S8 Poison Laws

Question 1

What information does a schedule 8 prescription have to include?

Answer 1

• name, address and telephone number of the prescriber
• patient full name, address, and date of birth
• date of prescription (less than 6 months)
• medicine, strength, and form
• quantity for supply
• precise dosing directions
• number of times the prescription may be supplied
• a repeat interval, if the prescription is to be supplied more than once

Question 2

What action is required by a pharmacist if presented with a suspected fraudulent prescription?

Answer 2

Take possession of the prescription ASAP and forward the prescription to the CEO of the health department

Question 3

What does the term drug-dependent person mean?

Answer 3

Means a person who has acquired, as a result of repeated administration of drugs of addiction or Schedule 9 poisons, an overpowering desire for the continued administration of a drug of addiction or a Schedule 9 poison

Question 4

What are the emergency situations for someone who self-prescribes?

Answer 4

1. the immediate administration of the drug of addiction was necessary for therapeutic purposes
2. it was not reasonably practicable to arrange for another person to prescribe the drug of addiction without there being a delay that would pose an unreasonable threat to the health, safety and welfare of the person

Question 5

When does the practitioner need to inform the CEO of the health department about the drug-dependent status of a patient?

Answer 5

Within 48 hours of forming the belief

Question 6

What are the conditions required for a prescriber to give direction to a pharmacist to supply a medicine that is an S4 or S8 poison?

Answer 6

Prescriber must provide confirmation of directions by sending a prescription within 24 hours to the patient

• If pharmacist does not receive the prescription within 5 working days –> notify CEO of the health department

Question 7

What details does a pharmacist need to confirm when presented with a prescription for a schedule 8 drug? What happens if a pharmacist is unable to confirm these details?

Answer 7

• Authenticity of prescription
• Identity of person who issuesd the prescription
• The bona fides authenticity of the person presenting the prescription

If unable to confirm details: pharmacist may supply a quantity of medicine required to provide treatment for 2 days

Note: this process is not required for prescription issued by electronic prescribing systems

Question 8

In what situations does a pharmacist not dispense medication that is schedule 8. Provide 3 reasons

Answer 8

• More than 6 months old
• Illegible or appears to have been altered by a person other than the prescriber who issued it
• Or is cancelled

Question 9

Does a pharmacist keep the repeat prescription of a S8 drug? Can the repeats be transferred to another pharmacist?

Answer 9

Repeat prescriptions for S8 medicines must be retained by the pharmacy that dispenses the original prescription

• Repeats may not be transferred unless approved by the DOT

Question 10

What is the process of requesting a transfer of a repeat prescription for an S8 medicine?

Answer 10

• Requests should be made in writing using a form, the form should be faxed or emailed to the medicines and poisons regulation branch of the health department. A copy of the prescription should be attached
• Reason for transfer must be provided and a pharmacy must be nominated to receive the repeats

Transferring the prescription

• Repeat prescriptions may not be returned to the patient. The repeats should be posted to the new pharmacy and the pharmacy alerted to expect the transfer

Question 11

In what situations does a pharmacist cancel a prescription for a schedule 8 drug?

Answer 11

• the supply is the last repeat or only supply ordered,
• the prescription appears to be fraudulent or false in any manner

Prescription is cancelled by marking the words “cancelled” across the prescription

Question 12

Where are S8 poisons stored at relevant premises for the following amount of doses?

A) < 250 doses

B) Between 250 and 500 doses

C) > 500 doses

Answer 12

A) Small Safe

B) Small Safe with a monitored alarm

C) Large Safe with a monitored alarm

Question 13

How to store s8 poison in a pharmacy/pharmacy department of a hospital?

Answer 13

• in secure cabinet access to which is supervised at all times by a pharmacist
• in a large safe with a detection device
• in accordance with an approved alternative storage arrangement

Question 14

What are the requirements for transporting S8 medicines for commercial purposes? Provide three requirements

Answer 14

• that does not contain goods other than medicines that are Schedule 8 poisons (therefore they are separated)
• that is secure and sturdy without any exterior writing that might indicate the contents of the package
• that is clearly addressed to a person who is authorized to be in possession of the medicine

Question 15

When can S8 medicines be advertised?

Answer 15

Must be in a publication that is normally sold or intended for a sale only to health professionals or persons licensed to manufacture/supply medicines

Question 16

Can an authorized health professional administer/prescribe/supply an S8 medicine for a drug-dependent person/ oversupplied person?

Answer 16

Yes, an authorised health professional may administer/prescribe/supply S8 poison for the treatment of a patient who is drug dependent or oversupplied

CEO of the Health Department may authorize prescribing of specified medicine that is Schedule 8 poison to specified patient. The authorization —must be in writing, and may be subject to conditions; and may, at any time, be amended, suspended or revoked by the CEO

Question 17

A prescription for the supply of opioid pharmacotherapy must not cover a period of more than?

Answer 17

Must not cover a period of more than 3 months

Question 18

What information is required to be kept for an authorised health professional who administers or supplies a medicine that is an S4 or S8?

