Treating a drug-dependent person
Information for medical practitioners
2014.1
This document has been prepared by Drugs and Poisons Regulation (DPR) to assist prescribers in understanding the key
legislative requirements associated with treating a drug-dependent person. For simplicity of reading, this document does not
refer to all legislative requirements; merely those that may be relevant to the majority of general practitioners. For full details,
reference should be made to the Drugs Poisons and Controlled Substances Act 1981 and Drugs Poisons and Controlled
Substances Regulations 2006 (at www.legislation.vic.gov.au). Documents dealing with other key legislative requirements,
may be found on the DPR website (at www.health.vic.gov.au/dpcs/reqhealth)
Clinical advice
Whilst this document includes references to treatment strategies and options, it relates primarily to legislative
issues associated with the prescribing of drugs of dependence for drug-dependent persons. Clinical advice,
relating to the treatment of drug-dependent persons (including other treatment options), should be sought from
appropriate authoritative sources.
To obtain clinical advice from specialist consultants, registered health practitioners (only) may phone the Drug
and Alcohol Clinical Advisory Service (DACAS) on 1800 812 804 (at any time).
For 24-hour confidential drug and alcohol counselling and treatment information; patients, family members or
health practitioners may phone Direct Line - 1800 888 236.
What is a drug-dependent person?
Whilst the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) lists criteria to assist
medical practitioners attempting to diagnose the condition, the Drugs Poisons and Controlled Substances Act
1981 does not define the term “drug-dependent person”. It refers instead to when a practitioner has reason to
believe a patient is a drug-dependent person.
The following list contains examples of circumstances that might (or should) represent a reason to believe,
especially when multiple circumstances apply:

Admitted current misuse or abuse of pharmaceutical drugs and/or illicit drugs

Prescription-shopping and/or obtaining prescription drugs from illicit sources

Physical signs of intravenous drug use

Forging prescriptions or obtaining drugs of dependence by false representation

Multiple unsanctioned dose escalations of prescribed drugs

Is being treated with opioid-replacement therapy for opioid-dependence
. Department of Health
Drugs of dependence
The term “drug of dependence” is used to describe drugs from Schedule 8 plus some Schedule 4 poisons
that are subject to misuse and trafficking. The Schedule 4 poisons in this category include all benzodiazepines
that are not in Schedule 8, propoxyphene (Digesic®, Doloxene®), phentermine (Duromine®), testosterone and
other anabolic steroids.
Before prescribing a drug of dependence, a medical practitioner must take all reasonable steps to ensure a
therapeutic need exists and to confirm the identity of the patient. Issuing a prescription, merely because
another prescriber has done so, is unlikely to satisfy these requirements.
Treating a drug-dependent person
It is an offence to prescribe a drug of dependence merely to support the drug-dependence of a person.
Treatment of a drug-dependent person should involve meaningful objectives and appropriate strategies to
reduce the risks associated with providing drugs of dependence to a drug-dependent person. Such strategies
typically include limiting a patient’s access so that drugs of dependence are prescribed by a single practitioner
and supplied, in a controlled manner, by a single pharmacy. A collegiate approach between prescriber and
pharmacist often represents an important component of sound treatment of a drug-dependent person.
Unless a prescriber holds a current Schedule 8 treatment permit to treat a drug-dependent person, he/she must
notify DPR if there is reason to believe a patient is a drug-dependent person and the patient seeks a drug of
dependence or the medical practitioner intends to prescribe a drug of dependence.
Schedule 8 poisons
Note: The following lists are not exhaustive and show only some brand names (in brackets). There are other
Schedule 4 and Schedule 8 poisons and there may be lesser-known brand names of the listed drugs.
Schedule 8 poisons (labelled Controlled Drug) have stricter legislative controls than other commonly available
drugs, including but not limited to morphine (Kapanol®, MS-Contin®), pethidine, oxycodone (OxyContin®,
OxyNorm ®, Endone®), buprenorphine (Subutex®, Suboxone®, Norspan®), fentanyl (Durogesic®) and
hydromorphone (Jurnista®) plus two benzodiazepines, alprazolam (from 1 February 2014) and flunitrazepam
(Hypnodorm ®).
Where there is reason to believe a patient is a drug-dependent person, a medical practitioner must obtain a
permit before prescribing a Schedule 8 poison – unless a specific exception applies. Please refer to the
summary document, “Permits and notifications to prescribe Schedule 8 poisons”, on the DPR website (at
www.health.vic.gov.au/dpcs/reqhealth) to see details of requirements and exceptions.
Treating opioid-dependence
Methadone and buprenorphine (Suboxone®, Subutex®) are the Schedule 8 poisons that have been registered in
Australia for opioid-replacement therapy (ORT).
To address the inherent risks, associated with the vulnerability of the patients and the potential toxicity of the
drugs (especially methadone), Schedule 8 treatment permits to prescribe ORT are issued only to medical
practitioners who have completed the training and assessment required to become an ‘approved prescriber’.
An exemption now exists that enables general practitioners who are not approved prescribers to obtain a
Schedule 8 treatment permit to prescribe Suboxone® ORT for up to 5 patients (see below).
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Department of Health
For more information, Victoria’s current “Policy for maintenance pharmacotherapy for opioid dependence” and
the National Clinical Guidelines for Methadone plus the National Clinical Guidelines for Buprenorphine may be
accessed on the department’s website at: www.health.vic.gov.au/dpcs/pharm
Suboxone® prescribing by general practitioners
Whereas Subutex® contains buprenorphine as the only active ingredient; Suboxone® also contains naloxone,
which was added to the formulation to deter injection of the drug.
In recognition of the lesser risk of diversion and less complicated pharmacokinetics of Suboxone® use, any
medical practitioner (after first obtaining a Schedule 8 treatment permit in relation to each patient) may prescribe
Suboxone® (sublingual films) for up to 5 patients without completing the training or assessment required to
prescribe methadone or Subutex®.
To ensure that their prescribing of Suboxone® is safe, appropriate and consistent with the current policy and
guidelines, medical practitioners who are not approved ORT prescribers should seek advice from an approved
prescriber (or DACAS) before prescribing to a patient. Guides (in document and video format) are also available
on the DPR website (at www.health.vic.gov.au/dpcs/pharm).
Notification of drug-dependence
A prescriber must notify DPR if there is reason to believe a patient is a drug-dependent person and the patient
seeks a drug of dependence or the medical practitioner intends to prescribe a drug of dependence.
This notification is a legislative requirement, which provides information to DPR. Notification enables DPR
officers to assist prescribers who might seek advice or apply for a permit to treat a person or to intervene to
address concurrent prescribing, when it is identified.
The notification also serves to inform DPR when a medical practitioner intends to treat a drug-dependent
person with a drug of dependence, in which case the corresponding box must be ticked.
The Notification Form, which is on the DPR website (at http://www.health.vic.gov.au/dpcs/reqhealth.htm), may
be submitted online.
Obtaining information for patients under treatment
In addition to its Prescription Shopper Information Service (PSIS), Medicare Australia is able to provide a
patient’s treating medical practitioner with detailed information about that patient’s consulting and prescription
history with other medical practitioners. Obtaining such information requires the consent of the patient but it
might be essential to the safe management of the patient.
See the Medicare Australia website:
www.medicareaustralia.gov.au/about/information/request-yourinfo.jsp (for further information)
http://www.humanservices.gov.au/spw/customer/forms/resources/2690-1003en.pdf (patient consent form)
Please refer to the document, “Obtaining information in relation to drug-seeking patients”, on the DPR website
(at www.health.vic.gov.au/dpcs/reqhealth) more information about patients who are suspected of drug-seeking
activities.
Other drugs
Medical practitioners should also consider the possibility that a patient might develop dependence to
medications that have not been classified as drugs of dependence. Similar problems and concerns have also
been identified in relation to patients receiving regular prescriptions for zolpidem (Stilnox ®), tramadol plus
Panadeine® Forte and other analgesics containing codeine.
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Department of Health
For further information
Department of Health (DH)
Drugs and Poisons Regulation,
GPO Box 4541
Melbourne 3001
Tel: 1300 364 545
Fax: 1300 360 830
Email: dpcs@health.vic.gov.au
Web: www.health.vic.gov.au/dpcs
Authorised and published by the Victorian Government, 50 Lonsdale St, Melbourne.
To receive this publication in an accessible format phone Drugs and Poisons Regulation on 1300 364 545 or
forward an Email to dpcs@health.vic.gov.au
February 2014
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Department of Health