Schedule 8 medicines are associated with significant risks. It’s essential to be aware of your professional obligations when managing and administering these medicines for your clients.
This article is intended for registered nurses and medication-endorsed enrolled nurses. However, the principles apply to all staff who manage and/or administer medication, including personal care assistants/other care workers working under supervision.
Note: This article primarily references Victorian legislation. See: https://www.health.vic.gov.au/public-health/medicines-and-poisons-regulation
However, you can find resources about other state legislation at the end of this article.
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).
Read: Drug Scheduling: Understanding the Basics
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).
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 offer significant therapeutic benefits, including severe pain relief (for cancer and major surgery) 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:
(Poisons Standard February 2024)
* Note: For more information on the scheduling of cannabis, tetrahydrocannabinol and cannabidiol, see: https://www.tga.gov.au/products/unapproved-therapeutic-goods/medicinal-cannabis-hub/medicinal-cannabis-access-pathways-and-patient-access-data
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 in order to obtain a desired medicine for the purpose of 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, Drugs and Poisons Information System Online Remote Access (DORA) 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 (Health.vic 2023a; Choahan 2018).
However, while real-time monitoring programs can help identify patients who are at risk, they may also have unintended consequences. Practitioners may negatively stereotype at-risk patients, fear sanction or hold other concerns that lead to a patient 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 those patients identified as 'at-risk' are treated with respect and receive individualised care free from bias (Dobbin & Liew 2020).
Compared to illegal opioids (such as heroin), pharmaceutical opioids are responsible for significantly more deaths and poisoning hospitalisations in Australia. Every day, there are about 150 hospitalisations, 14 emergency department admissions and 3 deaths related to opioid use (TGA 2021).
According to research conducted by the Therapeutic Goods Administration:
(TGA 2021)
As a result of this research, there have been many changes implemented by TGA, including:
(TGA 2021)
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 how long they can prescribe for, will depend on the jurisdiction and the patient’s medical diagnosis. PBS regulations have also changed to reduce opioid prescribing. 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). For more information, see: https://www.health.gov.au/sites/default/files/documents/2022/06/electronic-national-residential-medication-chart-enrmc-transitional-arrangement-prescriber-information-pack.pdf
In the case of an emergency (as determined by the prescriber), a pharmacist can lawfully supply a resident’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 in order to prescribe Schedule 8 medicines to aged care residents or hospitalised patients, as they do not manage their medicines personally. This greatly decreases the risk of concurrent prescribing or doctor shopping (Health.vic 2023b).
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 patient in their care. This must be done in accordance with other specific conditions (Health.vic 2023b).
Only practitioners who have been endorsed by the Nursing and Midwifery Board of Australia are allowed to supply Schedule 8 medicines (i.e. provide a medicine to be administered at a later time). However, even if you are not endorsed, you are still allowed to deliver medicines (apart from starter packs) to clients as long as they have been lawfully supplied (Health.vic 2023b).
In Victorian residential aged care facilities, a registered nurse must manage Schedule 8 (and Schedule 4) medicine administration in adherence to relevant requirements from the Nursing and Midwifery Board of Australia. This nurse may choose to delegate medicine administration duties to other staff, including other nurses and endorsed enrolled nurses. Personal care workers can only administer medications from a Dose Administration Aid.
When administering a Schedule 8 medicine, the nurse must refer to either:
(VIC DoH 2015b)
There are specific guidelines for the storage of Schedule 8 medicines in residential aged care facilities.
In Victoria, Schedule 8 medicines must be stored in a locked storage facility that is fixed to a floor or wall (Health.vic 2021).
Steel medicine cabinets are strongly recommended for medicines that are stored in their original containers or are unsuitable to be stored 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.
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. For more information, see: https://www.health.vic.gov.au/drugs-and-poisons/residential-aged-care-medicine-storage-and-record-keeping
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.
Look out for clients who:
(James 2016; The Avant Learning Centre 2023; SEMPHN 2019)
Note: Legislation and requirements may differ between states and territories. Always refer to your organisation's policy on Schedule 8 medicines.
Assign mandatory training and keep all your records in-one-place.
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