How many people received opioid pharmacotherapy treatment?

The number of people receiving opioid pharmacotherapy increased since 2019.

On a snapshot day in 2020, 53,316 people in Australia were on a course of pharmacotherapy treatment for their opioid dependence. This is a 4.7% increase in number of clients since 2019 and the largest increase in the number of clients over the last decade. The increase in client numbers was largely driven by increases in New South Wales and Victoria (Table S1). Changes in client numbers could be influenced by system changes, coding practices, changes in treatment policies or capacity within jurisdictions, which may contribute to variation over time. For Victoria, the increase in the number of clients may have been influenced by the implementation of the Victorian Governments SafeScript initiative. SafeScript has identified people with risky prescription opioid use who were previously undetected. For New South Wales, the increase in client numbers in 2020 could be attributed to the introduction of buprenorphine LAI. Buprenorphine LAI was reported in the NOPSAD collection for the first time in 2020. It is possible that some additional prescribing of buprenorphine occurred in correctional facilities, with the introduction of depot buprenorphine LAI during the year contributing to an increase in access to treatment. Some NSW Local Health Districts also reported having capacity to increase the number of new patients due to buprenorphine LAI.

In the 10 year period to 2020, client numbers have increased by 15% (46,446 clients in 2011 and 53,316 clients in 2020) (Table S1). Nationally, the rate of clients (21 clients per 10,000 people) receiving pharmacotherapy treatment has remained relatively stable since 2011. However, rates have fluctuated across most states and terrirtories during this time (Table S2).

In 2020, New South Wales had the highest rate of people receiving opioid pharmacotherapy treatment (28 clients per 10,000 people). This is an increase from 26 clients per 10,000 population in 2019. 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).

Figure CLIENTS1: Clients receiving pharmacotherapy treatment on a snapshot day, 2011 to 2020

On a snapshot day in 2020, there were 21 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 28 clients per 10,000 population in both New South Wales.

Data table

Who received pharmacotherapy treatment?

Age

The median age of opioid pharmacotherapy clients was 44 years.

In 2020, the median age of clients across all pharmacotherapy types was 44 years. This is an increase from 43 years in 2019 and from 38 years in 2011. Clients using services in South Australia had the highest median age (45 years), while clients in Tasmania had the lowest median age (41 years) (Table S5).

The highest proportion of clients fell within the 40–49 age group (36%), followed by those aged 30–39 (25%) and 50–59 (22%). Since 2011, the proportion of clients aged under 30 and 30–39 decreased (from 15% and 40% in 2011 to 7.0% and 25% in 2020, respectively). In contrast, the proportions of clients in the older three age groups (40–49, 50–59 and 60 and over) have all increased since 2011.

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 2020). 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.

Figure CLIENTS2: Clients receiving pharmacotherapy treatment on a snapshot day, by age group, 2011 to 2020

On a snapshot day in 2020, clients receiving pharmacotherapy treatment were most commonly aged 40–49. The proportion of opioid pharmacotherapy clients aged 40–49 increased between 2011 (29%) and 2020 (36%). Over the same period, the proportion of clients aged under 30 dropped from 15% to 7.0%, and the proportion aged 60 years and over increased from 1.4% to 9.4%.

Data table

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).

Figure CLIENTS3: Clients receiving pharmacotherapy treatment on a snapshot day, by age group and pharmacotherapy type, 2016 to 2020

The proportion of opioid pharmacotherapy clients receiving methadone was higher for older age groups. Where methadone was the pharmacotherapy treatment received, 4.6% of clients were aged under 30, compared to 62% aged 40–59.

Data table

Sex

More males than females received opioid pharmacotherapy treatment.

Around two-thirds (67%, or nearly 35,500) of clients receiving pharmacotherapy on the snapshot day in 2020 were male. This proportion was similar for each of the 4 pharmacotherapy types (methadone, buprenorphine, buprenorphine-naloxone and buprenorphine LAI) and has remained stable over the 10 years since 2011 (Table S7).

The rate of clients receiving pharmacotherapy was highest for people in the 40–49 age group for both males and females (Figure CLIENTS4). The rate peaked at age 40 for males (96 clients per 10,000 population). The rate for females peaked at 41 years (47 clients per 10,000 population).

Figure CLIENTS4: Clients receiving pharmacotherapy treatment on a snapshot day, selected states and territories, by age and sex, 2016 to 2020

The rate of pharmacotherapy clients per 10,000 population peaked at the age of 40 years for males (96 clients per 10,000 population) and 41 years for females (47 clients per 10,000 population).

Data table

Aboriginal and Torres Strait Islander people

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

In June 2020, there were 5,693 clients receiving pharmacotherapy treatment who identified as Indigenous Australians (Table S9). This is a rate of 66 clients per 10,000 Indigenous Australians.

Of those Indigenous Australian clients with pharmacotherapy type provided, over half (53%) were treated with methadone in 2020. The remaining Indigenous Australian clients were treated with buprenorphine (32%), buprenorphine naloxone (13%) or buprenorphine LAI (1%). Victoria provides pharmacotherapy type as a total for Indigenous clients (Table S9).

