A volunteer and Remote Area First Aid instructor in NSW asks a question about the administration of penthrox (Methoxyflurane). He says that the advice he’s received form the Registered Training organization is:
- Only be possession of penthrox with a prescription from (your) doctor
- When delivering penthrox do it as exactly as you have been trained
- Do not go ever go beyond your level of training
He asks
Is this advice correct?
The relevant law here is the Poisons and Therapeutic Goods Act 1966 (NSW) and the Poisons List that is made under s 8 of that Act (though it should be noted that this Act, along with its equivalent in other jurisdictions is given effect to a national scheme). The current NSW poisons list can be found on the NSW Health website. Methoxyflurane is listed in Schedule 4.
Schedule 4 is for
Substances which in the public interest should be supplied only upon the written prescription of a medical practitioner, nurse practitioner … midwife practitioner … dentist, optometrist … podiatrist … or veterinary practitioner.
It is an offence (s 16) to be in possession of a schedule 4 substance unless the person is an appropriately authorized health professional, the drug has been prescribed for them or the person has been authorized by the Director General of Health:
… to obtain possession of the prescribed restricted substance for the purposes of the person’s profession or employment and obtains, or attempts to obtain, as the case may be, possession of the prescribed restricted substance in accordance with any conditions subject to which the person is so authorised
or
the person is licensed or otherwise authorised by this Act or the regulations to obtain possession of the substance for the purposes of his or her profession or employment.
The Director-General of Health may also issue authorities to allow people to possess and use scheduled drugs Poisons and Therapeutic Goods Regulation 2008 (NSW) r 170.
- Only be possession of penthrox with a prescription from (your) doctor
The Poisons and Therapeutic Goods Regulation 2008 (NSW) r 33(1) provides that ‘A medical practitioner must not issue a prescription for a restricted [ie Schedule 4] substance otherwise than for medical treatment’. The prescription must contain ‘the name and address of the patient’ (r 35(1)(b)). A medical practitioner cannot issue a prescription to allow someone to possess a scheduled drug for administration to an as yet unidentified patient as part of first aid (see also Doctors delegating authority to carry drugs (August 20, 2014)).
It follows that having a prescription from your doctor is relevant if the drug has been prescribed for you and your medical treatment. It is irrelevant if the purpose of having the drug is to give it to someone else in the course of first aid. A prescription from your doctor cannot lawfully authorize you to carry drugs to give to someone else.
- When delivering penthrox do it as exactly as you have been trained
If you have a license or authority to carry a scheduled drug, you must comply with any terms of that authority (r 171).
A number of people are authorized to possess and use Methoxyflurane in first aid. These authorities are set out in Schedule C to the Poisons and Therapeutic Goods Regulation 2008 (NSW). They are:
- A person who holds a current occupational first-aid certificate approved by the WorkCover Authority in accordance with the regulations under the Occupational Health and Safety Act 2000 … ([9]);
- A person who is trained and authorised to administer first aid at a mine (within the meaning of the Work Health and Safety (Mines) Act 2013) … ([11]); and
- A ski patroller who holds a valid first aid certificate issued by the Australian Ski Patrol Association for use in ski patrol duties … ([14]).
This list does not include a person qualified in remote area first aid. Unfortunately the list in Schedule C is not a complete list. Schedule C contains authorities made under regulation 129. As noted however, the Director General of Health may also grant authorities under regulation 170. These authorities are not publically accessible.
An authority under regulation 170 can be given to a particular person, or a class of persons. The DG may have given an authority to the effect that any person who has completed ‘the training package SISOOPS305A – Provide first aid in a remote location’ is entitled to possess and administer methoxyflurane but I cannot confirm that.
If that is the case (and let us assume that it is) then presumably the training reflects the terms and conditions of that authority – in which case yes, you must use and administer the penthrox only as you have been trained to do so and in circumstances provided for in that training.
Australian Emergency Law 
Do you have any further information available in regards to: “A person who holds a current occupational first-aid certificate approved by the WorkCover Authority in accordance with the regulations under the Occupational Health and Safety Act 2000”. I cannot locate any information in the Occupational Health and Safety Act 2000.
The Occupational Health and Safety Act 2000 (NSW) was repealed and replaced by the Work Health and Safety Act 2011 (NSW). Whenever they create a new Act to replace an old one there are ‘savings and transitional provisions’ (see in this case, Work Health and Safety Act 2011 (NSW) Schedule 4). These provide that any reference to the old Act is to be read as a reference to the new Act and any authority or approval granted under the old Act continues as if it is an authority or approval granted under the new Act (see Schedule 4 cl 8 and cl 9). What that means is that although Schedule C to the Poisons and Therapeutic Goods Regulation 2008 (NSW) refers to “A person who holds a current occupational first-aid certificate approved by the WorkCover Authority in accordance with the regulations under the Occupational Health and Safety Act 2000″ that has to be read as if it says ‘A person who holds a current occupational first-aid certificate approved by the WorkCover Authority in accordance with the regulations under the Work Health and Safety Act 2011”.
Interestingly the OCCUPATIONAL HEALTH AND SAFETY REGULATION 2001 (NSW)r 20 was headed ‘Employer to provide first aid facilities and personnel’ and referred to ‘a current occupational first aid certificate issued after successful completion of a WorkCover approved occupational first aid course’. The current version of that regulation is the WORK HEALTH AND SAFETY REGULATION 2011 r 42 and it makes not reference to a ‘WorkCover approved’ course. The website of SafeWork NSW (which took over the regulatory role of WorkCover) also doesn’t mention an ‘approved’ course. Rather it refers readers to the First aid in the workplace code of practice (July 2015). The Code of Practice says “First aiders should hold nationally recognised Statement/s of Attainment issued by a Registered Training Organisation (RTO) for the nationally endorsed first aid unit/s of competency.” It would appear that WorkCover, and now SafeWork NSW, have got out of the business of approving certificates which may mean this clause in the Poisons and Therapeutic Goods Regulation 2008 has no current application. To understand how the regulator views it, and whether they think this clause applies to anyone, you would need to contact the NSW Health, Pharmaceutical Services.