Prescribing stimulants for ADHD

All health practitioners who prescribe a controlled medicine under the Standing CHO Approvals must register for and review and consider relevant patient information in Canberra Script prior to prescribing.

All prescriptions for stimulants prescribed under the Standing CHO Approvals, for both GPs and non-GP specialists, must be generated electronically.  Electronic prescriptions must be either as a prescription token or a computer-generated prescription printed from clinical software with connection to the Australian Digital Health Agency’s (ADHA) National Data Exchange (NDE).

Canberra Script helps to reduce risks in prescribing monitored medicines and allows high-risk medicines to be effectively monitored. It may reduce administrative paperwork for clinicians and support timely access for patients.

Health practitioners can register for Canberra Script and can receive technical support by emailing canberrascript@act.gov.au.

If you have completed specified training, you can continue prescribing ADHD stimulant medicines for stable patients aged 6 years and older, after diagnosis by a defined non-GP specialist – psychiatrist, paediatrician or neurologist. You must notify the CHO and receive confirmation from Health Protection Services (HPS) of your notification prior to prescribing under the Standing CHO Approval.

Under the Standing CHO Approval, you may make dose adjustments within defined maximum daily dose limits as part of ongoing treatment. Switching between ADHD medicines is permitted within a class of medications only (that is, immediate-release to slow-release).

Medicines and dose limits:

• Dexamfetamine: up to 50 mg per day
• Lisdexamfetamine: up to 70 mg per day
• Methylphenidate: up to 108 mg per day

Prescribing of these ADHD medications outside of these dosage ranges and patient criteria will still require individual CHO approval and support from the relevant paediatrician, psychiatrist or neurologist. This includes when patients are:

• not stable or require medication class switching
• children aged under 6 years
• drug-dependent patients.

GPs will continue to make referrals to paediatricians, psychiatrists, neurologists, or allied health professionals such as psychologists, and escalate care, if required to make sure their patients are receiving the treatment they need.

For GP continuation prescribing, you must have completed at least one of the below approved training courses prior to prescribing under the Standing CHO Approval.

RACGP GPlearning completion of these 2 modules:

• Identification and management of ADHD
• The pharmacological management of ADHD.

Medcast ADHD Uncovered completion of these 2 modules:

• Diagnosis and management of ADHD
• Pharmacological management of ADHD.

The Academy by Psych Scene completion of these 3 modules:

• Diagnosis and management of ADHD in childhood and adolescence
• A comprehensive guide to adult ADHD in general practice
• Advanced ADHD psychopharmacology: medications, neuroscience and prescribing guidelines for clinicians.

Once training is complete, GPs must notify HPS of their intention to prescribe by completing the online notification form.

Psychiatrists, paediatricians, and neurologists will not need CHO approval to prescribe ADHD stimulant medicines for non-drug dependent patients aged 4 years and older, provided doses stay within the defined maximum daily dose limits.
Medicines and dose limits:

• Dexamfetamine: up to 50 mg per day
• Lisdexamfetamine: up to 70 mg per day
• Methylphenidate: up to 108 mg per day

CHO approval is required for:

• higher doses
• drug-dependent patients
• scenarios outside the conditions in the Standing CHO Approval.

No additional training is required for these defined non-GP specialist prescribers.

Some of the GPs with whom you share patient care may complete training to become continuation prescribers under the stage 1 expanded scope of practice for GPs in the ACT. This enables the GP to continue prescribing medications for patients who are stable, including minor dosage adjustments, but not changes to the class of medication. If you believe your patient may require a more complex change of medication dosage and/or type or medicine, you can provide the patient’s GP with written documentation to support these changes. The GP may use this under to make changes medication class under the existing shared care protocols with a CHO approval.

GPs who have not undertaken the training to become continuation prescribers will continue to prescribe under the ongoing shared care model with CHO approval. Their patients will continue to require non-GP specialist review every 3 years and a letter of specialist support to submit with their CHO approval application. The scope of their prescribing is defined by your handover letter.