Clinical update
The PSB and stimulant prescribing in WA T
By Ms Alpa Dodhia, Pharmacist and Coordinator Stimulant Regulatory Scheme, PSB DoH
he Pharmaceutical Services Branch (PSB) provides advice, develops policy and administers regulatory controls for Schedule 8 medicines including stimulant medicines (dexamphetamine and methylphenidate), the monitoring of which includes taking over 200 phone calls and sending out over 250 letters each month to prescribers over monitoring issues. PSB also provides education, training and support to prescribers and pharmacists. Prescribers can check the prescription history of new and existing patients prior to initiating stimulant medication by ringing the Stimulant Co-ordinator on 9222 2483 (Mon-Fri 8.30-16.30).
Stimulant Prescribing Code This Code, established in 2003, is the overarching regulatory framework that sets the clinical criteria for prescribing of stimulant medicines in WA. The aim is to ensure the most effective medication is prescribed and overall patient health and safety is maintained. Useful information and further resources on stimulant prescribing is located at www.health.wa.gov.au/stimulants. PSB processes approximately 1000 stimulant Notifications from specialist prescribers every month. General practitioners can be nominated as co-prescribers by the specialist medical practitioners who hold Stimulant Prescriber Numbers (SPNs). Patients with a history of substance abuse, bi-polar disorder or psychosis, require prior written authorisation from the Chief Executive Officer of Health before initiation of treatment. Prescribing of atomoxetine, a non stimulant does not require Notification to the Department of Health (DoH).
Stimulants Assessment Panel The Stimulants Assessment Panel meets monthly and provides advice on all applications for authorisation and consists of specialist psychiatrists and paediatricians from the public and private sector. In the past year, 68% of applications were declined and an appropriate stimulant treatment was recommended as per the strict protocol the panel uses when assessing applications.
Interim authorisations Interim authorisations may be issued to
GPs to prescribe stimulant medicines whilst patients are transitioning between specialists or have recently arrived from interstate/overseas. The GP needs to refer the patient to the most appropriate specialist and indicate a definite referral date on the application to prescribe a drug of addiction (see: www.health.wa.gov.au/ S8). An authorisation to prescribe a Schedule 8 medicine (including stimulants), which is granted by the CEO of the WA Department of Health, is separate to a Pharmaceutical Benefits Scheme (PBS) ‘authority prescription’, which is a Commonwealthfunded scheme providing affordable access to basic treatments for chronic health conditions under Medicare (see Schedule of Pharmaceutical Benefits, or phone 1800 552 580). Stimulant medications covered by WA’s PSB Stimulant Regulatory scheme are currently authority prescriptions requiring Authority approval numbers issued by Medicare or Department of Veteran Affairs (DVA). Note that paediatricians do recommend that children have regular holidays from stimulant medication i.e. during weekends and school holidays.
Diversion of stimulant medication As well as diversion for financial gain, DoH has come across several occasions where stimulant medication prescribed to children is being used by parents. The DoH liaises with the specialists, schools and hospital departments and a multi-
CASE HISTORY KM and her two children were diagnosed with ADHD and all prescribed stimulant medication. Over a 23 month period, KM accessed 8000 dexamphetamine tablets, 1430 more tablets than her notified dose. It became apparent that KM was also using the dexamphetamine tablets prescribed for her son and daughter. This was achieved by: • visiting multiple specialists (psychiatrists/paediatricians) and medical practitioners; • having prescriptions dispensed at multiple pharmacies; • requesting prescriptions due to ‘lost/ stolen’ tablets or prescriptions; and • taking advantage of times that medical practitioners were away. The PSB was alerted to the patient’s activities from phone calls from various parties, including pharmacists and PMH where the mother had presented without the children and requested dexamphetamine ‘on their behalf’. The children’s stepmother contacted PSB, concerned the children were not getting their medication. Finally, a paediatrician rang to express concerns that KM’s daughter was not getting the medication as prescribed and informed the department that the medication would now be dispensed at school.
disciplinary approach is used to confirm the diagnosis of ADHD in the child and then ensure the children receive their required medication.
New Initiatives for Fast-Growing Peel Peel is the happening location. Last month the state government committed $140,000 a year for five years to help establish a mobile health service for those in outlying areas in the region. The Peel Mobile Health Service, which starts this month, will provide health and health promotion services to the communities of Pinjarra, Waroona, Boddington, Serpentine and Jarrahdale medicalforum
from a modified vehicle which can operate at difference locations, even sites without water. It is a joint initiative between WA Health, the Peel Health Foundation and GP Down South. The Peel Health Foundation raised more than $220,000 to buy and modify the vehicle, and the WA Health commitment will keep it on the road. GP Down South are the service providers.
The Peel Health Campus has also recently launched the PHC Community Fund to raise funds for community campaigns raising health awareness and wellbeing programs. Health Solutions WA, which manages PHC, kicked off the fund with a $250,000 contribution. The grants procedure is explained on the PHC website or through the community relations team.l 45