Can I dispense this?

The Pharmacy Council of NSW has identified a “knowledge gap” for many pharmacists around authority requirements for certain scripts

In a piece adapted from an article written by the Medical Council of NSW, the state’s Pharmacy Council says that it recently considered interim action against nine pharmacists regarding the dispensing of drugs of addiction.

The Medical Council of NSW actually did undertake interim action to protect the public, prohibiting seven doctors from prescribing these medicines.

“Central to all cases was inappropriate prescribing and dispensing of opioids or other Schedule 8 Drugs in contravention of the requirements of NSW Poisons and Therapeutic Goods legislation,” warns the Pharmacy Council of NSW.

It outlines the two types of authorities prescribers may need to get before they can prescribe restricted or S8 medicines:

The first is “the familiar PBS Authority which prescribers obtain every day by calling 1300 888 333 or sending the script through the mail.  This authority ensures the patient will get a PBS subsidy for the medication prescribed”.

But there is also the “much less commonly required” NSW Ministry of Health Authority.

This is necessary when Alprazolam, Flunitrazepam or S8 opioids are prescribed for any period of time for someone considered to be drug dependent; or when Alprazolam, Flunitrazepam, Buprenorphine (except transdermal), Hydromorphone, methadone or any other injectable, intranasal or spray S8 opioid is prescribed for more than two months for someone not considered to be drug dependent.

This Authority is also required for stimulants such as Dexamfetamine, Lisdexamfetmine (Vyvanse) or Methylphenidate (Ritalin, Ritalin LA and Concerta).

“A Ministry of Health Authority (as well as other approvals) is also required when someone is enrolled in the NSW Opioid Treatment Program (aka the ‘Methadone program’),” the Council warns.

It says that “many” pharmacists and doctors seem to get the PBS Authority confused with the NSW Ministry of Health Authorities.

“A PBS Authority number means ONLY that the Commonwealth has agreed to subsidise the cost of a medicine,” it warns.

“It does not grant approval for the prescriber to prescribe the medicine and therefore does not necessarily mean that it is legal for a prescriber to prescribe it.

“The people on the end of the PBS line have no legal authority to allow the prescriber to prescribe stimulants and S8 medications.”

Instead, when a prescriber contacts this line to request a PBS Authority, the PBS Officers assume the prescriber already has a NSW Ministry of Health Authority to prescribe that medication, and will not conduct a check to ensure that the prescriber has a NSW Ministry of Health Authority.

“Telling a regulatory body such as the Pharmacy Council, Medical Council or the HCCC that the prescription had a PBS Authority is no defence for a pharmacist should you get into trouble for dispensing these medications in inappropriate circumstances.”

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  1. Michael Post

    The onus is on the pharmacist! Yeah right.
    Notice the article does not mention ”’how’ to validate this approval.
    When questioning duty pharmacist at NSW Pharmaceutical Services whether an authority from NSW Ministry of Health had been obtained for long term Physeptone prescribing in chronic pain several years ago I was informed that it was none of my business. I did contact the GP in writing and advised of authority requirements- who knows if it was arranged .
    So just like CTG ,the system is broken and the blame falls on the pharmacist-?! I don’t think so.

  2. Gavin Mingay

    Why can’t we have Australia wide real-time monitoring? Link the State Health Departments’ approvals, PBS approvals, etc. So we can look up a script, check it has all the correct approvals, see when it was last dispensed and then dispense it if appropriate. This would almost put an end to forged S8 and S4D scripts…

  3. pagophilus

    The onus is on the doctor to get the authority. In Victoria we call it a permit, and there is no requirement for the pharmacist to check if the doctor has a permit to prescribe a medication, nor a requirement for a doctor to supply a copy of the permit to the pharmacist along with the prescription. When I recently dispensed medicinal cannabis I made sure all the right documents were in place, but can you imagine the extra time and paperwork checking permits for every S8 script? If the authorities want it done, THEY need to implement a mechanism to enable it to take place.

  4. Peter Ghobros

    “Telling a regulatory body such as the Pharmacy Council, Medical Council or the HCCC that the prescription had a PBS Authority is no defence for a pharmacist should you get into trouble for dispensing these medications in inappropriate circumstances.”
    What does this mean ? Is it the dispensing pharmacist to blame now ?
    I believe it is not our responsibility nor we have the time as a dispensing pharmacist to check whether GP got a permit to continue prescribing S8 medications or not. I asked this question before at multiple occasions and was informed it is not the pharmacist responsibility.
    With introduction of safescript in VIC, there is a tab at the top for permits. It is not for pharmacists, it is more for GPs for them to know whether they got a permit or not.

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