Answer 18

• the name, quantity, strength, and form of the medicine supplied or administered
• the address of the person treated or the name and address of the owner of the animal treated
• the date on which the medicine is supplied or administered
• if the medicine is supplied in accordance with a prescription

> the prescription reference number

> the date of issue of the prescription

• if the medicine is a Schedule 8 poison administered or supplied for the treatment of a person — the date of birth of the person
• if the medicine is a Schedule 8 poison — the name and address of the prescriber

Question 19

How long must the record of supply of medicine of S4 and S8 poisons be kept for? Who do these records have to be provided to?

Answer 19

S4 poison: be kept for at least 2 years from the date on which the medicine is administered or supplied

S8 poison: be kept for at least 5 years from the date on which the medicine is administered or supplied

> Record must be provided to the CEO of the Health Department in the manner and form and at the times specified by the CEO –> be produced for inspection on the request of the CEO or an investigator

Question 20

What information must be recorded in the register for S8s NOT dispensed on prescription?

Answer 20

• name, quantity, strength and form of the medicine supplied
• name address of the person ordering and receiving the medicines
• date of supply
• identifying number of any request document

Question 21

When can schedule 8/ schedule 9 medicines be destroyed?

Answer 21

No longer suitable for patient use, such as being expired, contaminated, damaged or otherwise unfit for human or animal use

• They must be destroyed and disposed of under the personal supervision of an authorized person

Question 22

Who are the persons authorised to destroy schedule 8/schedule 9 medicines?

Answer 22

Health practitioners ordinarily permitted to obtain, possess or supply an S8, such as medical practitioners, pharmacists, registered nurses, etc.

Question 23

Who witnesses the destruction of schedule 8/schedule 9 medicines?

Answer 23

Destruction of a Schedule 8 must also be independently witnessed by another approved person

• Each time a Schedule 8 is destroyed this action must be recorded in the approved transaction Register, including the date, item and quantity destroyed and reason for destruction

Question 24

What are the THREE main methods of destruction of S8/S9 medicines? Describe the processes.

Answer 24

FINAL DISPOSAL

• To physically dispose of a Schedule 8 medicine they should be first be made unidentifiable by removing all labelling and packaging, and then made physically or chemically unusable by breaking ampoules, emptying liquid contents, crushing tablets and using a disposal kit

Disposal kit

• Purpose made controlled drug disposal kits suspend the Schedule 8 medicine in a gel preventing retrieval. They are strongly recommended to maintain security and those with a chemical neutralising agent included are preferred

Secure Transfer

• While awaiting final disposal Schedule 8 medicines must continue to be held securely to prevent theft or diversion.
• Storage in an approved drug safe should continue, until immediately before final transfer to the place of incineration

Question 25

When do pharmacies have to provide information on supply of schedule 8 medicines?

Answer 25

At the end of each month

> includes dispensed items, doctors bag items and CPOP summaries

Send via:

• email to poisons@health.wa.gov.au
• post to Medicines and Poisons Regulation Branch, PO Box 8172 Perth Business Centre 6849

Question 26

What is the official way of correcting a schedule 8 register imbalance as stated by the chief pharmacist?

Answer 26

Identify the incorrect entry by means of an asterisk and then writing a marginal or footnote of the correct entry. If the mistake is discovered at the time of writing the correct entry may be placed on the next line in the S8 register, if the mistake is discovered at a later date then the correct entry would be placed at the foot of the page.

Question 27

Can prescriptions that are written by an interstate based practitioner for S4 and S8 medicines be dispensed in WA? What information is required?

Answer 27

Yes, all S4 medicines and most S8 medicines

To be valid, the prescriptions must:

• contain all the information normally required by WA legislation
• be issued by a class of prescriber authorised under WA law
• interstate S8 prescriptions must contain all additional information required for these documents in WA such as patient DOB, exact repeat interval and precise directions for use

Question 28

What S8 medicines require specific approval of the CEO of the health department to prescribe for interstate prescriptions?

> CEO doesn’t do this often so medications not dispensed by WA pharmacists

Answer 28

• opioid pharmacotherapy for treatment of dependence
• stimulants
• cannabis-Based Products (CBP)
• flunitrazepam, alprazolam or methadone

Question 29

What does the department records monitor for S8 medicines?

Answer 29

• oversupply
• excessive doses
• patients visiting large numbers of prescribers
• prescribing without authority
• prescribing that does not match an authority issued (wrong medicine, dose, form)
• other high risk usage (e.g. inappropriate form, inadequate repeat intervals, excessive medicines in combination)

Question 30

What is the WA prescribing code for S8 medicines?

Answer 30

Question 31

What do patients need to know about S8 prescriptions?

Answer 31

• Prescriptions can only contain one Schedule 8 medicine per prescription.
• Prescriptions are only valid for only 6 months and after that time they have expired and cannot be dispensed
• Prescriptions for Schedule 8 medicines must meet strict legal requirements and require the following additional information that prescribers MUST include:

> patient’s date of birth

> specific instructions for use

> the interval between dispensing repeat prescriptions

• Prescriptions for Schedule 8 medications can take longer for pharmacists to dispense as they require additional checking and recording procedures to be followed. Therefore, this may mean that patients may have to wait slightly longer to collect their prescription
• If a prescriber orders a repeat then they MUST include a repeat interval and it is this interval that determines when patients can collect their next supply of medication. Pharmacists cannot dispense a Schedule 8 medication repeat earlier than the specified date.
• All prescription repeats of Schedule 8 medicines must be kept at the same pharmacy that dispensed the original prescription.