Pharmacy rules you may not have been taught.

The pharmacy must check SafeScript before dispensing any monitored medicine for opioid dependence pharmacotherapy. The check happens at every supply, not just the first one, and overrides must be clinically justified and recorded.

• Real-time Prescription Monitoring (RTPM) is a mandatory check for the pharmacist at the time of supply for monitored medicines, including pharmacotherapy.
• A flagged or red SafeScript record does not stop dispensing. It triggers a clinical conversation. The pharmacist may contact you to discuss before proceeding.
• If a patient is travelling and needs an early or forward supply, please indicate the rationale on the prescription so the pharmacist has the clinical justification in record.
• For complex flags (e.g. concurrent benzodiazepine, multiple prescribers, dose escalation), expect a call from the dosing pharmacist before dispensing, not after.

Pharmacists follow the Victorian policy on missed-dose management. The pharmacy will phone you when a patient misses doses, and clinical decision-making escalates by day.

• One missed dose. The next scheduled dose is supplied as normal. The pharmacy logs the miss.
• Two consecutive missed doses. The pharmacy contacts you to confirm safety to resume at usual dose.
• Three or more consecutive missed doses. The patient must be re-assessed before resuming. The pharmacy will not supply the usual dose without your re-induction decision because tolerance may have changed.
• Document the re-induction or dose-reduction decision on a fresh prescription where required so the dispensing record is unambiguous.

Takeaway approval is a clinical assessment, not a tenure milestone. The pharmacist verifies the prescription, checks SafeScript, and confirms the takeaway is documented before releasing.

• Indicate clearly on the prescription which days are supervised and which are takeaway. Ambiguous "as per policy" wording slows the supply.
• Vulnerability factors (children at home, mental health acuity, recent overdose) should be discussed with the patient and noted in the script. The pharmacist does not have access to the GP record.
• For takeaways supplied in a takeaway-secured container (e.g. for the long-acting injectable formulation context), confirm patient education on safe storage at first supply.
• Lost takeaways are not replaced. The pharmacy documents the report and flags the SafeScript record. Replacement requires a new prescription with clinical justification.

The Victorian protocol for vomited doses is time-bounded and witness-dependent. The pharmacist applies a strict rule because of overdose risk.

• Vomiting within 30 minutes of a supervised dose, witnessed by pharmacy staff: the pharmacist may redose the same daily dose once, in the pharmacy, with documentation.
• Vomiting after 30 minutes, even if witnessed, does not warrant a redose. The pharmacy will not give a replacement dose.
• Unwitnessed vomiting at home is not a replacement event. The patient should contact the prescriber to discuss whether a fresh prescription is appropriate.
• Chronic vomiting in early induction is a clinical signal that warrants escalation to the prescriber, not a routine redose.

A patient cannot collect on two prescriptions at two pharmacies in the same supply window. The transfer is a clinical hand-over, not just a paperwork move.

• Notify both pharmacies in writing (email is fine) that the patient is transferring on date X, and indicate which doses (if any) have already been supplied at the original pharmacy that week.
• Issue a fresh prescription to the new pharmacy that starts on the transfer date. Do not split an existing one.
• The dosing pharmacist at the receiving pharmacy will call the originating pharmacist to confirm the last supplied dose and any outstanding takeaways before first dispense.
• Interstate transfers follow the same principle; please include a brief clinical summary so the receiving pharmacist has the context (e.g. recent dose stability, takeaway history).

Forward supply (a patient receiving doses ahead of schedule due to travel or unavoidable absence) is permitted under defined conditions. The pharmacy will not exercise its discretion alone.

• Mark the prescription with the forward-supply window dates and the reason, so the pharmacist has the clinical authority in the dispensing record.
• For patients travelling interstate or overseas, recommend they carry a copy of the prescription and a clinician letter, particularly for any controlled drug class.
• Cross-border supply (e.g. visiting NSW or SA) is governed by the destination state; the receiving pharmacy should be contacted in advance to confirm willingness to supply.
• Holiday supplies for unstable patients are not appropriate. The pharmacist will phone you if they assess vulnerability factors.

Co-prescription of CNS depressants alongside opioid dependence pharmacotherapy raises overdose risk and triggers a SafeScript flag. The pharmacist will escalate.

• A concurrent benzodiazepine or Z-drug script, regardless of dose, is a routine call from the pharmacy to discuss clinical context, because the SafeScript flag is mandatory.
• Gabapentinoid co-prescription is increasingly flagged as a risk, especially with concurrent alcohol use disorder.
• Patients who have had a recent overdose, hospital ED presentation, or relapse should be confirmed safe to resume the usual dose, not auto-resupplied.
• If you intend a slow benzodiazepine taper alongside pharmacotherapy, please document the taper plan on the prescription so the pharmacist supports continuity.

Discontinuing pharmacotherapy in pregnancy is not recommended; the pharmacy supports continuation in coordination with the obstetric team and the addiction-medicine specialist.

• Notify the pharmacy when a patient becomes pregnant so dosing supervision can be adjusted (more frequent contact, smaller intervals where clinically warranted).
• Specialist input from an addiction-medicine physician (e.g. via Western Health Addiction Medicine, or a hospital-based AOD consult) is the appropriate referral pathway during pregnancy.
• Post-partum dose adjustments should be timed to a clinical review; the pharmacy will not adjust without a fresh prescription.
• Take-home naloxone supply remains appropriate during pregnancy and post-partum; no contraindication.

Under the Commonwealth Take Home Naloxone Program (THN), the pharmacy can supply naloxone at no out-of-pocket cost to any patient at risk of opioid overdose. No prescription needed.

• Patients on opioid dependence pharmacotherapy, family members, and support workers all qualify under the THN program.
• Both intranasal and intramuscular formulations are typically stocked. The pharmacist provides brief education on use at supply.
• Repeat supply is supported; pharmacists log each supply to the PPA but do not require a prescription.
• When prescribing for a new patient with opioid dependence, please indicate to the patient that they may collect take-home naloxone at the pharmacy the same day.

The pharmacy maintains records of all supervised supplies, takeaways, missed doses, and clinical conversations. Retention is governed by Victorian Health (Drugs, Poisons and Controlled Substances Act).

• The S8 register entry is held for 3 years from the last entry.
• The dispensing record + SafeScript audit trail is retained for 7 years.
• Patients may request a copy of their dispensing history; the request is fulfilled under APP 12.
• For prescribers requesting a hand-over summary on transfer, the pharmacy can provide a written extract.