Summary of key changes to the regulations and code

S8 Medicinal Cannabis Products

Provided the criteria specified in the Code are met, medical practitioners may now prescribe S8 Medicinal Cannabis Products without authorisation of the WA Department of Health’s Chief Executive Officer (CEO). Where the criteria outlined in the Code are not met (e.g., patient is under 18 years or recorded as a ‘Drug Dependent’ or ‘Oversupplied’ person), prescribers need to obtain a patient-specific authorisation from the CEO before prescribing.

These requirements are separate, and additional to, any requirements of the Therapeutic Goods Administration (TGA).

S8 stimulant medicines

There is no longer a requirement for individual Approved Specialists (as specified in the Part 3 of the Code, see table 3) to obtain authorisation as a Stimulant Prescriber or to provide notification to the Department of Health that they have commenced (or changed) their patient’s treatment with S8 stimulant medicines.

Provided the criteria specified in the Code are met:

• Approved Specialists, whose practice involves conditions where stimulants are used, may now prescribe the following S8 stimulant medicines without authorisation of the WA Department of Health’s Chief Executive Officer (CEO):
  • dexamfetamine or methylphenidate to patients ≥ 4 years; and
  • lisdexamfetamine to patients ≥ 6 years.
• other medical practitioners may now prescribe continuing S8 stimulant treatment under a shared care model with their patient’s Approved Specialist, without authorisation of the CEO, either at the same dose and form or in accordance with written directions from the specialist.

Where the criteria specifed in the Code are not met:

• prescribers need to obtain a patient-specific authorisation from the CEO before prescribing. Other prescribers are not permitted to prescribe stimulants for patients with a current authorisation unless they are listed on the authorisation. Prescribers can see if there is a current authorisation for their patient through ScriptCheckWA.

S8 ketamine

Provided the criteria specified in the Code are met, medical practitioners who hold specialist registration on the AHPRA register of practitioners in one of the following specialities, or speciality fields may now prescribe ketamine without authorisation of the CEO:

• Pain medicine
• Palliative medicine
• Paediatric palliative medicine.

S8 opioids

Approved Specialists (as specified in Part 2 of the Code, see table 2) may prescribe up to 14-days of

• opioid treatment above the dose limit and/or in injectable formulation
• methadone

without authorisation of the CEO, provided the patient is not recorded as Drug Dependent or Oversupplied.

S8 opioids, except methadone

Provided the criteria specified in the Code are met, nurse practitioners may now prescribe S8 opioids, excluding methadone, without authorisation of the WA Department of Health’s Chief Executive Officer (CEO) .

S8 stimulant medicines

Provided the criteria specified in the Code are met, nurse practitioners may now prescribe continuing S8 stimulant treatment under a Shared Care Model with their patient’s Approved Specialist, without authorisation of the CEO.

S8 Medicinal Cannabis Products

Nurse practitioners are permitted to prescribe medicinal cannabis products and must comply with the Code’s requirements. Prescribers need to obtain a patient-specific prescribing authorisation if high risk circumstances (as outlined in the Code) are met, such as if the patient is under 18 years of age or is classified as a ‘drug dependent person’ or an ‘oversupplied person. 

These requirements are separate, and additional to, any requirements of the Therapeutic Goods Administration (TGA). Nurse practitioners always require a SAS-B approval from the TGA.

Other S8 medicines

Nurse practitioners, like other prescribers, require authorisation for all other schedule 8 medicines including ketamine. Medical specialist support relevant to the condition is required, but formal collaborative care arrangements are not.

Date of birth requirements

If a prescriber has not included the patient's date of birth on a prescription for an S4 medicine, the pharmacist can still dispense it, provided they have verified and recorded the patient's date of birth.

Retention and transfer of handwritten and computer-generated S8 prescriptions

Retaining S8 prescriptions:

• Paper-based repeat prescriptions for S8 medicines must be retained by the pharmacy that dispenses the original prescription.
• Under no circumstances can repeats be returned to the patient.

Transfer of S8 prescriptions:

• Approval from the Department of Health is no longer required to transfer S8 prescription repeats to another pharmacy.
• Repeat prescriptions must not be returned to the patient.
• The repeats should be posted to the new pharmacy and the pharmacy alerted to expect the transfer.
• Pharmacies should document the address where the prescription was posted in case of queries.

Dispensing of interstate prescriptions

Except for prescriptions for opioid substitution therapy, all valid S4 and S8 prescriptions issued by interstate prescribers may be dispensed in Western Australia (WA).

To be valid in WA, prescriptions issued by interstate prescribers must contain all the information normally required by the WA Medicines and Poisons legislation and be issued by a health practitioner authorised under the WA Medicines and Poisons legislation.

• For S8 prescriptions this includes the patient’s date of birth, exact repeat intervals and precise directions for use, generated by the prescriber.

Pharmacists must still take reasonable steps to verify the authenticity of paper-based prescriptions (handwritten and computer-generated S8 prescriptions) from both interstate and WA prescribers. This applies even if the patient presents a repeat prescription, as not all states and territories require paper-based repeats to be retained at a dispensing pharmacy.

Pharmacists should use ScriptCheckWA to assist in the risk assessment of prescriptions, particularly from interstate prescribers to ensure dispensing the prescription to the patient is safe and appropriate.

Record of supply of Monitored Medicines

In addition to the usual dispensing recording requirements, pharmacists must record the prescriber's name and address and the patient's date of birth when dispensing Monitored Medicines.

Endorsed podiatric surgeons: prescribing of immediate release oxycodone

The Code now aligns with the Registration standard: Endorsement for scheduled medicines, Podiatry Board of Australia.

Where the total duration of treatment is less than or equal to 3 days, provided the criteria specified in the Code are met, endorsed podiatric surgeons may now prescribe up to 10mg doses (with a maximum of 20mg in 24 hours) of immediate release oxycodone for the purpose of treating an acute condition without authorisation of the WA Department of Health’s Chief Executive Officer (CEO).

A patient-specific prescribing authorisation would be required before prescribing oxycodone to a patient who is under 18 years or recorded in ScriptCheckWA as a ‘drug dependent person’ or an ‘oversupplied person’.