Notes

  • Technical notes 09 Apr 2018

    Age

    Age is calculated as at 30 June of the collection year.

    Agency remoteness area

    Dosing points have been classified according to their remoteness area (RA) as defined by the Australian Statistical Geography Standard (ASGS) Remoteness Structure [1]. This structure allows areas that share common characteristics of remoteness to be classified into broad geographic regions of Australia. These areas are:

    • Major cities
    • Inner regional
    • Outer regional
    • Remote
    • Very remote.

    The Remoteness Structure divides each state and territory into several regions on the basis of their relative access to services.

    Examples of places that are considered Major cities in the ASGS classification include Sydney, Canberra and Newcastle. Hobart and Bendigo are Inner regional areas and Cairns and Darwin are Outer regional areas. Katherine and Mount Isa are Remote areas and Tennant Creek and Meekatharra are Very remote.

    Using this classification, dosing points were assigned to an RA based on their recorded Statistical Areas Level 2 (SA2) code.

    Some SAs are split between multiple remoteness areas. Where this was the case, the data were weighted according to the proportion of the population of the SA2 in each remoteness area.

    Average annual rates of change

    The average annual rates of change or growth rates have been calculated as geometric rates:

    Average rate of change = ((Pn/Po)^(1/n) -1) x 100

    where:

    Pn= value in the later time period

    Po= value in the earlier time period

    n = number of years between the 2 time periods.

    Confidentiality

    The Australian Institute of Health and Welfare (AIHW) has strict confidentiality policies which have their basis in section 29 of the Australian Institute of Health and Welfare Act 1987 (the AIHW Act) and the Privacy Act 1988 (the Privacy Act). Cells in supplementary tables may be suppressed for either confidentiality reasons or where estimates are based on small numbers, resulting in low reliability. Information that results in attribute disclosure will be suppressed unless agreement from the particular data provider to publish the data has been reached. Information on the AIHW's Privacy policy is available on the privacy page.

    Population estimates used for rates calculations

    All rates in this report, including historical rates, have been calculated using population estimates based on the 2011 Census. All Indigenous rates in this report are calculated using the Indigenous population estimates and projections, based on the 2011 Census.

    Population rates

    Crude rates are calculated using the Australian Bureau of Statistics estimated resident population (ERP) as at 30 June of each collection year. Rates for 2017 data were calculated using the preliminary ERP at 30 June 2017, with the exception of remoteness rates which were calculated using the preliminary ERP at 30 June 2016.

    Trends

    Trend data may differ from data published in previous versions of National opioid statistics in Australia due to data revisions.

  • Data collection by states and territories 09 Apr 2018

    State and territory governments use different methods to collect data about the clients, prescribers and dosing points associated with the opioid pharmacotherapy system. These methods are driven by differences between the states and territories in relation to legislation, information technology systems and resources. Caution should be taken when comparing one state or territory with another. Information on these differences is detailed in the following tables:

    • Table T1—Administrative features of the NOPSAD collection in each state and territory
    • Table T2—Methodological differences for the NOPSAD collection in each state and territory
    • Table T3—Policies and guidelines for opioid pharmacotherapy
    • Table T4—History of data reported for the NOPSAD collection, 2005 to 2016.
    Table T1: Administrative features of the NOPSAD collection in each state and territory
    State/territory Administrative features
    New South Wales

     

