Please resolve the following issues before proceeding
Click on an issue to go directly to the related section of the form.
errors found:
warnings found:

Getting Started

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required
Please note all Schedule 8 permits and correspondence are no longer faxed or emailed to medical clinics and are now sent to SafeScript for you to view and/or download. The SafeScript portal will also provide you with the status of your permit application. For help using SafeScript, please download the FAQ document Using SafeScript - most commonly asked questions for prescribers or visit SafeScript information for prescribers for more information.


To save time filling out the form in the future, please tick the checkbox at the end of the form to confirm that you want to save your Prescriber Details on this computer. Future use of this form on this computer will automatically populate with your Prescriber Details.

Select an option below

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Patient treatment details

Please select one of the options below

*Please note you will be requested under the Treatment Details of this application form to indicate the reason(s) you believe your patient is drug-dependent.

For circumstances that might (or should) be a reason to believe that a patient is a drug-dependent person, please click here.


Please click CONTINUE below.

A Schedule 8 permit is not required. For more information, please refer to the Victorian Government Gazette notice or visit Schedule 8 treatment permits - requirements in Victoria.
NOTE: If you have reason to believe your patient is drug-dependent, please select Option 1 above. Click here for circumstances that might (or should) be a reason to believe that a patient is a drug-dependent person.Otherwise, you do not need a Schedule 8 permit.

A Schedule 8 permit is not required. For more information, please refer to the Victorian Government Gazette notice or visit Schedule 8 treatment permits - requirements in Victoria.To calculate your patient's total morphine equivalent dosage (MED), please download the Opioid Tapering Calculator.
NOTE: If you have reason to believe your patient is drug-dependent, please select Option 1 above. Click here for circumstances that might (or should) be a reason to believe that a patient is a drug-dependent person.Otherwise, you do not need a Schedule 8 permit.

Schedule 8 permits are no longer required if the patient is not drug-dependent and one of the scenarios below are applicable (and the prescriber checks SafeScript prior to prescribing):Opioid analgesics
•For the treatment of medical conditions where an opioid analgesic is required, provided the total daily dose of the following opioid(s) does not exceed 100mg in morphine equivalent dose (MED):◦HYDROMORPHONE oral, max. dose 20mg daily◦MORPHINE oral, max. dose 100mg daily◦OXYCODONE oral or suppository, max. dose 65mg daily◦TAPENTADOL oral, max. dose 300mg daily◦BUPRENORPHINE patch, max. dose 40mcg/hr weekly◦FENTANYL patch, max. dose 25mcg/hr every three days
To calculate your patient's total morphine equivalent dosage (MED), please download the Opioid Tapering Calculator.

•Opioid analgesic in the treatment of pain caused by cancer or complication arising from cancer; and the diagnosis of pain caused by cancer or complications arising from cancer is made by a registered medical practitioner.

Psychostimulants
•Paediatricians treating a patient less than 18 years old with a psychostimulant drug approved by the Therapeutic Goods Administration for the treatment of attention deficit hyperactivity disorder.•Consultant psychiatrists treating a patient with a psychostimulant drug approved by the Therapeutic Goods Administration for the treatment of attention deficit hyperactivity disorder.

Palliative care
For the intention of palliative care treatment where: •the person to be administered, supplied or prescribed the Schedule 8 poison is suffering an incurable, progressive, far-advanced disease or medical condition; and•the prognosis is of limited life expectancy due to the disease or medical condition; and•the administration, supply or prescribing of the Schedule 8 poison is intended to provide palliative treatment.

If you still require a permit, please click CONTINUE below:

Prescriber Details

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Your details

To save time filling out the form in the future, please tick the checkbox at the end of this form to confirm that you want to save your Prescriber Details on this computer. Future use of this form on this computer will automatically populate with your Prescriber Details.

Patient Details

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Patient Details

Treatment Details

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Patient treatment details

Medicinal Cannabis Product
Please note that additional documentation may be required before your application can be assessed (eg. evidence of Commonwealth Therapeutic Goods Administration approval to prescribe a product not listed on the Australian Register of Therapeutic Goods)
Do you have additional documentation to support your application?

Supporting documentation

Please attach your supporting documentation here
File:
Please note: You may be requested to supply additional documentation to support your application (eg. evidence of Commonwealth Therapeutic Goods Administration approval to prescribe a product not listed on the Australian Register of Therapeutic Goods)
Drug and Dosage Details *
Name of drug *
Dose form *
Dose *
Unit *
Frequency *
Do you have any recent specialist report or additional information to support your application?

Supporting documentation

Please attach your supporting documentation here
File:
Please note: You may be requested to supply specialist report or additional information to support your application.
Evidence-based practice guidelines recommend that specialist advice should be sought for patients requiring opioid doses exceeding oral morphine 100mg daily, oxycodone 65mg daily or equivalent, for the treatment of chronic non-cancer pain, or when prescribing opioids to a patient with a history of drug dependency or aberrant drug-related behaviours. Opioids should only be prescribed as part of a comprehensive pain management plan. When applying for a permit to treat a patient with an opioid, applicants may be requested by the Secretary to provide the Secretary with evidence of a pain management plan or specialist review.

The morbidity and mortality risks associated with long term opioid therapy should be discussed with the patient; in particular the increased mortality risks correlated with the prolonged use of opioids at doses exceeding 100mg daily in morphine equivalents.
*Please indicate in the Additional Comments below the reason(s) you believe your patient is drug-dependent.
For circumstances that might (or should) be a reason to believe that a patient is a drug-dependent person, please click here.

