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 more than once. 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 2020, there were 3,422 authorised prescribers of opioid pharmacotherapy drugs, a 15% increase since 2016 (Table S15). Of these prescribers, around 3 in 5 (61%) were authorised to prescribe more than one type of drug. A further 19% were authorised to prescribe methadone only and bupreprenorphine only (9.4% and 9.7% respectively). The remaining 20% were authorised to prescribe buprenorphine-naloxone only.

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 2020 (Table S16).

Figure PRESCRIBER1: Prescribers by pharmacotherapy type, 2011 to 2020

The number of prescribers registered to prescribe more than 1 pharmacotherapy drug type increased from 1,128 in 2011 to 2,091 in 2020. Buprenorphine-naloxone only prescribers rose from 16 in 2011 to 677 in 2020. Buprenorphine only prescribers increased from 59 in 2011 to 332 in 2020, and methadone-only prescribers increased from 346 in 2011 to 322 in 2020.

Data table

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 part of government, 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.

On a snapshot day in 2020, the majority of prescribers worked in the private sector (2801, or 82%) with the remainder working in the public sector (13%), correctional facilities (3.7%), or a combination of sectors (less than 1%) (Table 1).

Table 1: Prescriber types, states and territories, 2020
Prescriber type NSW Vic Qld WA SA Tas ACT NT Aust
Public prescriber 243 — 118 29 31 14 11 10 456
Private prescriber 731 1,572 120 81 223 23 49 2 2,801
Public/private prescriber — — — — — 2 1 — 3
Correctional facility 53 13 18 24 7 1 8 2 126
Total 1,027 1,585 292 134 261 40 69 14 3,422

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 36 prescribers who have a prescriber type of 'Not stated'.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2020 collection. Supplementary Table S15.

Of the 53,316 clients receiving pharmacotherapy treatment in Australia on a snapshot day in 2020, 64% received treatment from a private prescriber, 28% received treatment from a public prescriber, and 8% 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 2016 and 2020, the ratio of clients per prescriber decreased in all jurisdictions, with the exception of the Australian Capital Territory and the Northern Territory (Figure PRESCRIBER2). Western Australia had the largest decrease (from 31 to 25 clients per prescriber).

In 2020, Western Australia had the highest number of clients per prescriber (25), while Victoria had the lowest (9) (Figure PRESCRIBER2).

Figure PRESCRIBER2: Clients per prescriber, states and territories, 2016 to 2020

The ratio of clients per prescriber varied by state and territory. Nationally, there was 16 clients per prescriber in 2020. On a snapshot day in 2020, Western Australia had the highest number (25) of clients per prescriber, while Victoria had the lowest (9 clients per prescriber).

Data table

Prescribers working in the public sector had, on average, more than twice as many clients as prescribers in the private sector (33 clients per prescriber compared with 12, respectively) (Table S22).

Clients per prescriber

Nationally, client to prescriber ratios in private sectors remained relatively stable between 2019 and 2020 (Table S22). 

Private prescribers had a lower average number of clients than public prescribers in all jurisdictions except Tasmania. Victoria had no public prescribers.

Nationally, prescribers working in correctional facilities had an average of 33 clients in 2020. This varies widely at the state and territory level, from 5 clients per prescriber in the Northern Territory to 65 in Victoria (Table 2).

The Australian Capital Territory had the highest ratio of clients to prescribers in the public sector (59) followed by Western Australia (48). Queensland had the highest ratio of clients to prescribers in the private sector (27).

Table 2: Ratio of clients to prescriber type, states and territories, 2020
Prescriber type NSW Vic Qld WA SA Tas ACT NT Aust
Public prescriber 33.2 — 30.1 47.8 30.6 10.4 58.8 14.4 32.8
Private prescriber 17.0 8.9 27.1 21.8 8.2 16.0 7.0 1.5 12.2
Public/private prescriber — — — — — 67.5 — — 45.0
Correctional facility 46.1 64.8 12.1 10.1 35.9 31.0 16.0 5.0 33.1
Total 22.3 9.4 24.0 25.3 11.6 17.0 16.2 11.2 15.6

— Nil or rounded to zero.
Notes:

  1. This ratio was calculated using the formula: number of clients, by prescriber type and state/territory (Table S3) divided by registered prescribers by prescriber type and state/territory (Table S15).
  2. WA and SA have prescribers who prescribe in more than one location, and as such are counted more than once. This will lead to slightly deflated client to prescriber ratios in these jurisdictions.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2020 collection. Supplementary Table S22.

Almost half (48%) of prescribers treated between 1 and 5 clients, with 9.7% treating more than 50 clients—the majority of which were in New South Wales and Victoria (77%). Across states and territories, the proportion of pharmacotherapy prescribers treating between 1 and 5 clients ranged from 13%  in Queensland to 79% in the Northern Territory. Around 21% of prescribers were not treating any clients on the snapshot day (Table 3).

Table 3: Clients receiving pharmacotherapy treatment on a snapshot day per prescriber, states and territories, 2020
Clients per prescriber NSW Vic Qld WA SA Tas ACT NT Total Total (%)
0 pharmacotherapy clients — 553 164 — — — 15 — 732 21.4
1–5 pharmacotherapy clients 635 651 39 66 189 16 25 11 1,632 47.7
6–10 pharmacotherapy clients 87 93 18 14 19 4 5 — 240 7.0
11–15 pharmacotherapy clients 41 64 11 9 8 6 3 — 142 4.1
16–20 pharmacotherapy clients 34 23 12 2 7 4 4 2 88 2.6
21–25 pharmacotherapy clients 23 29 4 4 5 2 5 — 72 2.1
26–50 pharmacotherapy clients 64 61 17 14 16 6 6 — 184 5.4
51–100 pharmacotherapy clients 80 43 24 14 12 1 4 1 179 5.2
101+ pharmacotherapy clients 63 68 3 11 5 1 2 — 153 4.5
Total 1,027 1,585 292 134 261 40 69 14 3,422 100.0

— Nil or rounded to zero.
Notes:

  1. Prescribers classified as treating '0 pharmacotherapy clients' on a snapshot day must have held an authority to prescribe and had a client who was receiving treatment during the collection year.
  2. These data were introduced into the collection in 2014.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2020 collection. Supplementary Table S19.

Did drug treatment vary between prescriber types?

Treatment varied between prescriber types.

Treatment type

In 2020, methadone was the most commonly prescribed drug across all prescriber types. However, a higher proportion of clients in correctional facilities were prescribed methadone (2,605 or 63% of clients) when compared with clients of private (60%) and public prescribers (7,968 or 53%). Clients of private prescribers were more likely to be prescribed buprenorphine-naloxone (7,696 or 23%) compared with public (2,850 or 19%) and correctional facility (316 or 7.6%) prescribers (Table S12). 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.

Client characteristics

Based on 2020 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 under 30 at 2.9 times the rate of public prescribers and 3.9 times that of private prescribers.
    • Correctional facilities treated clients aged between 30 and 39 years at 1.5 times the rate than that of public prescribers and 1.8 times the rate than that of private prescribers. This has remained relatively stable since 2016.
    • 1 in 10 (10.1%) clients treated in correctional facilities were aged 50 years and over, compared with 3 in 10 clients treated by public prescribers (32%) and almost 4 in 10 by private prescribers (38%).
  • 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.