Pharmaceuticals: client demographics and treatment

In 2019–20, pharmaceutical drugs were reported in 12% of all closed treatment episodes, either as a principal or additional drug of concern:

  • 5% (9,904 episodes) of treatment episodes were for pharmaceutical drugs as a principal drug of concern
  • pharmaceutical drugs were more likely to be reported as an additional drug of concern (7% of episodes)
  • the most common additional drugs of concern reported with pharmaceuticals include amphetamines (19%), cannabis (18%) or alcohol (14%), but these drugs are not necessarily the subject of any treatment within the episode (FIGURE DRUGS1; tables SD.6–8).

Pharmaceutical use

Pharmaceuticals are drugs that are available from a pharmacy—over the counter or by prescription—which may be subject to misuse (MCDS 2011). Results from the National Drug Strategy Household Survey showed that, in 2019, 4.2% of Australians aged 14 and over reported non-medical, or extra-medical use of a pharmaceutical in the last 12 months (including pain killers/pain-relievers and opioids, tranquillisers/sleeping pills, steroids, or methadone/buprenorphine). This represents a decline in recent use, down from 4.8% in 2016 (AIHW 2020). This decline may in part be due to the rescheduling of codeine to a schedule 4 drug in February 2018, meaning that codeine could no longer be purchased from a pharmacy or chemist without a prescription. Between 2016 and 2019, codeine use halved (from 3.0% to 1.5%).

Pharmaceuticals are not listed as a broad drug group in the Australian Standard Classification of Drugs of Concern (ASCDC) classification. In the Alcohol and Other Drug Treatment Services National Minimum Dataset report, 10 drug types were identified as making up the group ‘pharmaceuticals’ for the purposes of this analysis: codeine, morphine, buprenorphine, oxycodone, methadone, benzodiazepines, steroids, other opioids, other analgesics, and other sedatives and hypnotics. Further information corresponding to the ASCDC codes and classifications is in Technical notes. Of these drugs, the most common classes are benzodiazepines and opioids (e.g., codeine).

Opioids

Opioids are a class of depressant drugs originally derived from the opium poppy, including both heroin and medicinal (pharmaceutical) opioids such as morphine and oxycodone. Pharmaceutical opioids are commonly prescribed for pain relief as they have strong analgesic effects; however, these drugs also produce effects including sedation and euphoria, and can be associated with negative health outcomes such as dependence and overdose (ADF 2020). Some people may purchase opioids illegally, or use their own medicine to become intoxicated; for example, by taking a higher dose than recommended.

Benzodiazepines

Benzodiazepines are depressant drugs: they slow down the activity of the central nervous system and the speed of messages going between the brain and the body. Formerly known as ‘minor tranquillisers’, benzodiazepines are most commonly prescribed by doctors to relieve stress and anxiety, and to aid sleep. They are a drug of dependence, and are associated with fatal and non-fatal overdose among people who use opioids. Some people use benzodiazepines illegally to become intoxicated or to come down from the effects of stimulants, such as amphetamines or cocaine (ADF 2013).

Over the 10-year period, the proportion of treatment episodes with a pharmaceutical drug as the principal drug of concern decreased from 7% (10,231 of episodes) in 2010–11 to 5% (9,904 episodes) in 2019–20 (Figure PHARMS1).

In 2019–20, among treatment episodes with a pharmaceutical as the principal drug of concern:

  • the most common single drug type was benzodiazepines (2,736 episodes) and the most common drug class was opioids (4,942 episodes) (codeine, morphine, buprenorphine, methadone, oxycodone, and other opioids)
  • opioids were the principal drug of concern in 3% (or 4,942) of all treatment episodes and an additional drug of concern in 3% of episodes (5,752)
  • benzodiazepines were a principal drug of concern in 1% (2,736) of all treatment episodes and an additional drug of concern in 3% (7,158) of episodes (Table SD.9)
    • the most common principal drugs of concern in combination with benzodiazepines as an additional drug of concern were cannabis (23%), alcohol (19%) or amphetamines (15%) (Table SD.7)
  • opioids accounted for half (50%) of all pharmaceutical treatment episodes
  • among treatment episodes with a pharmaceutical as the principal drug of concern, over one-quarter (28%) of episodes were for benzodiazepines and 11% were for both methadone and buprenorphine (Figure PHARMS2; Table SD.146).

Figure PHARMS1 and PHARMS2: Proportion of closed treatment episodes for the top 5 principal drugs of concern and selected pharmaceutical drugs of concern, 2010–11 to 2019–20 (%)  

The line graph shows that alcohol has remained the most common main principal drug of concern over this period, fluctuating from 47% in 2010–11 to 32% in 2015–16 and 34% in 2019–20. The proportion of treatment episodes for amphetamines has consistently increased over this same period, rising from 8.7% in 2010–11 to overtake cannabis as the second most common principal drug of concern in 2015–16 at 23% and reaching 28% in 2019–20. The proportion of treatment episodes for cannabis as the principal drug of concern has decreased, falling from 24% in 2014-15 to 18% in 2019–20.

