Managing Schedule 8 Medicines Safely

Schedule 8 medications can have an increased potential for abuse, misuse and physical or psychological dependence (Healthy WA 2024). It is essential to understand your professional obligations when managing and administering these medicines to the people in your care.

Staff working in residential aged care must be familiar with the Guiding Principles for Medication Management in Residential Aged Care Facilities, which outlines recommendations for medication management in residential aged care settings based on current best practices (DoHaAC 2022).

Staff must also be aware that state and territory legislation may impose additional, binding requirements that go beyond these guiding principles. Residential aged care staff in Victoria should be aware of an important change: from 1 July 2026, new legislation limits who can administer certain medicines. Drugs of Dependence, along with Schedule 4, 8 and 9 medicines, can only be administered by registered nurses, enrolled nurses and registered health practitioners, except in a small number of specific circumstances (DoH 2026a).

What is Medication Scheduling?

Scheduling is the classification system used in Australia to regulate the availability of medicines and poisons. Medicines and poisons are classified into 10 schedules depending on the level of safety risk they pose. Each schedule has its own level of regulatory control that dictates how freely available it is to the general public, with lower-risk medicines generally being less tightly regulated (TGA 2023; Drugs, Poisons and Controlled Substances Regulations 2017).

The aim of scheduling is to protect the health and safety of the general public by exercising greater control over medicines that are more likely to cause harm or be misused (Healthdirect 2022).

What are Schedule 8 Medicines?

Schedule 8 medicines are 'controlled drugs' that must meet specific conditions when produced, supplied, distributed, owned and used (Drugs, Poisons and Controlled Substances Regulations 2017).

Like Schedule 4 medicines, Schedule 8 medicines are prescription-only. However, they are more tightly controlled than those in Schedule 4.

Schedule 8 medicines are classified as drugs of dependence. While they can offer significant therapeutic benefits, including severe pain relief and management of attention-deficit/hyperactivity disorder (ADHD), they also pose a high risk of misuse, abuse and dependence. For this reason, they require strict regulation (Drugs, Poisons and Controlled Substances Regulations 2017).

Medicines that are classified as Schedule 8 include, but are not limited to:

Opioid analgesics, including:

• Buprenorphine
• Codeine
• Fentanyl
• Hydromorphone
• Methadone
• Morphine
• Oxycodone
• Oxycodone with naloxone
• Pethidine
• Tapentadol

Cannabis*

Stimulants, including:

• Dexamfetamine
• Lisdexamfetamine
• Methylphenidate

Ketamine

Benzodiazepines (flunitrazepam and alprazolam)

Cocaine.

(Poisons Standard February 2026)

*Note: For more information on the scheduling of cannabis, tetrahydrocannabinol and cannabidiol, see: Medicinal Cannabis Access Pathways and Patient Access Data.

What Are the Risks of Schedule 8 Medicines?

Schedule 8 medicines are associated with a risk of dependence and, consequently, drug-seeking behaviour. This term describes a range of activities that may be performed to obtain a desired medicine for misuse (James 2016). Drug-seeking behaviour and medicine misuse may adversely affect relationships, finances and mental and physical health. It may also have legal consequences if the individual partakes in unlawful activities (DoHaAC 2019).

Real-time monitoring programs such as SafeScript in Victoria, TasScript in Tasmania, SafeScript NSW, ScriptCheck SA, ScriptCheckWA, Qscript in Queensland and Canberra Script are being used to identify overuse, fraudulent behaviour and ‘doctor shopping’. This occurs when an individual attempts to illicitly obtain medicine from multiple practitioners simultaneously (DoH 2026c; Choahan 2018).

However, while real-time monitoring programs can help identify people who are at risk, they may also have unintended consequences. Practitioners may negatively stereotype at-risk individuals, fear sanctions, or hold other concerns that lead to a person receiving delayed treatment or being discharged from care entirely. Even the term 'doctor shopping' may be unhelpfully contributing to the stigmatisation of these people. Therefore, it is important that people identified as 'at-risk' are treated with respect and receive individualised care free from bias (Dobbin & Liew 2020).

Issues Related to Opioids

Pharmaceutical opioids are responsible for a significant number of deaths and poisoning hospitalisations in Australia. Every day, there are approximately 150 hospitalisations, 14 emergency department admissions and 3 deaths related to opioid use (PBS 2020; TGA 2021).

According to research conducted by the Therapeutic Goods Administration:

• Only half (53%) of those taking opioids knew they were taking an opioid medication, and 18% were unfamiliar with the term 'opioids'
• Only 17% of those taking opioids believed they were using them safely and effectively, and that they were not dependent
• Only 2% of those taking opioids could identify every prescription opioid medicine
• Only half (56%) of those taking opioids believed they were using them safely
• One-third (30%) of those taking opioids considered themselves dependent.

(TGA 2021)

As a result of this research, there have been many changes implemented by TGA, including:

• Smaller pack sizes for immediate-release prescription opioids to reduce the circulation of unused opioids in the community.
• TGA sponsors (the TGA-registered supplier of the medicine) are required to include boxed warnings and class statements in the Product Information (PI) documents for all prescription opioids about their potential for harmful and hazardous use.
• Safety information, including relevant warnings, is prominently displayed in the Consumer Medicines Information (CMI). This aims to ensure that language and information remain consistent across all prescription opioid classes.
• Indications in the PI documents for immediate-release and modified-release products reinforce that opioids should only be used when other analgesics are not appropriate or have been proven ineffective.
• Hydromorphone and fentanyl modified-release products are contraindicated for 'opioid naive individuals', i.e. those who do not already use opioids regularly.
• There are stronger restrictions on the use of fentanyl, which is one of the strongest opioids available in Australia.
• There is increased education for both prescribers and consumers.

