Alcohol and other drug treatment services is an Australia's health topic

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Alcohol and other drug (AOD) use is linked to increased risk of injury, mental illness, preventable disease, road trauma and death (AIHW 2021). AOD treatment agencies across Australia provide a range of services and support to people receiving treatment for their own drug use, as well as their families and friends.

Many types of treatment are available in Australia to assist people with their drug use. Most treatments aim to reduce the harm of drug use (for example, counselling). Some treatments help clients to develop skills that facilitate drug-free lifestyles and prevent relapse (for example, abstinence-oriented interventions in a structured, substance-free setting).

Opioid pharmacotherapy is a type of treatment that can reduce drug cravings and other withdrawal symptoms in people experiencing opioid drug dependence (such as codeine or heroin dependence).

See Alcohol and Illicit use of drugs for information on use of alcohol and other drugs.

Data sources

  • Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS): provides information about publicly funded alcohol and other drug treatment services in Australia, the people they treat and the treatment provided.
  • National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection: provides information about people receiving opioid pharmacotherapy for their opioid dependence in Australia, as well as health professionals who prescribe opioid pharmacotherapy and dosing points (such as pharmacies) where clients receive treatment.

Agencies whose sole function is to prescribe or provide dosing services for opioid pharmacotherapy are excluded from the AODTS NMDS, as data from these agencies are captured in the NOPSAD collection (AIHW 2022a, 2022b).

Who uses alcohol and other drug treatment services?

Data from the AODTS NMDS indicate that around 138,000 clients aged 10 and over received AOD treatment in 2020–21. These clients received just over 242,000 closed treatment episodes from 1,278 publicly funded AOD treatment agencies.

In 2020–21:

  • Just over 6 in 10 clients of AOD treatment services were male (62% of clients), and around 5 in 10 were aged 20–39 years (52% of clients).
  • Just under 2 in 10 clients (17%) identified as Aboriginal and/or Torres Strait Islander.
  • Over 9 in 10 clients sought treatment for their own drug use (93% of clients).

Between 2013–14 and 2020–21, the estimated number of clients receiving AOD treatment rose by 21%. Across the same period, after adjusting for population growth, the rate of clients accessing AOD services increased from 564 to 616 per 100,000 population.

Who receives opioid pharmacotherapy treatment?

Data from the NOPSAD collection showed that around 47,600 clients received opioid pharmacotherapy treatment across Australia on a snapshot day in mid-2021 (excluding data for Queensland, which were not available in 2021). There were just under 2,500 dosing points nationally.

Opioid pharmacotherapy clients had broadly similar characteristics to clients of publicly funded AOD treatment agencies, but there was a higher proportion of people in older age groups. On a snapshot day in 2021:

  • Almost 7 in 10 opioid pharmacotherapy clients were male (68% of clients), and 6 in 10 were aged 30–49 (60% of clients).
  • Just over 1 in 10 clients (12%) identified as Aboriginal and/or Torres Strait Islander.

What drugs do people seek treatment for?

Data from the AODTS NMDS indicate that alcohol continued to be the most common principal drug of concern (PDOC) that led clients to seek treatment for their own drug use in 2020–21.

However, between 2011–12 and 2020–21:

  • The proportion of closed treatment episodes provided for alcohol as a PDOC  decreased from 46% to 37% (in relation to all principal drugs of concern).
  • The proportion of episodes for amphetamines as a PDOC rose from 11% to 24% (Figure 1).

Figure 1: Proportion of closed treatment episodes for clients’ own drug use, by selected principal drugs of concern, 2011–12 to 2020–21

The stacked bar graph shows closed treatment episodes for clients’ own drug use by principal drug of concern, from 2011–12 to 2020–21. Alcohol, amphetamines, cannabis and heroin have remained the 4 most common principal drugs of concern across the period.

In 2020–21, 37% of closed treatment episodes were for alcohol as the principal drug of concern, 24% were for amphetamines, 19% were for cannabis and 4.6% were for heroin.

AODTS NMDS data indicate that there is variation across age groups in terms of the most common principal drugs of concern. In 2020–21:

  • Cannabis was the most common PDOC for young people, accounting for 60% of closed treatment episodes provided to clients aged 10–19.
  • Amphetamines were the most common PDOC for people aged 20–29 (27% of treatment episodes) and 30–39 (34% of episodes).
  • Alcohol was the most common PDOC for older people, accounting for 46% of treatment episodes provided to clients aged 40–49, 59% of episodes for those aged 50–59, and 75% of episodes for those aged 60 and over.

