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Restrictive practice framework8 states
ACT2 citations
In the Australian Capital Territory, use of Pethidine as chemical restraint is regulated by the Senior Practitioner Act 2018 (ACT), which establishes the Office of the Senior Practitioner with independent oversight across disability services, education, residential care, and child protection. A Positive Behaviour Support Plan must justify the practice as the least-restrictive option, with active reduction strategies. The ACT framework's stated aim is the reduction and elimination of restrictive practices.
Statutory anchor: Pethidine use as chemical restraint in the ACT is regulated by the Senior Practitioner Act 2018 (ACT). The Act's stated object is the reduction and elimination of restrictive practices and it applies broader-than-NDIS oversight: disability services, education, residential care, and child protection all sit within scope.
In New South Wales, use of Pethidine as chemical restraint by a registered NDIS provider must be authorised under the NSW Restrictive Practices Authorisation framework administered by the Department of Communities and Justice (DCJ). Authorisation requires a Behaviour Support Plan documenting the practice, evidence that it is the least-restrictive option, and a documented reduction strategy. Psychotropic medications used as restraint should be reviewed at least every six months by a medical practitioner and at least every twelve months by a psychiatrist.
In the Northern Territory, use of Pethidine as chemical restraint by a registered NDIS service provider requires authorisation by the NT Senior Practitioner via the Restrictive Practice Authorisation System administered by NT Health. Applications must include the Behaviour Support Plan, evidence of consultation with the participant and relevant others, particulars of the providers applying the practice, and a summary of every restrictive practice applied in the preceding 12 months.
In Queensland, use of Pethidine as chemical restraint on an adult with disability requires consent from a restrictive-practices guardian appointed by the Queensland Civil and Administrative Tribunal (QCAT), or short-term approval by the chief executive of the relevant disability service while a Positive Behaviour Support Plan is being developed. The Office of the Public Guardian acts as substitute decision-maker where appointed. Use must be the least-restrictive option to prevent serious harm and is subject to reduction planning.
In Queensland, use of Pethidine as chemical restraint by funded disability service providers is governed by the Disability Services Act 2006 (Qld) and the positive behaviour support / restrictive practices framework administered by the Department of Families, Seniors, Disability Services and Child Safety. Authorisation must follow assessment by an appropriately qualified practitioner, a Positive Behaviour Support Plan, and the legislative tests of least-restrictive practice and reduction planning. Authorisation is granted per restrictive-practice type — separate authorisation is required for each.
Statutory anchor: substitute decision-making for Pethidine use as chemical restraint on adults with impaired capacity in Queensland is governed by the Guardianship and Administration Act 2000 (Qld). Chapter 5B Part 4 sets out QCAT's powers to appoint a restrictive-practices guardian and the Office of the Public Guardian's role as substitute decision-maker.
Statutory anchor: Pethidine use as chemical restraint by funded disability service providers in Queensland is regulated by the Disability Services Act 2006 (Qld), Chapter 5B of which sets out the positive behaviour support and restrictive-practice authorisation framework. The PBSRP Reform Bill 2024 lapsed in October 2024; the existing framework remains in force.
In South Australia, use of Pethidine as chemical restraint is a Level 2 restrictive practice under the SA Restrictive Practices Authorisation Scheme (in force from 30 May 2022) and can only be authorised by the Senior Authorising Officer — Authorised Program Officers cannot approve chemical restraint. Authorisation requires a Behaviour Support Plan, advice from a Specialist Behaviour Support Practitioner, and consultation with the participant and their family. The scheme is administered by the Restrictive Practices Unit within the Department of Human Services.
Statutory anchor: Pethidine use as chemical restraint in South Australia is regulated by the Disability Inclusion Act 2018 (SA), with the operative detail in the Disability Inclusion (Restrictive Practices — NDIS) Regulations 2021. Together they establish the two-tier authorisation scheme (Authorised Program Officer for Level 1, Senior Authorising Officer for Level 2 including chemical restraint) in force from 30 May 2022.
In Tasmania, use of Pethidine as chemical restraint by a disability service provider requires authorisation by the Tasmanian Senior Practitioner under the Disability Rights, Inclusion and Safeguarding Act 2024 (Tas). The Senior Practitioner authorises, oversees, and reports on restrictive practice use in NDIS-funded and Department of Communities Services–funded disability services, with a statutory requirement to protect the rights of people subject to restrictive practices to the greatest extent possible.