    Treatment for a client under the NSW Opioid Treatment Program (OTP) must be initiated by an accredited OTP prescriber. A NSW medical practitioner who has not received accreditation as a NSW OTP prescriber may be authorised by the Ministry of Health to prescribe methadone or buprenorphine for up to 5 ‘stable’ clients; that is, a client may be transferred to them, but they cannot induct a person onto treatment.
    To participate in the NSW OTP, community pharmacies must register with the Ministry of Health and comply with the protocol for community pharmacy dosing points issued by the Ministry.
    Victoria The Victorian pharmacotherapy system is essentially community‑based, other than inpatients in hospitals and in prisons. Although a small number of services receive government funding, services are independent bodies and the government does not manage them directly.
    Since the release of the 2013 policy, general practitioners have been able to prescribe buprenorphine‑naloxone for up to 5 patients without the need to attend specific training (Vic Health 2013). Victoria’s Policy for maintenance pharmacotherapy for opioid dependence was revised in 2016.
    Queensland The Queensland Opioid Treatment Program is essentially community based, other than inpatients in hospitals and correctional facilities. Prescribers attend training provided by Medicines Regulation and Quality Unit (Queensland Department of Health) and the Chief Executive Officer provides authorisation to commence prescribing on successful completion of the training program. Prescriber training is provided for all pharmacotherapies currently available.
    Western Australia The Western Australian pharmacotherapy program is community‑based, other than inpatients in hospitals, prisons and the public clinic. Prescribers attend training provided by the Mental Health Commission (MHC) and the Chief Executive Officer of Health provides authorisation under the Medicines and Poisons Regulations 2016, the legislative instrument. Prescriber training is provided for all pharmacotherapies currently available and now includes prescriber training for practitioners wishing to prescribe Suboxone® to up to 5 patients.
    Community pharmacies are authorised to participate in the Community Program for Opioid Pharmacotherapy (CPOP). The Pharmacist with overall responsibility is required to ensure that all pharmacists dosing clients have completed the pharmacist online training module on the MHC website.
    South Australia In 2011 a program to allow any medical practitioner to prescribe buprenorphine-naloxone film for up to 5 patients for the treatment of opioid drug dependence was introduced. This program is known as the Suboxone® Opioid Substitution Program (SOSP). Authorities granted by the Drugs of Dependence Unit are still required to be held before starting treatment with buprenorphine-naloxone, and the usual program rules for all pharmacotherapy programs remain in force. Buprenorphine-naloxone film is the only drug option authorised for this program. A prescriber can treat up to 5 patients with buprenorphine-naloxone film before having to undertake accreditation by Drug and Alcohol Services South Australia and formal approval by the Drugs of Dependence Unit to be an accredited prescriber via the Opioid Dependence Substitution Program (ODSP). A prescriber cannot provide treatment with buprenorphine alone or methadone liquid without first being accredited.
    Tasmania In Tasmania, pharmacotherapy training is provided separately for each pharmacotherapy drug.
    Australian Capital Territory All pharmacists are required to attend training in ‘Risk Management of the Process of Dosing Opioid Dependent Consumers’ before they start dosing clients. The Canberra Hospital Pharmacy Services conducts this training.
    Northern Territory Accredited prescribers complete an ‘Application for authority to prescribe a restricted Schedule 8 substance for the treatment of addiction’ and submit the form with a photograph of the client to the Department of Health, Medicines and Poisons Control. A contract between the client, prescriber and supplying pharmacy is also required for all applications for maintenance treatments. The application information is recorded in the Drug Monitoring System database. The prescriber is not permitted to prescribe until they receive a signed authorisation document. The prescriber must notify Medicines and Poisons Control within 14 days of cessation of treatment.
    Table T2: Methodological issues of note for the NOPSAD collection in each state and territory
    State/territory Methodological issues
    National While the standard snapshot day is set in June of any given year, it varies between states and territories. Despite this variance, it allows the number of clients to be estimated at a single point in time. Data collected for a snapshot day are likely to result in an underestimate of total clients receiving pharmacotherapy within a year. In general, all clients receiving their pharmacotherapy dose in person on the snapshot day are counted.
    New South Wales The NSW Electronic Recording and Reporting of Controlled Drugs (ERRCD) system is used in the administration of the New South Wales Opioid Treatment Program. It replaced the legacy Pharmaceutical Drugs of Addiction System (PHDAS) in September 2016. The ERRCD system is used to record authorisations to prescribe as part of the New South Wales Opioid Treatment Program. It also records client admissions to, and exits from, treatment, as well as details of prescribers and dosing points. For these reasons, the ERRCD system is characterised by continual fluctuations and data extracted at different times for the same period may not be the same. However, while delays in reporting entries to the program, exits from the program and changes in the status of dosing points cause short-term fluctuations in the database, these flatten out over time.
    Clients prescribed buprenorphine-naloxone are counted under ‘buprenorphine’.
    Similarly, New South Wales data collection does not differentiate between prescribers who are authorised to prescribe buprenorphine and those authorised to prescribe buprenorphine-naloxone.
    Data on prescribers refer to prescribers who were treating at least 1 client on the snapshot day.
    Data on dosing point sites relate to sites that had at least 1 client receiving treatment on the snapshot day.
    Client data are reported in New South Wales as at 30 June.
