If a prescription for a Schedule 8 drug has repeats, the prescriber must write a repeat interval on the prescription. If no repeat interval is written on the prescription, then only the original supply quantity can be dispensed and the pharmacist must cancel (as well as retain) the prescription. No further repeats can be dispensed from the prescription. The pharmacist cannot add this detail to the prescription. The same rules apply to prescriptions for anabolic steroids.
First you should contact the doctor and discuss your concerns with the doctor. If applicable, ask the doctor if he or she regards the patient is drug dependent. (Note: The prescribing of a drug of addiction to a person who is drug dependent requires prior written approval from the NSW Ministry of Health.) Make a permanent dated record of the conversation.
If you have done this and the doctor is dismissive and continues as before and you still have concerns, report the details to the Duty Pharmaceutical Officer at Pharmaceutical Services during business hours on (02) 9391 9944.
Contact each of the prescribers and inform them of the situation. Enquire whether, considering this information, the prescriber deems it safe and appropriate for the patient to have the prescription dispensed. Generally a patient with a valid therapeutic need for a Schedule 8 drug should have one principal medical practitioner to manager his/her condition. Concurrent prescribing by other doctors may compromise or be detrimental to the patient’s treatment.
Prescribers should be reminded of their legal obligation to obtain a NSW Health Authority to prescribe certain Schedule 8 drugs in specific circumstances, and that this obligation is separate and distinct from any authority from the Pharmaceutical Benefits Scheme or Medicare for funding the cost of the medication. The prescribers may be referred to the Pharmaceutical Services website or encouraged to contact a Senior Pharmaceutical Officer at the Pharmaceutical Regulatory Unit to discuss the matter further. Prescribers can also be referred to Medicare Australia’s Prescription Shopping Program website for information about the release of all PBS or MBS patient claims information.
Prescription shopping or drug seeking behaviour is not limited to illicit drug users, some patients may have a genuine medical condition but have developed an iatrogenic dependence.
Prescription shopping may also be associated with diversion and the sale of prescription drugs.
Pharmacists are reminded that they may only dispense drugs of addiction in an appropriate quantity and for a purpose in accord with the recognised therapeutic standard of what is appropriate in the circumstances (see clause 109 of the Poisons and Therapeutic Goods Regulation 2008). The effect of this is that the quantity and frequency of dispensing must correspond with the dosages indicated on the prescription and that these dosages and quantities are appropriate in the circumstances.
If you continue to have concerns about a particular patient or the practice of a prescriber, contact the Duty Pharmaceutical Officer at the Pharmaceutical Regulatory Unit on (02) 9391 9944 for further advice.
Contact each prescriber and inform them of the situation. Enquire whether, considering this information, the prescriber deems it safe and appropriate to continue to have the prescription dispensed.
Benzodiazepines and anabolic steroids are often diverted for illicit supply on the street. Furthermore there may be significant clinical complications for patients taking high doses of benzodiazepines such as alprazolam or clonazepam in combination with other prescribed medications such as methadone or other opiates. Prescribers may be referred to the Pharmaceutical Services website or encouraged to contact a Senior Pharmaceutical Officer at the Pharmaceutical Regulatory Unit to discuss the matter further. Prescribers can also be referred to Medicare Australia’s Prescription Shopping Program website for information about the release of all PBS or MBS patient claims information.
Pharmacists are reminded that they may only supply restricted substances in an appropriate quantity and for a purpose that accords with the recognised therapeutic standard of what is appropriate in the circumstances (see clause 54 of the Poisons and Therapeutic Goods Regulation 2008). The effect of this is that the quantity and frequency of dispensing must correspond with the dosages indicated on the prescription and that these dosages and quantities are appropriate in the circumstances.
If you continue to have concerns about a particular patient or the practice of a particular prescriber, contact the Duty Pharmaceutical Officer at the Pharmaceutical Regulatory Unit during business hours on (02) 9391 9944 for further advice.