(TGA 2021)

Prescribing Schedule 8 Medicines

Depending on the state or territory in which they are operating, the prescriber may need to obtain a permit to prescribe a Schedule 8 medicine. The exact requirements, including who can prescribe and for how long, will depend on the jurisdiction and the individual's medical diagnosis. PBS regulations have also changed to reduce opioid prescribing (PBS 2020). Regulations for hospitals and private hospitals differ from those for residential aged care facilities.

A pharmacist cannot supply a Schedule 8 medicine on a chart instruction given on a paper residential medication chart. Instead, a separate prescription for the Schedule 8 medicine is required.

In July 2022, the Federal Government implemented an eNRMC (Electronic National Residential Medication Chart) Transitional Arrangement, allowing residential aged care services, prescribers and pharmacists to use Transitional eNRMC Products for PBS medication chart prescribing, dispensing and administration (DoH 2022).

In the case of an emergency (as determined by the prescriber), a pharmacist can lawfully supply an older person's Schedule 8 medicine upon verbal instruction from the prescriber (Drugs, Poisons and Controlled Substances Regulations 2017).

In such circumstances, the prescriber who issued the verbal instruction must provide written confirmation (most commonly in the form of a prescription) to the pharmacist as soon as practicable (Drugs, Poisons and Controlled Substances Regulations 2017).

In Victoria, permits are not required to prescribe Schedule 8 medicines to aged care residents or hospitalised patients, as they do not manage their own medicines. This greatly decreases the risk of concurrent prescribing or doctor shopping (DoH 2025).

Possessing Schedule 8 Medicines

It is a criminal offence to possess a Schedule 8 medicine unless authorised. A registered nurse (or other appropriately qualified practitioner) is allowed to possess a Schedule 8 medicine for the purpose of administering it to a person in their care. This must be done in accordance with other specific conditions (DoH 2025).

Administering Schedule 8 Medicines

In Victorian residential aged care facilities, a registered or enrolled nurse must manage the administration of Schedule 8 medicines in accordance with the relevant requirements of the Nursing and Midwifery Board of Australia. A small exemption applies for rare situations, for example, if a medical emergency, fire or flood suddenly leaves no nurse available. In these cases, if a dose is time-sensitive and can't wait, it may be delegated to a non-nurse staff member, such as a personal care worker.

In Victoria, personal care workers are not permitted to administer Schedule 4 or Schedule 8 medicines unless a specific exemption applies. This restriction also extends to medicines packed in a Dose Administration Aid (DAA) (DoH 2026a).

Providers must document any such unforeseen events, as the Health Regulator may request these records if concerns about non-compliance are raised (DoH 2026a).

When administering a Schedule 8 medicine, the nurse must refer to either:

• Written directions from a medical practitioner or nurse practitioner (or other authorised practitioner)
• In the case of an emergency, oral instructions from a medical practitioner or nurse practitioner (or other authorised practitioner)
• A written transcript of emergency instructions by the nurse who received them, or
• Directions for use on the medicine's container are provided by a medical practitioner, pharmacist or other authorised practitioner.

(DoH 2026a)

To learn more about the new legislation introduced in Victoria, see Nurses in Residential Aged Care Facilities – Legal Requirements.

Storing Schedule 8 Medicines

There are specific guidelines for the storage of Schedule 8 medicines in residential care homes. In Victoria, Schedule 8 medicines must be stored in a locked storage facility that is fixed to a floor or wall (DoH 2026b).

Steel medicine cabinets are strongly recommended for medicines stored in their original containers or for those unsuitable for storage in dose administration containers. There are certain cases in which steel medicine cabinets are required.

In some cases, unused components of a Schedule 8 medicine or its container may need to be destroyed or discarded. This must be recorded. A witness is required while the medicine is being destroyed.

Imprest Systems

In Victoria, these require a permit from the Department of Health and Human Services, an approved list of drugs and strict protocols for ordering, administration and record-keeping (DoH 2026b).

For more information, see Residential Aged Care: Medication Storage and Record Keeping.

Identifying Drug-Seeking Behaviour

In addition to adhering to legislation and guidelines related to Schedule 8 medicines, it is also important to be aware of potential drug-seeking behaviour.

Potential indicators of drug-seeking behaviour include:

• Persistent or urgent requests for a specific medicine or dose by name
• Requests for the dose to be increased without an indication of increased pain
• Reports that alternative medicines are ineffective or cause an allergic reaction, without a documented or verifiable history
• Increased anger and agitation when questioned about symptoms
• Vagueness or reluctance to provide information about medication history
• An unusually significant level of knowledge about medicines and symptoms
• Taking extra or unauthorised doses
• Stockpiling or accumulating medicines
• Using medicines supplied from friends, family or illicitly
• Refusal to consider alternative medicines or treatment options
• Greater focus on obtaining the medicine than on the underlying health issue
• Use of threats or bribery to obtain medicine
• Impatience or pressure to expedite medicine administration
• Physical symptoms of intoxication or drug withdrawal

(QLD Health 2024; James 2016; The Avant Learning Centre 2023)

Note: Legislation and requirements differ between states and territories, and administrative restrictions similar to those introduced in Victoria may already be in place or be introduced elsewhere. Always check current legislation for your jurisdiction, in addition to your organisation's policy on Schedule 8 medicines.

Conclusion

Managing Schedule 8 medicines safely requires a clear understanding of your professional obligations, from prescribing and possession through to administration, storage and disposal. These medicines offer significant therapeutic value but carry a high risk of misuse and dependence, making strict adherence to legislation and organisational policy essential.