This line graph shows the proportion of closed treatment episodes for 7 pharmaceutical drugs of concern between 2010–11 and 2019–20. Benzodiazepines were the most common pharmaceutical drug of concern, rising from 17% in 2015–16 to 28% in 2019–20. This was followed by methadone, dropping from 19% in 2015–16 to 11% in 2019–20 and codeine, also falling from 14% in 2015–16 to 5.3% in 2019–20.

Over the 10-year period from 2010–11 to 2019–20, among treatment episodes with a pharmaceutical drug as the principal drug of concern:

  • the number of treatment episodes with benzodiazepines as the principal drug increased from 2,488 in 2010–11 to 2,736 in 2019–20 (Table SD.146)
  • treatment episodes for codeine decreased from 922 episodes in 2010–11 to 526 in 2019–20. The number of codeine episodes peaked in 2015–16 (1,448 episodes) and steadily declined, to less than half from 2017–18 (1,203) to 2019–20 (526)
  • oxycodone treatment episodes more than doubled over time from 2010–11 (471 treatment episodes), peaking in 2013–14 (1,404) and then decreasing to 842 treatment episodes in 2019–20.
  • treatment episodes fell for both methadone (from 1,961 in 2010–11 to 1,046 in 2019–20) and morphine (from 1,796 to 611) (Figure PHARMS2; tables SD.9, SD.146).

Client demographics

Where pharmaceuticals were the principal drug of concern in 2019–20:

In 2019–20, for clients whose principal drug of concern was a pharmaceutical drug:

  • a higher proportion of clients receiving treatment for codeine as their principal drug of concern were female (51%) (Table SC.6)
  • the most common age group for clients was 30–39 (29%), followed by clients aged 20–29 (24%) and 40–49 (22%)  (Table SC.7).

 Treatment

In 2019–20, for treatment episodes where a pharmaceutical drug was the principal drug of concern:

  • around 2 in 5 referrals were from either self/family or a health service (both 42%) (Table SD.149)
  • the most common main treatment type was counselling (24%), followed by assessment only (19%), support and case management (15%) and withdrawal management (14%) (Table SD.148).

The relative proportions of treatment episodes for each main treatment type by individual pharmaceuticals varied substantially (Figure PHARMS3). For example, in 2019–20:

  • about 3 in 10 episodes with counselling as the main treatment type were for benzodiazepines (29%) or codeine (31%)
  • where the main treatment was withdrawal management, the most common principal drug of concern was benzodiazepines (18%), followed by oxycodone (14%)
  • the principal drugs where pharmacotherapy was a main treatment ranged from 2% for benzodiazepines to 21% for codeine (Figure PHARMS3).

Figure PHARMS3: Proportion of closed treatment episodes with selected pharmaceutical drugs as a principal drug of concern, by main treatment type, reason for cessation or treatment delivery setting, 2019–20 (%)

The grouped vertical bar graph shows that within each treatment type, the selected pharmaceutical drug of concern varied substantially in 2019–20. Where counselling was a main treatment almost 1 in 10 treatment episodes were for codeine (31%) followed by benzodiazepines (29%) and morphine (24%). The principal drugs of concern where withdrawal management was the main treatment type was highest for benzodiazepines (18%), followed by oxycodone (14%) and buprenornorphine (13%).

For treatment episodes where a pharmaceutical drug was the principal drug of concern in 2019–‍20:

  • 6 in 10 (59%) treatment episodes ended with an expected cessation, while 1 in 5 (19%) ended unexpectedly
  • steroids had the highest proportion (69%) of treatment episodes ending with an expected cessation, followed by methadone (62%) and benzodiazepines (61%)
  • the proportion of treatment episodes ending with an unexpected cessation was highest for morphine (21%), followed by codeine and benzodiazepines (both 20%), and was lowest for steroids (13%) (Table SD.150).

In 2019–20, for treatment episodes where benzodiazepines were the principal drug of concern:

  • the most common source of referral was self/family (42%), followed by a health service (41%) (Table SD.101)
  • counselling was the main treatment provided (40% of episodes) in a non-residential treatment facility, followed by support and case management (18%) (Table SD.110)
  • almost one-third (32%) of episodes lasted 2–29 days, around one-quarter (26%) of episodes lasted 1–3 months and 21% of episodes lasted 1 day (Table SE.25)
  • 6 in 10 (61%) episodes ended with an expected cessation, while 20% ended unexpectedly.

References

See reference list.