The ‘other’ medication (i.e., the medication which is not a drug of addiction) can be dispensed but the drug of addiction cannot be dispensed and should be clearly marked ‘CANCELLED’.For a prescription for a drug of addiction (Schedule 8 drug) to be valid, the Schedule 8 drug must be the only item on the prescription. If different strengths of the same Schedule 8 drug are required for a patient, a separate prescription is required for each strength.
No. All dispensed Schedule 8 prescriptions must be separately retained on the premises of the pharmacy that dispensed them. The patient (or agent) will need to come back to your pharmacy to get the repeats dispensed when they are due, or make arrangements for the medicine to be delivered/sent to them from your pharmacy. If these options are not convenient, the patient will need to obtain a new prescription from his or her doctor.
No. All dispensed prescriptions for anabolic androgenic steroidal agents must be retained on the premises of the pharmacy where they were originally dispensed. The patient (or agent) will need to come back to your pharmacy to get the repeats dispensed when they are due, or make arrangements for the medicine to be delivered to them from your pharmacy. If these options are not convenient, the patient will need to obtain a new prescription from his or her doctor.
The same requirements apply to the barbiturates amylobarbitone and pentobarbitone when packed and labelled for injection. More information is available in the Guide to Poisons and Therapeutic Goods Legislation for Pharmacists (TG79).
No, unless the practitioner is also registered on the relevant Australian Register of Practitioners. The registration status of a practitioner can be accessed on the AHPRA website.
Yes, provided the practitioner is registered on the Australian Register of Practitioners. The registration status of a practitioner can be accessed on the AHPRA website.
All the normal restrictions on dispensing prescriptions still apply and details are available in the Guide to Poisons and Therapeutic Goods Legislation for Pharmacists (TG79).
There are requirements concerning Schedule 8 medicines that pharmacists should pay particular attention to when dispensing prescriptions for these medicines:
If the patient lives outside NSW, inform him or her before dispensing a paper prescription that you will need to retain the prescription (including any repeats).
See also Cannabis medicines - frequently asked questions.
Further information can be obtained by contacting the Duty Pharmaceutical Officer, Pharmaceutical Regulatory Unit during business hours on (02) 9391 9944.
This scenario is a matter for concern and consideration should be given to contacting the Duty Pharmaceutical Officer at the Pharmaceutical Regulatory Unit, NSW Ministry of Health on (02) 9391 9944 for assistance in the first instance. There are two possibilities, the first being that the doctor is suffering from an impairment and is using this method to obtain medication for his/her own consumption.
The second may be that the doctor is ignoring the NSW Medical Council’s guidelines that medical practitioners should have their own independent GP and that prescribing for family members may compromise their professional objectivity and his/her judgment may be influenced by the nature of his/her relationship with the patient and it should be avoided.
The Duty Pharmaceutical Officer will seek clear information from you to decide on a way forward. It may be that the doctor’s prescribing at other pharmacies in the area will need to be reviewed to get a more complete picture of the extent of the doctor’s prescribing before a decision is taken by the Officer on the best way to approach the doctor.
No. The Medicare authority number means only that the Commonwealth has agreed to pay for it (via the PBS - Pharmaceutical Benefits Scheme). It does not provide legal authorisation to the doctor to prescribe the drug. Every prescription for a Schedule 8 psychostimulant (whether PBS or private) needs to have the NSW Health Authority number written on the prescription by the prescriber. Information on authorisation requirements is available or can be obtained by contacting the Monitoring and Compliance Unit, Pharmaceutical Services on (02) 9424 5923 during business hours.
Special conditions apply to the supply of certain restricted substances such as clomiphene. Only an authorised doctor may issue a prescription for these substances. A prescription for clomiphene can be dispensed only if:
Other restricted substances with similar requirements are: acitretin, cyclofenil, dinoprost, dinoprostone, etretinate, follitropin beta, isotretinoin for oral use, luteinising hormone, tretinoin for oral use and urofollitrophin (human follicle stimulating hormone). Further details are available in the Guide to Poisons and Therapeutic Goods Legislation for Pharmacists (TG79).