Statutory anchor: Pethidine use as chemical restraint by disability service providers in Tasmania is regulated by the Disability Rights, Inclusion and Safeguarding Act 2024 (Tas), which establishes the Tasmanian Senior Practitioner with statutory powers to authorise, oversee, and report on restrictive-practice use in NDIS-funded and Department of Communities Services–funded disability services.
In Victoria, use of Pethidine as chemical restraint requires authorisation by the Victorian Senior Practitioner under the Disability Act 2006 (Vic). Authorisation must satisfy the legislative tests of necessity to prevent harm, least-restrictive option, and a documented reduction plan.
Statutory anchor: Pethidine use as chemical restraint in Victoria is regulated by the Disability Act 2006 (Vic), Part 7 of which establishes the Senior Practitioner role and the regulated-restrictive-practice authorisation framework. The Act's tests of necessity, least-restrictive option, and reduction planning are statutorily binding.
In Western Australia, use of Pethidine as chemical restraint requires authorisation through a Quality Assurance Panel under the WA Department of Communities Authorisation of Restrictive Practices framework (effective 1 December 2020). The panel must include at least two decision-makers: a senior manager from the implementing provider and an independent NDIS Behaviour Support Practitioner external to that provider who did not write the Behaviour Support Plan. Unlike single-administrator state models, the panel decision is the authorisation.
The short-term management of severe pain for which other treatment options have failed, are contraindicated, not tolerated or are otherwise inappropriate to provide sufficient management of pain.
Patients who are taking or have taken a mono amine oxidase inhibitor (including selegiline) within the previous fourteen days. The combination of mono amine oxidase inhibitors and pethidine has caused hypotension, hypertension, excitation, rigidity, hyperpyrexia and/or convulsions, and in some cases fatalities have been reported. This combination should be avoided.
Patients with severe respiratory disease and acute respiratory disease. Respiratory depression, or patients in whom respiratory reserve is significantly depleted (e.g. severe emphysema, severe chronic bronchitis, kyphoscoliosis, acute bronchial asthma, chronic airway disease).
Convulsive states such as status epilepticus, tetanus and strychnine poisoning, due to the stimulatory effects of pethidine on the spinal cord.
§05
Mechanism & pharmacology
“Pethidine is a synthetic opioid with analgesic and sedative properties, its actions qualitatively similar to those of morphine.”
“The concomitant use of pethidine and CYP3A4 or CYP2B6 inhibitors such as macrolide antibiotics (e.g. erythromycin), azole-antifungal agents (e.g. ketoconazole), and protease inhibitors (e.g. ritonavir), can increase the plasma concentration of pethidine, resulting in increased or prolonged opioid effects.”
respiratory depression is the major hazard of parenteral pethidine therapy
Pethidine associated neurotoxicity (PAN) is a range of excitatory central nervous system effects including tremor, hallucinations, seizures and mood changes attributed to the metabolite norpethidine
convulsions or tremor
coma
gangrene following inadvertent intra arterial administration
Curated subset. The full adverse-effect list is in the TGA Product Information; click any citation above to open it.
Pre-eclampsia, eclampsia.
Cardiac arrhythmias, especially supraventricular tachycardias; cor pulmonale. Pethidine has a possible vagolytic action which may produce a significant increase in the ventricular response rate.
Diabetic acidosis where there is a danger of coma.
Acute alcoholism or delirium tremens.
Severe liver disease, incipient hepatic encephalopathy.
Known or suspected gastrointestinal obstruction, including paralytic ileus (see Section 4.4 Special warnings and precautions for use).
Head injury, raised intracranial pressure (may cause diagnostic and monitoring problems; also hypercapnia associated with depressed respiration may increase intracranial pressure by itself); brain tumour.
Patients with a low platelet count, coagulation disorders or receiving anticoagulant treatment.
Continuous intravenous infusion : The administration of pethidine via continuous intravenous infusion in patients with renal impairment is contraindicated.
Patient controlled analgesia : The administration of pethidine via patient controlled analgesia (PCA) in young children and adults with poor cognitive function is contraindicated. The administration of pethidine via PCA in patients with renal impairment is contraindicated.