Published: 17 December 2024
Consultations
Proposal to change the regulatory and funding restrictions for stimulant treatments for ADHD
Overview
Dexamfetamine, lisdexamfetamine and methylphenidate are medicines used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). They are classified as Class B controlled drugs by the Misuse of Drugs Act 1975.
Approval from the Minister of Health is required for a health practitioner to prescribe these medicines, pursuant to regulation 22 of the Misuse of Drugs Regulations 1977. This approval function is delegated to the Ministry of Health, and is administered by Medsafe.
Medsafe has issued approval notices under regulation 22 to enable the prescribing, supply and administration of these medicines by health practitioners under specific circumstances.
The current settings require treatment for ADHD to be initiated by a medical practitioner with a vocational scope of practice of paediatrics or psychiatry. For ongoing treatment of a patient under their care, any other medical practitioner or nurse practitioner may prescribe medicines for treatment of ADHD when acting on the written recommendation of one of the specified vocational medical practitioners.
Health practitioners and their professional activities, including prescribing decisions they make, are regulated by regulatory authorities, including the Medical Council of New Zealand and the Nursing Council of New Zealand. Medsafe expects all prescribers to prescribe in a manner that is consistent with their legislative, professional and ethical obligations, including the Code of Health and Disability Services Consumers’ Rights and any standards set by regulatory authorities.
The current approval notices are published in the New Zealand Gazette:
| Controlled Drug | Gazette Notice |
|---|---|
| Dexamfetamine | https://gazette.govt.nz/notice/id/2015-go761 |
| Lisdexamfetamine | https://gazette.govt.nz/notice/id/2022-go5683 |
| Methylphenidate | https://gazette.govt.nz/notice/id/2015-go760 |
Medsafe and Pharmac have been actively engaging with a multi-disciplinary group of experts from around New Zealand to review who can initiate prescribing of these medicines for the treatment of ADHD.
Based on the feedback from this group, Medsafe is proposing to update the current settings to enable additional practitioners to initiate prescribing.
Prescribing – current and proposed settings
The following classes of persons may prescribe the controlled drug products containing methylphenidate, dexamfetamine or lisdexamfetamine for a patient under their care, for the treatment of ADHD, in the specified circumstances.
Definitions:
A medical practitioner must be registered with and hold a current Annual Practising Certificate issued by the Medical Council of New Zealand under the Health Practitioners Competence Assurance Act 2003.
A nurse practitioner must be registered with and hold a current Annual Practicing Certificate issued by the Nursing Council of New Zealand under the Health Practitioners Competence Assurance Act 2003.
| CURRENT SETTINGS | ||
|---|---|---|
| PATIENT AGE | INITIATION OF PRESCRIBING | ONGOING PRESCRIBING |
| Any | Medical practitioners with a vocational scope of practice of paediatrics or psychiatry may initiate prescribing. | Any medical practitioner or nurse practitioner may prescribe when acting on the written recommendation of one of the practitioners who have initiated prescribing. |
| PROPOSED SETTINGS | ||
|---|---|---|
| PATIENT AGE | INITIATION OF PRESCRIBING | ONGOING PRESCRIBING |
| 17 years and under | Medical practitioners with a vocational scope of practice of paediatrics or psychiatry may initiate prescribing. Nurse practitioners working within paediatric services or child and adolescent mental health services, within their scope of practice, may initiate prescribing. | Any medical practitioner or nurse practitioner may prescribe when acting on the written recommendation of one of the practitioners who have initiated prescribing.* *Note. the written recommendations provided (for the treatment of ADHD) for dexamfetamine or lisdexamfetamine are interchangeable. (i.e. the following situations are considered to be ‘ongoing prescribing’ for the purposes of this Approval, where the prescriber considers it clinically appropriate: · prescribing of lisdexamfetamine may occur where the patient has been initiated on dexamfetamine. · prescribing of dexamfetamine may occur where the patient has been initiated on lisdexamfetamine. |
| 18 years and above | Medical practitioners with a vocational scope of practice of paediatrics, psychiatry or general practice may initiate prescribing. Nurse practitioners working within their scope of practice may initiate prescribing. | |
Consultation
We are seeking your feedback on the proposed updates. Please access the consultation published on the Pharmac website to provide your feedback
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