How many people received opioid pharmacotherapy treatment?

The number of people receiving opioid pharmacotherapy remained stable.

On a snapshot day in June 2019, 50,945 people in Australia were on a course of pharmacotherapy treatment for their opioid dependence. Client numbers have increased steadily (by 11%) since 2010. The rate of clients (20 clients per 10,000 people) receiving pharmacotherapy treatment has also remained relatively stable since 2010, with most states recording small increases during this time (Table S1).

In 2019, New South Wales and the Australian Capital Territory had the highest rate of people receiving opioid pharmacotherapy treatment (both 26 clients per 10,000 people). The Northern Territory remained the jurisdiction with the lowest rate of people receiving treatment (6 clients per 10,000 people) (Figure CLIENTS1). Rates for all states and territories have remained relatively stable over the last 5 years (Table S2).

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Who received pharmacotherapy treatment?

Age

The median age of opioid pharmacotherapy clients was 43 years.

In 2019, the median age of clients across all pharmacotherapy types was 43 years. This is an increase from 42 years in 2017. Clients using services in New South Wales and South Australia had the highest median age (44 years), while clients in Tasmania had the lowest median age (41 years) (Table S5).

Almost two-thirds (64%) of clients in 2019 were aged 30–49 years. This proportion has remained relatively consistent since 2010. The proportion of clients aged under 30 has declined, falling from 18% of clients in 2010 to 7.2% in 2019. Comparatively, the proportion of clients aged 60 years and over has continued to increase slowly, from 453 (1% of total clients) in 2010 to 4,144 (8.1% of total clients) in 2019 (Figure CLIENTS2).

This continues the trend of an ageing cohort in opioid pharmacotherapy treatment and is consistent with the pattern observed in other drug treatment services (AIHW 2016). This may be due to:

  • methadone treatment being available in Australia for more than 40 years
  • pharmacotherapy treatment reducing the risk of premature death, resulting in some clients remaining in treatment for decades
  • clients seeking treatment for the first time at an older age.
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Methadone was the most commonly prescribed pharmacotherapy type across most age groups. However, older clients (those aged 40 years and over) were more likely to receive methadone and less likely to receive buprenorphine and buprenorphine-naloxone than younger clients (Figure CLIENTS3).

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Sex

Males were more likely to receive treatment than females.

Around two-thirds (67%) of clients receiving pharmacotherapy on the snapshot day in 2019 were male. This proportion was similar for each of the 3 pharmacotherapy types (methadone, buprenorphine and buprenorphine-naloxone), and has remained stable over the 10 years since 2010 (Table S7).

The rate of clients receiving pharmacotherapy per 10,000 population was highest for people in the 40–49 age group for both males and females (Figure CLIENTS4). The rate peaked at age 41 for males (90 clients per 10,000 population). The rate for females peaked at 40 years (46 clients per 10,000 population).

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Aboriginal and Torres Strait Islander people

Most Aboriginal and Torres Strait Islander clients were treated with methadone.

In June 2019, there were 5,184 clients receiving pharmacotherapy treatment who identified as Indigenous Australian (Table S9). This is a rate of 82 clients per 10,000 Indigenous Australians.

Of those Indigenous Australian clients with pharmacotherapy type provided, over half (58%) were treated with methadone in 2019. The remaining 42% were treated with buprenorphine, either alone or in combination with naloxone, which is added to deter administration by injection (refer to the buprenorphine-naloxone entry in the Glossary for further details). Victoria provides pharmacotherapy type as a total for Indigenous clients (Table S9).

From 2015 to 2019, treatment with:

  • methadone fell (from 67% of Indigenous clients to 58%)
  • buprenorphine increased (from 20% of Indigenous clients to 27%), and
  • buprenorphine-naloxone rose (from 13% of Indigenous clients to 15%).

The Australian Capital Territory had the highest rates of Indigenous clients receiving pharmacotherapy treatment on a snapshot day (150 clients per 10,000 Indigenous Australians). This was followed by New South Wales and Victoria with 126 and 123 clients per 10,000 Indigenous Australians respectively. Northern Territory had the lowest rate of Indigenous clients with 4 clients per 10,000 Indigenous Australians.

What treatments did clients receive?

Methadone continued to be the most commonly prescribed drug.

On a snapshot day in 2019, 61% of clients were treated with methadone, 17% received buprenorphine and 23% received buprenorphine-naloxone (Table S4). However, it should be noted that New South Wales does not separately report clients receiving buprenorphine-naloxone­—these clients are included in the number of clients receiving buprenorphine.

From 2010 to 2019, treatment with:

  • methadone fell (from 69% of clients to 61%)
  • buprenorphine rose slightly (from 14% of clients to 17%), and
  • buprenorphine-naloxone increased (from 17% of clients to 23%) (Table S4).

Previous trend data has shown that buprenorphine-naloxone prescription is replacing buprenorphine prescription. This is in keeping with the national guidelineswhich recommend that buprenorphine-naloxone should be preferred over buprenorphine for most clients as it is expected to have a lower risk of diversion (that is, injected by the client or sold to others to inject) (DoH 2014).

The proportion of clients receiving each of the 3 pharmacotherapies varies across states and territories (Figure CLIENTS5). In 2019, methadone was the most common pharmacotherapy drug in all jurisdictions except Queensland, Tasmania and the Northern Territory where buprenorphine-naloxone was the most common pharmacotherapy drug (50%, 46% and 67% of clients respectively). The Australian Capital Territory and New South Wales had the highest proportion of clients receiving methadone (78% and 66% respectively). In contrast, only 21% of clients in the Northern Territory were prescribed methadone. Buprenorphine-naloxone is the default treatment drug for the main pharmacotherapy program in the Northern Territory (Table S4).

