Opioid pharmacotherapy prescribers

Medical personnel, such as general practitioners and medical specialists, prescribe opioid pharmacotherapy. Each state and territory has a registration process through which prescribers can undergo training and become registered or authorised to prescribe opioid pharmacotherapy to clients.

Data on all registered or authorised prescribers are included in this report, except for New South Wales, Western Australia and South Australia, where prescribers are included only if they are actively prescribing to at least 1 client on the snapshot day (refer to Table T2 of the Technical notes for further details). New South Wales, Western Australia and South Australia have prescribers who prescribe in more than 1 location, and as such are counted twice. This will lead to slightly deflated client to prescriber ratios. For more details about the collection, refer to the Technical notes. 

What were the numbers and types of prescribers?

Most prescribers were authorised to prescribe more than one type of drug.

On the snapshot day in 2019, there were 3,395 authorised prescribers of opioid pharmacotherapy drugs, a 33% increase since 2015 (Table S15).

Of these prescribers, almost two-thirds (61%) were authorised to prescribe more than one type of drug. A further 22% were authorised to prescribe buprenorphine-naloxone only, and 10% were authorised to prescribe methadone only. The remaining 7.4% were located in New South Wales and Victoria, and were authorised to prescribe buprenorphine only. However, New South Wales report both buprenorphine and buprenorphine-naloxone as ‘buprenorphine only’ (Figure PRESCRIBER1).

All prescribers in Queensland, Western Australia and the Australian Capital Territory were registered to prescribe more than one type of drug in 2019 (Table S16).

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Where did prescribers work?

Most prescribers worked in the private sector.

Prescribers are classified according to the sector in which they are working when prescribing pharmacotherapy drugs to clients.

  • Private prescribers work in organisations that are not controlled by governments, such as private general practice clinics.
  • Public prescribers work in organisations that are part of government or are government-controlled, such as public drug and alcohol clinics and public hospitals.
  • Correctional facility prescribers work in prisons or other correctional services.

The majority of prescribers worked in the private sector (84%) with the remainder working in the public sector (12%), correctional facilities (3%), or a combination of sectors (less than 1%) (Table 1). Victoria had the highest proportion of private prescribers (99%), followed by South Australia (87%). The Northern Territory had the highest proportion of public prescribers (83%), followed by Queensland (42%). (Table S15).

Table 1: Prescriber types, states and territories, 2019

Prescriber type

NSW

Vic

Qld

WA

SA

Tas

ACT

NT

Aust

Public prescriber

213

111

26

29

12

9

15

415

Private prescriber

630

1,688

119

96

235

22

53

1

2,844

Public/private prescriber

2

2

Correctional facility

48

12

3

19

7

2

8

2

101

Total

891

1,700

266

141

271

38

70

18

3,395

 

Notes
— Nil or rounded to zero.
1. The states and territories have different guidelines and policies regarding training and registration to prescribe opioid pharmacotherapy types. Refer to the Technical notes for more information.
2. The Qld total includes 33 prescribers who have a prescriber type of 'Not stated'.
Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2019 collection. Supplementary Table S15.

Of the 50,945 clients receiving pharmacotherapy treatment in Australia on a snapshot day in 2019, 65% received treatment from a private prescriber, 27% received treatment from a public prescriber, and 7% from a correctional facility prescriber (Table S12).

Private prescribers treated the majority of clients in New South Wales, Victoria, Western Australia, South Australia and Tasmania. Public prescribers treated the majority of clients in Queensland, the Australian Capital Territory and the Northern Territory (Table S3).

How many clients did prescribers treat?

The ratio of clients per prescriber decreased in the last 5 years.

Between 2015 and 2019, the ratio of clients per prescriber decreased in all jurisdictions, with the exception of the ACT (from 14 clients per prescriber in 2015 to 16 clients per prescriber in 2019). In relative terms, the Northern Territory had the largest decrease (from 20 to 8 clients per prescriber). Overall, in 2019, Queensland had the highest number of clients per prescriber (27), while Victoria and the Northern Territory had the lowest (8) (Figure PRESCRIBER2).

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Prescribers working in the public sector had, on average, almost three times as many clients as prescribers in the private sector (34 clients per prescriber compared with 12) (Table S22).

Clients per prescriber

Client to prescriber ratios in both the private and public sectors remained stable between 2018 and 2019 (Table S22).

Nationally, prescribers working in correctional facilities had an average of 36 clients. This varies widely at the state and territory level, from 2 clients per prescriber in Tasmania to 76 in Victoria (Table S22). The Australian Capital Territory had the highest ratio of clients to prescribers in the public sector (59) followed by Western Australia (49). Queensland had the highest ratio of clients to prescribers in the private sector (29). Private prescribers had a lower average number of clients than public prescribers in all jurisdictions except Victoria (where there were no public prescribers) and Tasmania.

The majority (45%) of prescribers treated between 1 and 5 clients, with only 10% treating more than 50 clients. Across states and territories, the proportion of pharmacotherapy prescribers treating between 1 and 5 clients ranged from 13% in Queensland to 72% in South Australia. Around 27% of prescribers were not treating any clients on the snapshot day (Table S19).

Did drug treatment vary between sectors?

Treatment varied between sectors.

Treatment type

In 2019, methadone was the most commonly prescribed drug across all sectors. However, a higher proportion of clients in correctional facilities were prescribed methadone (79% of clients) when compared with clients of private (61%) and public prescribers (56%). Clients of private prescribers were more likely to be prescribed buprenorphine-naloxone (24%) compared with public (22%) and correctional facility (7%) prescribers. Given that clients prescribed buprenorphine-naloxone in New South Wales are reported as receiving buprenorphine, the proportion of clients receiving buprenorphine-naloxone nationally is likely to be an underestimate (Table S12).

Client characteristics

Based on 2019 unit record data from 6 states and territories (excludes data from Victoria and Queensland) on a snapshot day, clients of prescribers in correctional facilities were more likely to be:

  • Younger (Table S27)—correctional facilities treated clients aged between 30 and 39 years at 1.5 times the rate than that of public or private prescribers. Public and private prescribers treated similar client groups. Around 1 in 10 (11%) clients treated in correctional facilities were aged 50 years and over, compared with 3 in 10 treated by public prescribers (31%) and almost 4 in 10 by private prescribers (36%).
  • Males (Table S28)—correctional facilities treated about 9 males for every female. Public and private prescriber types were generally similar in terms of the proportion of male and female clients treated, each treating about twice as many males as females.

Alternative text

Figure PRESCRIBER1: Prescribers by pharmacotherapy type, 2010 to 2019

The number of prescribers registered to prescribe more than 1 pharmacotherapy drug type increased from 1,077 in 2010 to 2,079 in 2019. Buprenorphine-naloxone only prescribers rose from 1 in 2010 to 731 in 2019. Buprenorphine only prescribers increased from 34 in 2010 to 250 in 2019, while methadone-only prescribers remained relatively stable since 2010.

Figure PRESCRIBER2: Clients per prescriber, states and territories, 2015 to 2019

The ratio of clients per prescriber varied by state and territory. Nationally, the number of clients per prescriber has dropped from 19 in 2015 to 15 in 2019. On a snapshot day in 2019, Queensland had the highest number (27) of clients per prescriber, while Victoria and the Northern Territory had the lowest (8 clients per prescriber).