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Prescribing drugs of dependence

When is an authority required?

It is an offence to prescribe or supply (including administering from the prescribers’ own supply), drugs of dependence for a patient’s  regular use during a period exceeding two months without an authority from the Minister.

Treatment provided by other prescribers must be considered when calculating the two-month period.

Treating drug dependence, be it illicit, licit or iatrogenic dependence, requires an authority from the Minister in the first instance; it is an offence to prescribe for this purpose without an authority for any period.

How do you apply for an authority?

Applications must be made to the Minister via the Drugs of Dependence Unit.  Applications are to be made in writing only and signed by the applying prescriber.

Applications generally take 15 days to process (unless issued to treat drug dependence).

More information, including the forms are all available on the Legal requirements for the prescription and supply of drugs of dependence page

When is an authority not required?

An authority is not required when prescribing or supplying a drug of dependence in the following circumstances:

  • A patient aged 70 years or more and the drug involved is not pethidine
  • A patient whose life expectancy is less than 12 months if the drug is not pethidine and the prescriber has informed the Minister of the patient’s name, address, date of birth and the nature of the condition for which the drug is prescribed.  In these cases, the prescriber must endorse the prescription either “Notified Palliative Care Patient” or “NPCP”
  • An inpatient in a hospital or correctional institution where the duration of treatment with a drug of dependence does not exceed 14 days
  • A patient discharged from a hospital following an inpatient stay and the duration of treatment after discharge does not exceed 14 days

Veterinary surgeons are not required to hold an authority to treat animal patients.

Difference between a Controlled Substances Act authority and a Medicare Australia authority

An authority granted under section 18A of the Act stipulates the conditions under which drugs of dependence must be prescribed, including dosage and quantity.  It is not the same as an authority issued by Medicare Australia that issues its authorities for the subsidy of medications under the Pharmaceutical Benefits Scheme (PBS).   Please refer to the PBS information line for more information on 1800 020 613.

Authorities to treat pain with opioid drugs of dependence and the procedure for granting pain authorities

Our primary focus in regulating controlled drugs is to limit public health harms associated with drug dependence, misuse and drug diversion. All applications for authority are considered on a case-by-case basis. While clinical appropriateness of opioid therapy rests with the treating practitioner, documented relevant specialist medical practitioner support may be required in some instances. Some examples include: high doses, young patients, patients with a history of substance misuse and patients with pain conditions that are not usually responsive to opioids.

Application form for treating pain with opioid drugs of dependence (PDF 92KB)

Authorities to treat and maintain opioid dependence- MATOD Programs

Through the MATOD (Medication Assisted Treatment for Opioid Dependence) Program accredited prescribers may apply for authority to prescribe methadone or buprenorphine for the treatment of drug dependence.

Unaccredited prescribers may apply for authority to prescribe Suboxone® film for up to TEN patients for the treatment of drug dependence.

Application form for treating or maintaining drug dependence (PDF 181KB)

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).

Maintenance and continued prescribing

A general practitioner (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.

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.

Treatment with flunitrazepam or alprazolam

Treatment should generally be overseen by a psychiatrist. General Practitioners should forward any relevant specialist reports with the application if seeking an authority to prescribe flunitrazepam or alprazolam.

Infants requiring morphine - Neonatal Abstinence Syndrome

Medicinal cannabis

Medical practitioners in South Australia can legally prescribe medicinal cannabis medicines with relevant State and Commonwealth approvals.

Existing South Australian Controlled Substances legislation regulates the prescribing and supply of Schedule 8 medicines in South Australia applies to Schedule 8 medicinal cannabis drugs.

For more information about the patient access pathway to medicinal cannabis in South Australia:

Medicines and Technology Programs
Department of Health and Ageing
Email:   medicinal.cannabis@sa.gov.au
Phone: (08) 8226 6169

For information about industry development support in South Australia:

Office of Industrial Hemp and Medicinal Cannabis
Email: officeihmc@sa.gov.au
Phone: (08) 8463 5630

‘Locum’ prescribing

A prescriber working in the same practice as the authority holder (authorised prescriber) can act as a locum and continue to prescribe treatment in the short term absence of the authorised prescriber.  Prescribing must comply with the conditions of the authority.

Note: this also applies to prescribing treatment (as a locum) via the Medication Assisted Treatment for Opioid Dependence (MATOD) program. Locums prescribing MATOD treatment should continue treatment according to the plan and dosage regimen set out by the authorised prescriber. Significant changes should not be initiated by a locum and may require consultation and clinical support from Drug and Alcohol Clinical Advisory Service (DACAS) on (08) 7087 1742.

How prescriptions for drugs of dependence are to be written (what they must contain)

All prescriptions must include:

  • prescriber name, address, telephone number and signature
  • date on which the prescription is written
  • patients full name and address
  • patient’s date of birth
  • the quantity to be supplied in words and numerals
  • in the case of veterinary prescriptions to treat an animal; the species of animal, name if applicable, and the name and address of the owner of the animal

MATOD prescriptions

In addition to the above, MATOD prescriptions should also include:

  • The dose in milligrams, and for methadone, millilitres as well to minimise error,
  • The doses to be administered under supervision
  • The number of take away doses that may be provided each week
  • The 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
  • The name of the pharmacy that can dispense the prescription

More information is available on the Legal requirements for the prescription and supply of drugs of dependence page

Faxing prescriptions

Prescriptions for drugs of dependence may be sent by fax for a pharmacist to dispense, but generally must be followed with the original prescription being forwarded to the pharmacist within 24 hours of faxing the prescription. However, a faxed prescription that has been endorsed with the name and address of a single pharmacy that may dispense the prescription does not need to be followed-up with a confirmatory prescription.

Recognising and handling drug dependent persons

Information is available on ways you can recognise and handle people who are drug dependent. This fact sheet includes

  • common characteristics
  • typical tactics
  • the consequences of prescribing a drug of dependence for a dependent person
  • legal obligations
  • recommended actions

Appeal options

There are appeal options for administrative decisions made by the Drugs of Dependence Unit. The appeal options vary for patients and doctors. More information is available on the appeal options page.

Contact for Drug and Alcohol Clinical Advisory Service (DACAS)

For assistance and support on clinical issues, contact the DACAS on telephone (08) 7087 1742.

DACAS is a 24-hour service for doctors, nurses and other health professionals seeking medical advice in managing people experiencing alcohol or other drug-related problems.

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