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Did clients stay in treatment?

Most clients were continuing treatment.

Clients interact with the pharmacotherapy treatment system in a number of ways. A client’s status may differ according to whether they are:

  • receiving treatment for the first time (new);
  • re-entering treatment after a lapse (re-admission);
  • continuing treatment (ongoing); or
  • transferring from another state/territory (interstate transfer).

Client status data were available for Victoria, Western Australia, Tasmania, the Australian Capital Territory and the Northern Territory. In these jurisdictions, the majority of clients (57%) were classed as ongoing, and readmissions (15%) (Figure CLIENTS6). The proportion of clients re-entering treatment ranged from 1.3% in the Northern Territory to 22% in Victoria (Table S11). Across jurisdictions where client status data was available, the proportion of new clients has doubled in the last 5 years, from 6.8% of clients in 2015 to 14% of clients in 2019.

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What drug of dependence did clients receive treatment for?

Heroin was by far the most common opioid drug of dependence for clients.

Clients receive pharmacotherapy treatment for a range of opioid drugs. These include illicit opioids (such as heroin), and pharmaceutical opioids available by prescription (such as oxycodone), or through illicit means. From 1 February 2018, all formerly over-the-counter (non-prescription) codeine-containing medicines for pain relief, cough and colds became available by prescription only.

Data for opioid drug of dependence should be used with caution due to the high proportion of clients with ‘Not stated/not reported’ as their opioid drug of dependence (39% of clients in 2019). In New South Wales, patients who transfer from one program to another (for example, by changing opioid pharmacotherapy drug or changing prescriber) have a higher rate of Not stated/not reported than those clients who do not have program changes.

Nationally in 2019, 37% of clients reported heroin as their opioid drug of dependence. Oxycodone (5.8%) was the next most commonly reported drug of dependence followed by codeine and buprenorphine (both 4.3%) (Figure CLIENTS7). Heroin was also the most common drug of dependence in all states and territories, except Tasmania and the Northern Territory, where morphine was the most common.

For the 61% of clients with a reported opioid drug of dependence, heroin was the most commonly reported drug of dependence (60%) followed by oxycodone (9.6%) and buprenorphine (7.1%). These proportions exclude ‘not stated/not reported’. High rates of ‘Not reported’ were shown in New South Wales (64%), the Australian Capital Territory and Victoria (39% and 34% respectively) (Table S10).

Pharmacotherapy drugs may be subject to misreporting if a client’s treatment drug is reported instead of the opioid drug of dependence which led to the client seeking treatment.

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References

AIHW (Australian Institute of Health and Welfare) 2016. National Drug Strategy Household Survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW.

DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH. Viewed 18 January 2019.

Alternative text

Figure CLIENTS1: Clients receiving pharmacotherapy treatment on a snapshot day, per 10,000 population, 2015 to 2019

On a snapshot day in 2019, there were 20 clients per 10,000 population who received pharmacotherapy treatment in Australia. This ranged from 6 clients per 10,000 population in the Northern Territory to 26 clients per 10,000 population in both New South Wales and the Australian Capital Territory. These trends have remained relatively stable since 2015.

Figure CLIENTS2: Clients receiving pharmacotherapy treatment on a snapshot day, by age group, 2010 to 2019

On a snapshot day in 2019, clients receiving pharmacotherapy treatment were most commonly aged 40–49. The proportion of opioid pharmacotherapy clients aged 40–49 increased between 2010 (28%) and 2019 (35%). Over the same period, the proportion of clients aged under 30 dropped from 18% to 7.2%, and the proportion aged 60 years and over increased from 1% to 8.1%.

Figure CLIENTS3: Clients receiving pharmacotherapy treatment on a snapshot day, by age group and pharmacotherapy type, 2015 to 2019

The proportion of opioid pharmacotherapy clients receiving methadone was higher for older age groups. Where methadone was the pharmacotherapy treatment received, 5.1% of clients were aged under 30, compared to 59% aged 40–59.

Figure CLIENTS4: Clients receiving pharmacotherapy treatment on a snapshot day, by age and sex, 2015 to 2019

The rate of pharmacotherapy clients per 10,000 population peaked at the age of 41 years for males (90 clients per 10,000 population) and 40 years for females (46 clients per 10,000 population).

Figure CLIENTS5: Clients receiving pharmacotherapy treatment on a snapshot day, by pharmacotherapy type, states and territories, 2015 to 2019

Methadone was the most common pharmacotherapy type in each state and territory except the Northern Territory, Queensland and Tasmania. The Australian Capital Territory had the highest proportion of clients receiving methadone (78%). In the Northern Territory, Queensland and Tasmania, buprenorphine-naloxone was the most common pharmacotherapy drug (67%, 50% and 46% of clients respectively).

Figure CLIENT6: Clients receiving pharmacotherapy treatment on a snapshot day, by client status, states and territories, 2015 to 2019

The majority of clients were ongoing in all states and territories. This ranged from 99% in Tasmania to 57% in Victoria. The proportion of clients re-entering treatment ranged from 22% in Victoria to 1% in the Northern Territory. New clients comprised 23% of clients in the Northern Territory. Data were only available from Victoria, Western Australia, Tasmania, the Australian Capital Territory and the Northern Territory.

Figure CLIENTS7: Clients receiving pharmacotherapy treatment by opioid drug of dependence, 2015 to 2019

Between 2015 and 2019, the proportion of clients receiving pharmacotherapy varied by opioid drug of dependence. The graph shows that heroin was the most common opioid drug of dependence for clients receiving opioid pharmacotherapy treatment (45% in 2015 and 37% in 2019). There was a high proportion of not stated/not reported responses (rising from 31% in 2015 to 39% in 2019). All other opioid drugs of dependence remained relatively stable.