    Victoria Data are collected from 2 sources: a yearly census of pharmacists who are requested to report the actual number of clients being dosed on a snapshot day, and the permit database, which records information about prescribers authorised to prescribe pharmacotherapy drugs, as well as demographic information about clients accessing pharmacotherapy treatment. These 2 data sources cannot be linked.
    The number of clients receiving pharmacotherapy treatment is reported on a snapshot day in June.
    The number of prescribers in Victoria is determined by adding the number of prescribers registered for that year to the number of existing prescribers.
    Victoria does not provide data for age and sex by individual pharmacotherapy drug type. Age and sex data for all pharmacotherapy drugs (combined) were are provided. Prior to 2013, Victoria estimated these data.
    Victoria has commenced collecting the Indigenous status of clients. Data for 2016 and 2017 included Indigenous status for totals.
    Client data are reported in Victoria on a snapshot day in June.
    Queensland Data are collected monthly from pharmacists and entered into a central database that Medicines Regulation and Quality manages. Data are also collected from administrative ‘Admission’ and ‘Discharge’ forms. Queensland totals may vary slightly due to these data source differences. For example, a client may be counted as registered and having received a dose on the snapshot day, but a dosing point cannot be assigned because the dose consumed on that day was a takeaway dose.
    The total number of prescribers for Queensland includes those from private practice, public clinics, correctional facilities and government medical offices.
    Client data are reported in Queensland on a snapshot day in June.
    Western Australia Data are collected from the monthly reports received from pharmacies and other dosing sites authorised to participate in the Community Program for Opioid Pharmacotherapy (CPOP). The dosing data are entered into the Medicines and Poisons Regulation Branch’s Monitoring of Drugs of Dependence System (MODDS) database. Data are also collected from the ‘Application for authority’, ‘Authority to prescribe’ and ‘Termination of treatment’ forms. The number of clients receiving pharmacotherapy treatment is reported through the month of June.
    The total number of prescribers usually includes those treating at least 1 client as at 30 June 2017 in private practice, public clinics and correctional facilities.
    In Western Australia, data relating to the Indigenous status of clients is now being collected from new ‘Application to prescribe opioid substitution treatment’ forms but not at the time of renewal for patients continuing in treatment.
    Client data are usually reported in Western Australia for the entire month of June. Specifically, pharmacies supply information at the end of June relating to the last dose supplied to the patient for the month of June. If a patient changes pharmacies mid-month, it is possible that they appear on more than 1 pharmacy’s monthly transaction reports and are counted more than once.
    In 2017 data for WA were reported for the month of May.
    Before 2005, Western Australia reported clients over a year.
    South Australia Data are collected from the forms ‘Application for authority’, ‘Termination of treatment’ and ‘Request for additional methadone/buprenorphine takeaway’, which are entered into a central database system at the Drugs of Dependence Unit, SA Health. Information from dispensed prescriptions is also collected electronically from the majority of pharmacies on a monthly basis by the Drugs of Dependence Unit.
    From 2011, data have been collected via a half-yearly survey that pharmacists completed and reported on a snapshot day in June. From 2014, this survey has been conducted annually. Other data are drawn from the Drugs of Dependence Unit’s Drugs of Misuse Surveillance System and are about those clients registered for treatment on the snapshot day (but who may not actually receive treatment on that day).
    Clients who did not enter a dosing point on the snapshot day are reported as ‘other’ when describing clients by dosing point site.
    All tables include Opioid Dependence Substitution Program (ODSP) and Suboxone® Opioid Substitution Program (SOSP) clients and prescribers.
    In South Australia, data relating to prescribers refer to prescribers who were treating at least 1 client on the snapshot day.
    Tasmania Data are collected monthly from all pharmacies participating in the Tasmanian Opioid Pharmacotherapy Program (TOPP), and entered into the Drugs and Poisons Information System (DAPIS). This system is administered by the Pharmaceutical Services Branch (PSB) and manages client registration, dosing activity, dosing sites, authority to prescribe and dispensing information relating to drugs of high abuse potential. The system also makes available limited information to relevant medical practitioners and pharmacists, both within and external to the Department to assist safe treatment of patients requiring drugs of a high abuse potential.
    Data from DAPIS are made available for management style reporting from a Qlikview-based intranet dashboard.
    Client data in Tasmania are reported from a snapshot for the month of June. However, clients are counted only once—if they change dosing point site during the month, the dosing point site that administered the greater number of doses is attributed the activity.
    Data on prescribers refer to prescribers who were treating at least 1 client during the month of June.
    Data on dosing points refer to dosing points that had a client receiving treatment during the month of June.
    Australian Capital Territory Client participation data are collected manually from the Health Directorate’s Alcohol and Drug Services spreadsheets and from Medication Administration Chart (MAC) Sheets which the community pharmacies provide every month. Client participation data are also collected via iDose which is an in-house database that contains client dosing information in real time. General practitioner and pharmacy participation data are also collated from the MAC Sheets.
    Client data are reported on clients receiving treatment in the Australian Capital Territory on a snapshot day in June.
    Northern Territory Data are generated from the current active authorisations in the Drug Monitoring System database on the snapshot day in June. The data are audited against current Schedule 8 prescription data also within the database.
    Table T3: Policies and guidelines for opioid pharmacotherapy
    State/territory Policies and guidelines

