug Information Network.

General advice on handling drug-seeking patients can be obtained from the Duty Pharmaceutical Officer at Pharmaceutical Services (NSW Ministry of Health) during business hours on telephone (02) 9391 9944.

A patient has presented to the surgery asking for medicines that are subject to abuse - what should I do?

Anytime a patient presents requesting a medicine that is subject to abuse a doctor should be very circumspect. Before prescribing for the patient the doctor must be satisfied – based on clear and reasonable medical judgement – that the medication requested is the most appropriate for the situation. A doctor should not just take the word of the patient.

Requests for medications such as opioids and benzodiazepines might indicate that the patient is a doctor shopper or a drug dependent person.

If a doctor suspects a patient of getting medicine in excess of medical need, they can call Medicare Australia's Prescription Shopping Program on 1800 631 181 to obtain a summary of what medicines have been supplied to the patient on Commonwealth PBS subsidised prescriptions from community pharmacies. Doctors must first register with the service.

General advice on handling drug-seeking patients can be obtained from the Duty Pharmaceutical Officer at Pharmaceutical Services (NSW Ministry of Health) during business hours on (02) 9391 9944. The Duty Officer can also provide advice as to whether another doctor holds an authority to prescribe a drug of addiction (Schedule 8 medicine) for the patient.

Useful literature on drug-seeking behaviour is also available.

A patient has come to my surgery who is dependent on a benzodiazepine – he's been on it for years. Another doctor started him on it. Can I keep prescribing it to him so he won't get withdrawal symptoms?

It is inappropriate to prescribe a benzodiazepine simply to maintain a patient’s dependence. A withdrawal plan should be developed for the patient, which may require consultation with a doctor who has experience in drug dependence.

The NSW Ministry of Health has published practice guidelines for the treatment of withdrawal from alcohol and other drugs such as benzodiazepines.

My patient wants to try steroids to enhance his appearance. I am concerned that he will experiment with illegal steroids. Can I prescribe steroids for him?

No. By law a doctor may not issue a prescription for a medicine for a purpose that does not accord with recognised therapeutic standards of what is appropriate in the circumstances. Improvement of physical appearance is not a therapeutic purpose.

The patient should be counselled on the risks and harms associated with using anabolic androgenic steroids and other performance enhancing drugs. A factsheet on anabolic steroids for patients is available.

The patient can also be advised that it is an offence for him to be in possession of anabolic steroids that have not been prescribed for him.

Doctor's bag or emergency drug supplies

For the convenience of myself and my patients, I want to get some medicines to supply (and administer) to my patients, such as premedication prior to minor surgery conducted on my premises. Can I obtain them from a pharmacy?

No, you should obtain them from a licensed wholesaler. A doctor can obtain scheduled medicines from a pharmacy only:

  • on an emergency drug order in the doctor’s own name for bona fide emergency use only; or
  • on a prescription written in the name of an individual patient for treatment of that patient only.

Medicines obtained in the name of a patient are the property of that patient and any medicines left over after that patient’s treatment should not be supplied (or administered) to another patient.

Can I write a prescription in my own name to get supplies for surgery use from a community pharmacy?

No. A doctor cannot buy wholesale quantities of scheduled medicines for general surgery use from a community pharmacy; the medicines should be purchased from a licensed wholesaler.

As a doctor, you can write an emergency drug order (not a prescription) to obtain small quantities of medicines from a community pharmacy for use in emergencies. For example, when it wouldn't be practicable to give a patient a prescription for an urgently needed medicine to get it dispensed at a pharmacy.

Other questions

I am a doctor and have expired Schedule 8 (S8) medications. What do I do with them?

Destruction of a doctor’s Schedule 8 medications can be carried out by an authorised inspector of the NSW Ministry of Health, Pharmaceutical Services (contact the Duty Pharmaceutical Officer on (02) 9391 9944), the police, or a retail pharmacist.

A pharmacist working in any retail pharmacy (not necessarily the original supplier of the drugs) may destroy a S8 drug belonging to a doctor either at the pharmacy or at the premises where the doctor’s practice is conducted.

Doctors may find it most convenient to make arrangements to destroy unwanted S8 drugs at their local pharmacy. Where the drugs are to be destroyed at a pharmacy, the doctor will need to take their drug register, as well as the drugs, to the pharmacy and witness the destruction of the drugs. The pharmacist must record the destruction in the doctor’s drug register including the date, and the pharmacist’s name and professional registration number. The name of the doctor must also be entered in the drug register. Both the pharmacist and the doctor must write their signatures next to the entries. The pharmacist should not take possession of the drugs nor enter them into the pharmacy's drug register.

A pharmacist is not obliged to destroy drugs on request.

Because of quantity and repeat limits for PBS items, my patient needs to keep coming to my surgery every few days. Can I date a prescription with a past or future date so the patient doesn’t need to keep doing this?

No. You must date every prescription with the date that you gave it to the patient. If you don't want the patient to get the prescription dispensed straight away, you may if you wish write on the body of the prescription, ‘do not dispense before (a certain future date)’.

I printed a private (non-PBS) prescription from my computer and it automatically printed a duplicate copy as well. What do I do with the duplicate copy (i.e. the Medicare or Department of Veterans’ Affair copy)?

Destroy the duplicate and ask your software provider to set up the computer and printer so that duplicates are not printed for private prescriptions. Duplicate prescriptions are required only for prescriptions for which the pharmacist claims a refund from the Commonwealth (i.e. Medicare or Department of Veterans’ Affairs).

Private prescriptions should not be issued in duplicate, especially if they are for medicines which are subject to abuse.

I have a query about the availability of vaccines. Who should I contact?

Information is available online for the NSW Immunisation Program and the national immunisation program, Immunise Australia Program.

Information on vaccines can also be obtained by contacting Seqirus on 1800 008 275.

Where can I order a drug register?

All persons engaged in the manufacture, distribution, sale, administration or supply of drugs of addiction must keep a register. Drug registers, as well as ward registers, can be purchased from the State Government printing contractor Toll Stream Solutions.

A drug register can be ordered by contacting Toll Stream Solutions on 1300 786 075 or by emailing streampmunswh@stream.net.au

All orders will need to be paid for by Credit Card at the time of placing the order. The following registers are available for purchase, with a minimum order of 1 book:

  • Ward Register of Drugs of Addiction NH612005 - Form H22
  • Register of Drugs of Addiction NH612000 - Form H21

Drug registers may also be purchased from some pharmaceutical wholesalers and the Pharmaceutical Society of Australia. Subsidiary Drug registers for the dosing of methadone, Subutex and Suboxone​ (each one has their own) are available from the NSW Pharmacy Guild on (02) 9467 7100.

I have a "PBS Authority" issued by the Commonwealth Department of Human Services to prescribe a medicine. Does that mean I don't need a NSW Health Authority?

No. Authorities issued by the NSW Health Secretary should not be confused with any "PBS Authority" which may be required for cost subsidy under the Commonwealth's Pharmaceutical Benefits Scheme. A PBS Authority number means ONLY that the Commonwealth has agreed to subsidise the cost of a medicine to be supplied to the patient as an "Authority Required Pharmaceutical Benefit". It does not mean that it is legal for a doctor to prescribe it.

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Page Updated: Tuesday 26 March 2019
Contact page owner: Pharmaceutical Services