Paediatricians: No wait, interstate?
Here are some important clarifications that you need to know from the Department of Health’s Medicines and Poisons Regulations Branch.
ADHD medications & WA regulations
There’s been a lot of buzz on local parent groups about using interstate paediatricians or psychiatrists to have children evaluated for developmental or behavioural concerns.
Two year wait times – you’ll do anything right? And with some families getting in within weeks interstate, it’s a very attractive option.
Here are some important clarifications from the Western Australian Department of Health that may help you navigate the best care for your child.
Note, these apply to Western Australia only as each state has their own rules and regulations.
Cue eyeroll … you would think that there would be some kind of national agreement right?
It’s not as though you’re crossing international borders. But for those moving to Perth it may feel like it!
Parents can have an interstate paediatrician or psychiatrist assess and diagnose their child, either by flying there or via telehealth.
The Medicines & Poisons Act 2014/Regulations 2016 do not regulate diagnosis of conditions such as ADHD or autism, only the prescription of Schedule 8 stimulant medications.
If you are considering applying for an Individual Disability Allocation for autism or other supported disability, it is worth checking with your school first if they will recognise an interstate diagnosis.
[And, seriously … if they won’t then that is some next level BS because have they heard about the waitlists here?????????]
Pros of an interstate diagnosis
👍Some families have been able to get an appointment within weeks, bypassing the average wait time of 18 months in Western Australia.
👍Others have found they can get a full assessment done faster interstate than in WA, helping them to get answers and support.
👍Some families have reported that telehealth consultations gave a more realistic insight into their child’s behaviour.
👍Their child was more comfortable in their home environment and demonstrated more natural behaviours with less masking.
Cons of an interstate diagnosis
Pharmacies in WA are NOT allowed to dispense certain stimulant medicines in WA if they have been prescribed by an interstate doctor.
This includes stimulant medications often used for ADHD such as dexamphetamine (Dex) lisdexamphetamine (Vyvanse) and methylphenidate (Ritalin).
Otherwise known as Schedule 8 stimulant medications.
WA’s Medicines & Poisons Regulations 2016 only apply within WA.
This means the WA Department of Health can only authorise a WA-based specialist as an “authorised stimulant prescriber”.
Don't be taken advantage of
If an interstate provider promises to you that they are an authorised stimulant prescriber in WA –
THAT’S NOT TRUE.
Not all providers are aware of the differences in State regulations.
There is a particular provider in Brisbane whose practice is telling patients that they ARE authorised to prescribe stimulants in WA.
THAT IS INCORRECT.
If a friend tells you that they’ve had no problems getting e-scripts for stimulant medications filled here from interstate prescribers – be wary.
If someone in a Facebook group tells you they got in within weeks, diagnosed same day and are now on stimulant medications.
They’re not fibbing. They have just been lucky.
You may find that a chemist checks the prescriber details in the future and refuses to dispense the medication.
And you’ll be up Schitts Creek without medications. 🤯
So, ask yourself, do you feel lucky?
Some good news ...
Restrictions only apply to Schedule 8 stimulants and don’t apply to Schedule 4 medications such as atomoxetine and guanfacine.
While not ideal, interstate prescribers CAN have scripts dispensed outside of WA and posted to you here. Including Schedule 8 stimulants.
It seems like an illicit drug shipment but it’s above board according to the Department.
But seriously, if you’re concerned call them and check, they’re doing an awesome job answering curly questions.
Stay tuned for more flexibility in the future as they work on modernising the regulations.
The benefits of e-scripts...
In the days of paper scripts, you were locked into having S8 stimulant medications dispensed from one nominated chemist.
The introduction of e-scripts has made it much harder for anyone to provide forged scripts and you can now have your medications dispensed at more than one chemist.
It only applies to e-scripts though.
Some chemists will want to verify a doctors handwriting or speak to them verbally before dispensing if you are using paper scripts.
Ask your treating specialist to move with the times to make it easier on you.
30 days at a time
In WA, prescribers stipulate the NUMBER of repeats and the INTERVAL for dispensing repeats on the S8 prescription.
This is usually once every month.
So every month you go back to the chemist to have the stimulants dispensed for the next month.
But … what if you’re going on holidays out of state or overseas and will be away when your next script is due?
Chemists can’t dispense the medications early.
But, Doctors can write “Reg 24” (now Reg 49) which allows the pharmacy to dispense all repeats at once.
In WA, prescriptions for all S8 medicines are valid for six months.
So if you Doctor does this, you could have up to six months of medications dispensed.
This may also be helpful for those getting medications posted from interstate rather than relying on monthly deliveries (and potential delays).
What does this all mean?
It’s confusing, it’s complicated, there’s a lot to know and you really don’t want to be left without a continuous supply.
For neurodivergent parents managing stimulant medications for (often multiple) neurodivergent children, it can be an executive function disaster.
So what do the regulations mean in practical terms?
Here are a few example scenarios that have been playing out.
Example 1: Stable medications
John is 10 years old and on stimulant medication for his ADHD.
After some trial and error he is now on a long-acting stimulant medication and is doing well.
John’s parents ask their GP if she is willing to be a co-prescriber and she agrees.
John’s paediatrician completes the necessary authorisation paperwork.
The GP continues prescribing medication as per the specialist’s instructions.
The GP cannot change the stimulant type, formulation or dose without authority of the specialist.
John reduces his biannual appointments with his paediatrician to an annual review.
The family find this more convenient and cost effective.
Example 2: Interstate Telehealth
Example 3: Flying Interstate
Example 4: Medication unavailable
TLDR: The rules, according to WA
Where you should get your official advice from
Don’t get it from Facebook. Hell, don’t even take it from me.
Get your advice on all the little nuances of these regulations from the source.
The Department of Health regularly updates information on their website as things change relating to stimulant medicines.
For the latest advice it is always best to check their website at: health.wa.gov.au > search for stimulant medicines.
Or, you can call the Medicines & Poisons Regulation Branch on 9222 6883.
Stimulant prescribing legislation in WA will be changing in the future [hoorayyyy], once amendments to the Medicines and Poisons Regulations have been made.
When the change occurs, it will be communicated by Department of Health.
I don’t know how it will be communicated or to who, but I’m told all stakeholders will be notified.
So just in case I don’t make the stakeholder list, please do your own due diligence on how the regulations affect you.
Over to you
How do you stay on top of managing medications? Share your comments below.