    National

    New South Wales

    Victoria

    Queensland

    Western Australia

    South Australia The following documents are available via the SA Opioid Dependence Substitution Program:

    Tasmania

    Australian Capital Territory

    Northern Territory

    Table T4: History of data reported for the NOPSAD collection, 2005 to 2017

    Table T4 (45KB XLS)

  • Glossary 09 Apr 2018

    Concept Definition

    Buprenorphine (Subutex®)

    Buprenorphine acts in a similar way to methadone, but is longer lasting and may be taken daily or every second or third day. Two buprenorphine preparations are registered in Australia for the treatment of opioid dependence: a product containing buprenorphine only, and a combined product containing buprenorphine and naloxone. The buprenorphine only product is available as a tablet containing buprenorphine hydrochloride that is administered sublingually (by dissolving under the tongue) [3].

    Buprenorphine-naloxone (Suboxone®)

    The combination buprenorphine-naloxone product is a sublingual tablet or film containing buprenorphine hydrochloride and naloxone hydrochloride [1]. It is recommended that buprenorphine-naloxone should be prescribed in preference to buprenorphine for most clients [3]. This is because, when taken as intended by dissolving the tablet or film under the tongue, the combined product acts as if it was buprenorphine alone. However, if the combined product is injected, naloxone can block the effects of buprenorphine and increases opioid withdrawal symptoms. This reduces the risk that those receiving buprenorphine naloxone as a takeaway dose will inject it or sell it to others to inject [2, 3, 4].

    client

    A person registered as receiving opioid pharmacotherapy treatment on the snapshot day.

    correctional facility prescribers

    Prescribers who work in prisons or other correctional services.

    dosing point site

    A place at which a client is provided a pharmacotherapy drug. Sites include public and private clinics (such as methadone clinics), pharmacies, correctional facilities, hospitals (admitted patients and outpatients) and other locations such as community health centres and doctors’ surgeries.

    Methadone (Methadone Syrup®, Biodone Forte®)

    A synthetic opioid used to treat heroin and other opioid dependence. It reduces opioid withdrawal symptoms, the desire to take opioids and the euphoric effect when opioids are used. It is taken orally on a daily basis [3].

    prescriber

    A prescriber who held an authority to prescribe a pharmacotherapy drug and who has not been recorded as ceasing this authority before the snapshot day. See the Technical notes for information about the counting of prescribers for each state and territory.

    prescriber type

    The sector (public or private) in which the prescriber is practising when prescribing pharmacotherapy drugs.

    private prescribers

    Prescribers who work in organisations that are not controlled by government, such as private general practice clinics.

    public prescribers

    Prescribers who work in organisations that are part of government or are government controlled, such as public drug and alcohol clinics and public hospitals.

    Schedule 4 drug

    Prescription only medicine—substances, the use or supply of which, should be by, or on the order of, persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.

    Schedule 8 drug

    A controlled drug—substances which should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence. Methadone and buprenorphine are examples of Schedule 8 drugs.

    specified or snapshot day

    A particular day, usually in June each year, on which clients are counted for the NOPSAD collection. The snapshot day varies between states and territories, but allows the number of clients to be estimated at a single point in time. See the Technical notes for information about the use of the snapshot day for each state and territory.

    References

    1. ABS (Australian Bureau of Statistics) 2012. The ASGC remoteness structure. Canberra: ABS. Viewed 12 January 2017.
    2. Chapleo CB & Walter DS 1997. The buprenorphine naloxone combination product. Research and Clinical Forums 19(2):55–8.
    3. DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH. Viewed 24 January 2018.
    4. Dunlop A 2007. From Subutex to Suboxone: the Australian experience. Viewed 19 February 2018.
    5. Moon, C 2014. Northern Territory drug trends 2013: Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trends Series No. 116. Sydney: National Drug and Alcohol Research Centre.
  • Acknowledgments 09 Apr 2018

    The contributions, comments and advice of the NOPSAD collection Working Group are gratefully acknowledged.

    The Australian Government Department of Health provided funding for this report.

    Thanks are extended to the data managers and staff in the following departments:

    • Department of Health, Australian Government
    • Ministry of Health, New South Wales
    • Department of Health and Human Services, Victoria
    • Department of Health, Queensland
    • Department of Health, Western Australia
    • Department for Health and Ageing, South Australia
    • Department of Health and Human Services, Tasmania
    • Health Directorate, Australian Capital Territory
    • Department of Health, Northern Territory.