Data from the NOPSAD collection showed that heroin remained the most common opioid drug of dependence among opioid pharmacotherapy clients in 2021 (44% of clients, excluding data for Queensland). Consistent with previous years, there was a high proportion of clients with ‘Not stated/not reported’ as the opioid drug of dependence (35% of clients) (Figure 2).

Figure 2: Proportion of clients receiving opioid pharmacotherapy treatment on a snapshot day, by opioid drug of dependence, 2016 to 2021

The stacked bar graph shows that between 2016 and 2021, heroin was the most common opioid drug of dependence among pharmacotherapy clients (excluding ‘Not stated/not reported’). In 2021, 37% of clients reported heroin as their drug of dependence. Across the period, there was a high proportion of Not stated/not reported responses (35% in 2021). Data for Queensland were not available in 2021.

What types of treatment do people receive?

Data from the AODTS NMDS indicate that counselling continues to be the most common main treatment type for clients accessing AOD treatment. Among clients seeking support for their own alcohol or drug use, 37% of treatment episodes in 2020–21 involved counselling as a main treatment and 21% involved an assessment only (Figure 3).

Figure 3: Proportion of closed episodes for clients’ own drug use, by main treatment type, 2011—12 to 2020—21

The stacked bar graph shows the closed treatment episodes for clients’ own drug use by main treatment type, from 2011–12 to 2020–21. In 2020—21, counselling was the most common main treatment type (37% of closed treatment episodes), followed by assessment only (21%) and support and case management (14%).

Data from the NOPSAD collection showed that methadone continues to be the most common pharmacotherapy drug provided to opioid pharmacotherapy clients. On a snapshot day in 2021, 58% of opioid pharmacotherapy clients received methadone as pharmacotherapy treatment, 23% received buprenorphine and 15% received buprenorphine-naloxone (excluding data for Queensland).

How has COVID-19 impacted alcohol and other drug treatment services ?

Measures put in place to reduce the transmission of COVID-19 introduced new challenges for clinicians and clients accessing AOD treatment services and opioid pharmacotherapy. These challenges included:

  • regulatory changes to support treatment delivery
  • maintaining effective social distancing measures, particularly where people are required to visit a dosing site daily.

Impact of COVID-19 on alcohol and other drug treatment services

In response to COVID-19 restrictions, AOD treatment service providers across all jurisdictions have made changes to modes of treatment delivery. The aim is to support flexible treatment delivery and maintain the health and safety of clients and treatment service providers. While these changes varied across jurisdictions, changes included:

  • decreased bed capacity at residential rehabilitation and withdrawal services, or closure of these services for a period of time
  • ceased or reduced intake of new clients to residential rehabilitation and withdrawal services
  • adoption of telehealth including using phone, online and video conferencing (to deliver services in the place of face-to-face contact)
  • group sessions were cancelled, or moved to telehealth forums
  • prescription review periods increased
  • increased wait-time periods between referrals and admissions to AOD treatment due to reduced capacity.

Impact of COVID-19 on opioid pharmacotherapy

In response to COVID-19 restrictions, states and territories made temporary changes to opioid pharmacotherapy treatment guidelines and regulations. The aim was to support flexible treatment delivery and maintain the health and safety of patients and prescribers. While the implementation of these amended guidelines and regulations vary across jurisdictions, changes to pharmacotherapy treatment in the context of COVID-19 have included:

  • extending prescription duration
  • increasing the number of takeaway doses
  • arranging home delivery of medication
  • considering changing clients to buprenorphine LAI wherever appropriate
  • a transition to online delivery modes for pharmacist training and education on administering opioid pharmacotherapy treatment
  • the commencement of buprenorphine LAI under online supervision (with dosing administered in person at a pharmacy)
  • introducing third-party collections for clients who may require self-isolation
  • alleviating permit requirements for doctors taking over scripts from other doctors.

It is not yet known how COVID-19 will impact opioid pharmacotherapy treatment long-term.

Where do I go for more information

For more information on alcohol and other drug treatment services and opioid pharmacotherapy in Australia, see:

Visit Alcohol & other drug treatment services for more on this topic.

References

AIHW (Australian Institute of Health and Welfare) (2021) Alcohol, tobacco & other drugs in Australia, AIHW, Australian Government, accessed 22 March 2022.

AIHW (2022a) Alcohol and other drug treatment services in Australia: Early insights, AIHW, Australian Government, accessed 14 April 2022.

AIHW (2022b) National Opioid Pharmacotherapy Statistics Annual Data collection, AIHW, Australian Government, accessed 30 March 2022.