Introduction

Opioid drugs

Opioids are chemical substances that have a morphine-type action in the body. They are most commonly used for pain relief, but they are addictive and can lead to drug dependence. They include:

  • opiates—drugs naturally derived from the opium poppy, such as codeine and heroin
  • semi-synthetic opiates, such as hydromorphone and oxycodone
  • opioids, such as fentanyl and methadone.

Opioid drugs can be:

  • illicit opioids, predominantly heroin [1]
  • prescription opioids (whether prescribed for the person or obtained illicitly) such as morphine and oxycodone [2]
  • over-the-counter opioids in which the opioid drug codeine is combined with a non‑opioid analgesic such as paracetamol or ibuprofen [3].

Changes in 2018 will require a prescription for all codeine containing analgesics.

Opioid drug dependence

Dependence on opioid drugs such as heroin or morphine is associated with a range of health and social problems that affect individual drug users, their family and friends, and the wider public. Opioid dependence can lead to many problems such as overdose, medical and psychological complications, social and family disruption, harms to child welfare, violence and drug-related crime, and the spread of bloodborne diseases. It is considered a serious public health issue [1].

Drug dependence is characterised by drug seeking and using, but people experience it in various ways. The International statistical classification of diseases and related health problems, 10th revision (ICD-10) [4] defines 'dependence syndrome' due to the use of opioids as:

'A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state (Code F11.2).'

In 2013, it was estimated that about 2.4%, or 460,000 Australians aged over 14 years had used opioids—including heroin, methadone/buprenorphine, and other opiates (such as morphine and oxycodone)—for non-medical reasons over their lifetime, while 1.2%, or 230,000 had used heroin. Among those Australians seeking treatment for drug and alcohol problems in 2014–15, opioids were a drug of concern in about 1 in 10 (10%) treatment episodes.

Opioid pharmacotherapy treatment

Opioid pharmacotherapy treatment is one of the main treatment types used for opioid drug dependence and involves replacing the opioid drug of dependence with a legally obtained, longer-lasting opioid that is taken orally.

In Australia, 3 medications are registered for long-term maintenance treatment for opioid-dependent people:

  • methadone
  • buprenorphine
  • buprenorphine-naloxone.

These drugs, known as opioid pharmacotherapies, reduce withdrawal symptoms, the desire to take opioids, and the euphoric effect of taking opioids. Treatment with these drugs is administered according to the law of the relevant state or territory, and within a framework which includes medical, social and psychological treatment.

The Australian Government Department of Health, as part of the National Drug Strategy, published the National guidelines for medication-assisted treatment of opioid dependence [5] to provide a broad policy context and framework for state and territory policies and guidelines that are concerned with the medication-assisted treatment of opioid dependence.

The NOPSAD collection

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection is a set of jurisdictional data that includes information about:

  • clients accessing pharmacotherapy for the treatment of opioid dependence;
  • prescribers participating in the delivery of pharmacotherapy treatment; and
  • dosing sites providing pharmacotherapy drugs to clients.

The 2016 NOPSAD report contains data from New South Wales, Queensland, Western Australia, South Australia, Tasmania and the Northern Territory. At the time of publication, data from Victoria and the Australian Capital Territory were not available for this release. The NOPSAD report will be updated when data from these jurisdictions become available.

References

  1. WHO 2013. Management of substance abuse: opiates. Geneva: WHO. Viewed 12 January 2017.
  2. Roxburgh A, Bruno R, Larance B & Burns L 2011. Prescription of opioid analgesics and related harms in Australia. Medical Journal of Australia 195:280–284.
  3. Nielsen S, Cameron J & Pahoki S 2010. Over the counter codeine dependence: final report 2010. Melbourne: Turning Point Alcohol and Drug Centre.
  4. WHO (World Health Organization) 2010. Mental and behavioural disorder due to the use of opioids: dependence syndrome. ICD-10: International statistical classification of diseases and related health problems. Viewed 12 January 2017.
  5. DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoHA for National Drug Strategy. Viewed 12 January 2017.