What is a treatment instruction and who can issue one?

A treatment instruction is written documentation from a paediatrician, psychiatrist or ADHD practitioner authorising a GP to prescribe a specific psychostimulant at a specified dose, frequency and maximum dose for a named patient with an ADHD diagnosis. From 1 December 2026, it must include the medication name, dose, frequency, maximum dose, and the patient's ADHD diagnosis to be valid. Existing letters containing all five elements do not need to be reissued.

What stays the same under the new rules?

SafeScript must still be checked before every prescribing event. Schedule 8 permits remain required for patients who are drug-dependent, and for the use of psychostimulants for conditions other than ADHD. Existing permits remain valid until their expiry date and do not need to be cancelled. Pending permit applications for non-drug-dependent ADHD patients should be cancelled.

Victorian GPs can now prescribe ADHD stimulants without a permit

Victoria has changed the rules for prescribing ADHD psychostimulants in general practice, and the change matters. From 1 December 2026, Victorian GPs and nurse practitioners can prescribe dexamphetamine, lisdexamfetamine and methylphenidate for ADHD without a Schedule 8 treatment permit, provided a valid specialist treatment instruction is in place and the patient is not drug-dependent.

This is not a wholesale deregulation. The clinical gate remains — a specialist still needs to initiate and document the treatment plan. What is removed is the separate two-year administrative permit cycle that GPs had to manage on top of that specialist oversight.

What actually changed

Under the old system, GPs needed a Schedule 8 treatment permit to prescribe psychostimulants for ADHD, issued through SafeScript with a supporting letter from a specialist. Those permits lasted two years and had to be renewed.

Under the new rules, the permit is replaced by a “treatment instruction” — written documentation from a paediatrician, psychiatrist or ADHD practitioner that includes the medication name, dose, frequency, maximum dose, and the patient’s ADHD diagnosis. From 1 December 2026, instructions must include all five elements to be valid. Existing letters that already contain this information do not need to be reissued.

The two-year mandatory review cycle is abolished. The instruction remains valid until whatever review date the specialist has set, if any. Existing permits continue to be valid until their expiry without any action required from the prescriber.

Why this matters for adult ADHD

The RACGP estimates up to 163,000 Victorian children and 320,000 Victorian adults may have ADHD — roughly one in 20 Australians across the country. Psychostimulants accounted for 87 per cent of ADHD prescriptions dispensed in Australia in 2023–24 — meaning the medication that the new system is designed to streamline is the dominant treatment modality.

RACGP Victoria Chair Dr Anita Muñoz described the permit system as “totally overwhelmed by the volume of permits” — a system that was generating access delays not because of clinical risk but because of administrative throughput. She had been asking for this reform for two years.

For adult women in particular: late-diagnosed ADHD has become one of the most common presentations in general practice consultations for women in their 30s, 40s and 50s. Many of these patients have been waiting longer for treatment under the permit system than the clinical situation warranted. The administrative bottleneck was not neutral in its impact.

Both-and: access and safeguards

The reform is worth welcoming. It removes a layer of regulatory friction that was not protecting patients — it was delaying their treatment.

The safeguards that remain are the ones that matter. SafeScript checks are still mandatory at every prescribing event, which means real-time monitoring for concerning prescribing patterns, dose escalation, and concurrent prescribing across providers. Permits remain in place for drug-dependent patients, which is the population where Schedule 8 oversight has the clearest clinical rationale. And the specialist-initiated treatment instruction requirement means GPs are not being asked to diagnose and initiate de novo — they are continuing care within a specialist’s documented framework.

There is a risk worth naming on the other side. With the administrative barrier removed, there will be cases where patients arrive with instructions that are outdated, incomplete, or drawn up by a clinician who has since retired or moved. The five required elements of a valid instruction from 1 December 2026 — medication name, dose, frequency, maximum dose, ADHD diagnosis — are worth reviewing against your existing patient documentation now, before the change lands.

Rare but serious adverse effects are also worth having at the front of mind as more patients transition to streamlined GP care: the RACGP notes cardiovascular events, psychosis, mania, and dependence risk as requiring careful monitoring. That clinical vigilance does not change with the administrative landscape.

2 cents: check your patient panel before December

If you are a Victorian GP, the practical step is to audit your ADHD patients before 1 December. Identify who currently has an active permit, who has documentation that may fall short of the new five-element requirement, and who may need their specialist to update an instruction letter before you can prescribe under the new framework.

For patients waiting on permit renewal as the barrier to their current prescription: the transition removes that bottleneck, but only if the underlying documentation is valid. That check is worth doing this month.

The Australian ADHD Professionals Association is a useful resource for GPs managing more of this caseload directly. The Victorian Health Department page for the new framework should be treated as the primary source for transition rules.

Verdict: yes — a meaningful prescribing reform for ADHD in Victoria that affects hundreds of thousands of adults, with a 1 December 2026 operative date that requires action from GPs this month.