From 2016 to 2020, treatment with:

  • methadone fell (from 67% of Indigenous clients to 53%)
  • buprenorphine increased (from 22% of Indigenous clients to 32%), and
  • buprenorphine-naloxone rose (from 11% of Indigenous clients to 13%).

The Australian Capital Territory had the highest rate of Indigenous clients receiving pharmacotherapy treatment on a snapshot day with 144 clients per 10,000 Indigenous Australians (or 121 Indigenous Australian clients). This was followed by Victoria with 124 clients per 10,000 Indigenous Australians (or 791 Indigneous Australian clients) and New South Wales with 122 clients per 10,000 Indigenous Australians (or 3,482 Indigenous Australian clients). The Northern Territory had the lowest rate of Indigenous clients with 4 clients per 10,000 Indigenous Australians or 34 Indigenous Australian clients (Table S.9).

What treatments did clients receive?

Methadone continued to be the most commonly prescribed pharmacotherapy drug.

On a snapshot day in 2020, 58% or 31,093 clients were treated with methadone, 21% (10,950 clients) received buprenorphine-naloxone, 19% (9,970 clients) received buprenorphine and 2% (1,303) received buprenorphine LAI (Table S4). However, it should be noted that New South Wales does not separately report clients receiving buprenorphine-naloxone­ or buprenorphine LAI—these clients are included in the number of clients receiving buprenorphine.

From 2011 to 2020, treatment with:

  • methadone fell (from 69% of clients to 58%)
  • buprenorphine-naloxone increased (from 18% of clients to 21%), and
  • buprenorphine rose (from 14% of clients to 19%) (Table S4).

Previous trend data have shown that buprenorphine-naloxone prescription is replacing buprenorphine prescription. This is in keeping with the national guidelines which 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). On a snapshot day in 2020, the number of clients receiving methadone and buprenorphine-naloxone treatments both decreased compared with the previous year (from 61% and 23% in 2019 to 58% and 21% in 2020, respectively). Clients receiving buprenorphine increased between 2019 to 2020, from 17% to 19%. The introduction of buprenorphine LAI, reported in some jurisdictions for the first time in 2020, accounted for 2.4% of opioid pharmacotherapy treatment. Changes in treatment type between 2019 and 2020 may be impacted by this change.

The proportion of clients receiving each of the 4 pharmacotherapies varies across states and territories (Figure CLIENTS5). In 2020, 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 (46%, 46% and 67% of clients, respectively). The Australian Capital Territory and New South Wales had the highest proportion of clients receiving methadone (69% and 62%, respectively). In contrast, 19% 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).

Figure CLIENTS5: Clients receiving pharmacotherapy treatment on a snapshot day, by pharmacotherapy type, states and territories, 2016 to 2020

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 (69%). In the Northern Territory, Queensland and Tasmania, buprenorphine-naloxone was the most common pharmacotherapy drug (67%, 46% and 46% of clients respectively).

Data table

Did clients stay in treatment?

Most clients were continuing opioid pharmacotherapy 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 in 2020 for New South Wales, Victoria, Western Australia, Tasmania, the Australian Capital Territory and the Northern Territory. In these jurisdictions, the majority of clients (68%) were classed as ongoing and a further 15% were new in 2020 (Figure CLIENTS6). The proportion of clients re-entering treatment ranged from 1.0% in Tasmania to 23% in Western Australia (Table S11). Client status for New South Wales was reported for the first time in 2020.

Figure CLIENTS6: Clients receiving pharmacotherapy treatment on a snapshot day, selected states and territories, by client status, 2016 to 2020

The majority of clients were ongoing in all states and territories. This ranged from 98% in Tasmania to 58% in Victoria. The proportion of clients re-entering treatment ranged from 23% in Western Australia to 1% in the Tasmania. New clients comprised 21% of clients in the Victoria. Data were only available from New South Wales, Victoria, Western Australia, Tasmania, the Australian Capital Territory and the Northern Territory.

Data table

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. 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.

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 (38% of clients in 2020). 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 2020, 37% of clients reported heroin as their opioid drug of dependence. Oxycodone (5.7%) was the next most commonly reported drug of dependence followed by buprenorphine (4.9%) and methadone (both 4.0%) (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 62% of clients with a reported opioid drug of dependence, heroin was the most commonly reported drug of dependence (59%) followed by oxycodone (9.2%) and buprenorphine (8.0%). These proportions exclude ‘not stated/not reported’. High rates of ‘Not reported’ were recorded in New South Wales (64%), Victoria (33%) and Tasmania (19%) (Table S10).

Figure CLIENTS7: Clients receiving pharmacotherapy treatment by opioid drug of dependence, 2016 to 2020

Between 2016 and 2020, 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 (40% in 2016and 37% in 2020). There was a high proportion of not stated/not reported responses (rising from 36% in 2016 to 38% in 2020). All other opioid drugs of dependence remained relatively stable.

Data table

References

Australian Institute of Health and Welfare 2020. National Drug Strategy Household Survey 2019. Cat. no. PHE 270. Canberra: AIHW.

DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH. Viewed 18 December 2020.