Declaration

Application for a permit to treat a patient with Schedule 8 drugs
Fields marked with * are required

Schedule 8 permit NOT required


Based on the option selected on the previous page, a Schedule 8 permit is not required for your patient, unless you have reason to believe this patient is drug-dependent. For more information, please refer to the Schedule 8 permit exceptions listed below or refer to the Victorian Government Gazette notice or visit Medicines and Poisons Regulation.If you have reason to believe your patient is drug-dependent and therefore still require a permit, please GO BACK to the previous page and select Option 1. For circumstances that might (or should) be a reason to believe that a patient is a drug-dependent person, please click here. To close this application form, please EXIT your web browser.
Fields marked with * are required

Declaration

This application forms part of a legal document and penalties exist for providing false or misleading information.

I, confirm the information I provided in this application is true and complete to the best of my knowledge

Privacy Statement

It is a requirement of the Drugs, Poisons and Controlled Substances Act 1981 (the Act) that the information set out in this form is provided to the Department of Health to meet statutory notification requirements, and for the issuing of permits as required under the Act. The collection, use and disclosure of the information provided will be in accordance with the law, including the provisions of the Health Records Act 2001. The information collected may be disclosed to health practitioners practising in the following health professions: medical, nursing and midwifery and pharmacy, when necessary to facilitate coordination of the patient's drug treatment and safe prescribing of drugs. For example, it may be necessary to disclose this information when another health practitioner applies for a permit or is considering prescribing a drug of dependence. The application may not be processed if all information requested on the form is not completed.

Schedule 8 Permit Exceptions for patients who are NOT drug-dependent:

A registered medical practitioner or nurse practitioner is authorised to prescribe a Schedule 8 poison to or for a person who is not a drug-dependent person during a continuous period greater than 8 weeks without a Schedule 8 permit, if the prescription of that Schedule 8 poison is to treat that person in the circumstances specified below:Opioid analgesics
•For the treatment of medical conditions where an opioid analgesic is required, provided the total daily dose of the following opioid(s) does not exceed 100mg in morphine equivalent dose (MED):◦HYDROMORPHONE oral, max. dose 20mg daily◦MORPHINE oral, max. dose 100mg daily◦OXYCODONE oral or suppository, max. dose 65mg daily◦TAPENTADOL oral, max. dose 300mg daily◦BUPRENORPHINE patch, max. dose 40mcg/hr weekly◦FENTANYL patch, max. dose 25mcg/hr every three days
To calculate your patient's total morphine equivalent dosage (MED), please download the Opioid Tapering Calculator.

•Opioid analgesic in the treatment of pain caused by cancer or complication arising from cancer; and the diagnosis of pain caused by cancer or complications arising from cancer is made by a registered medical practitioner.
Psychostimulants
•Paediatricians treating a patient less than 18 years old with a psychostimulant drug approved by the Therapeutic Goods Administration for the treatment of attention deficit hyperactivity disorder.•Consultant psychiatrists treating a patient with a psychostimulant drug approved by the Therapeutic Goods Administration for the treatment of attention deficit hyperactivity disorder.
Palliative care
For the intention of palliative care treatment where: •the person to be administered, supplied or prescribed the Schedule 8 poison is suffering an incurable, progressive, far-advanced disease or medical condition; and•the prognosis is of limited life expectancy due to the disease or medical condition; and•the administration, supply or prescribing of the Schedule 8 poison is intended to provide palliative treatment.
You are reminded that you must take all reasonable steps to check SafeScript prior to prescribing monitored medicines.
To close this application form, please EXIT your web browser.
A registered medical practitioner or nurse practitioner is authorised to prescribe a Schedule 8 poison to or for a person who is not a drug-dependent person during a continuous period greater than 8 weeks without a Schedule 8 permit, if the prescription of that Schedule 8 poison is to treat that person in the circumstances specified below:Opioid analgesics
•For the treatment of medical conditions where an opioid analgesic is required, provided the total daily dose of the following opioid(s) does not exceed 100mg in morphine equivalent dose (MED):◦HYDROMORPHONE oral, max. dose 20mg daily◦MORPHINE oral, max. dose 100mg daily◦OXYCODONE oral or suppository, max. dose 65mg daily◦TAPENTADOL oral, max. dose 300mg daily◦BUPRENORPHINE patch, max. dose 40mcg/hr weekly◦FENTANYL patch, max. dose 25mcg/hr every three days
To calculate your patient's total morphine equivalent dosage (MED), please download the Opioid Tapering Calculator.

•Opioid analgesic in the treatment of pain caused by cancer or complication arising from cancer; and the diagnosis of pain caused by cancer or complications arising from cancer is made by a registered medical practitioner.
Psychostimulants
•Paediatricians treating a patient less than 18 years old with a psychostimulant drug approved by the Therapeutic Goods Administration for the treatment of attention deficit hyperactivity disorder.•Consultant psychiatrists treating a patient with a psychostimulant drug approved by the Therapeutic Goods Administration for the treatment of attention deficit hyperactivity disorder.
Palliative care
For the intention of palliative care treatment where: •the person to be administered, supplied or prescribed the Schedule 8 poison is suffering an incurable, progressive, far-advanced disease or medical condition; and•the prognosis is of limited life expectancy due to the disease or medical condition; and•the administration, supply or prescribing of the Schedule 8 poison is intended to provide palliative treatment.
You are reminded that you must take all reasonable steps to check SafeScript prior to prescribing monitored medicines.
To close this application form, please EXIT your web browser.

Remember Me

You can save time filling out the form by ticking the checkbox below. Your Prescriber Details will be saved and future use of this form on this computer will automatically populate with your Prescriber Details. Do not tick the checkbox below if this is a public/shared computer as it may compromise your privacy and security.
By unticking the checkbox below the Prescriber Details that have been saved on this computer will be removed.
Prescriber Details prefilled
Department of Health (VIC) - Medicines and Poisons Regulation