Opioid pharmacotherapy clients

On a snapshot day in June 2016, nearly 34,000 people in Australia (excluding Victoria and the Australian Capital Territory) were on a course of pharmacotherapy treatment for their opioid dependence.

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides information on clients accessing pharmacotherapy for the treatment of opioid dependence on a snapshot day in June 2016.

For more details about the collection, refer to the Technical notes.

The number of people receiving pharmacotherapy treatment has remained stable

The number of people receiving treatment has remained relatively stable since 2010, with most states recording small increases during this time.

Among the states and territories for which data were available, New South Wales remains as the state with the highest rate of people receiving opioid pharmacotherapy treatment (26 clients per 10,000 people). Queensland and Western Australia both reported a rise in the rate of people receiving treatment (both states reported 14 clients per 10,000 people, up from 13 clients per 10,000 in 2015) (Figure C1).

Figure C1: Clients receiving pharmacotherapy treatment on a snapshot day, per 10,000 population, 2016

The vertical bar chart shows the rate (per 10,000 population) of clients receiving treatment on a snapshot day was 14. The states and territories ranged from 6 in the Northern Territory to 26 in New South Wales. Victorian and ACT data were not available for this analysis.

Notes

  1. Australian population estimates for June 2016—sourced from ABS Australian Demographic Statistics, June 2015 (ABS cat. no. 3101.0)—were used to produce this figure.
  2. Data for Victoria and the Australian Capital Territory were unavailable for this release.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S2].

The relatively low rate of clients in the Northern Territory may be partially attributable to the limited availability of heroin (Moon 2014), the impact of remote locations on treatment delivery, and a highly mobile population.

The median age of opioid pharmacotherapy clients is increasing

In 2016, clients ranged in age from their late teens to 85. The median age of all clients across all pharmacotherapy types was 42 years. This is an increase from 38 years in 2011, 39 years in 2012 and 40 years in 2013, 2014 and 2015. The first year single-year age data were collected was in 2011.

Almost two-thirds (65%) of clients in 2016 were aged 30–49. The proportion of clients aged under 30 continues to decline (7.7% of clients).

The number of clients aged 60 and over continued to increase slowly, to 1,874 (6% of clients).

This continues the trend of an ageing cohort in opioid pharmacotherapy treatment and is consistent with the pattern observed in other drug treatment services. This may be due to:

  • methadone treatment having been available 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
  • an ageing cohort of injecting drug users which is strongly influenced by heroin use (people who had injected a drug in 2013 were 10 years older than they were in 2001 (their age rose from 26 to 36).

Figure C2: Clients receiving pharmacotherapy treatment on a snapshot day, by age group, 2007 to 2016

The line chart shows the proportion of opioid pharmacotherapy clients aged 30 to 49 years rose from 64%25 in 2006 to 72%25 in 2016. Over the same period, the proportion of clients aged less than 30 years dropped from 28%25 to 9%25 and the proportion aged 50 years and over increased from 8%25 to 30%25. Victorian and ACT data were not available for this analysis.

Notes

  1. Collection of age group began in 2006
  2. Data for Victoria and the Australian Capital Territory were unavailable for this release.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2016 collection. Data table [Table S6].

Among the states and territories for which data were available, clients using services in New South Wales and South Australia had the oldest median age of 43 years while clients in Tasmania and the Northern Territory had the lowest median age of 40 years.

As with previous years, methadone was the most commonly prescribed pharmacotherapy type across all age groups, followed by buprenorphine and buprenorphine-naloxone. Older clients were more likely to receive methadone and less likely to receive buprenorphine and buprenorphine-naloxone than younger clients (Figure C3).

Figure C3: Clients receiving pharmacotherapy on a snapshot day, by age group and pharmacotherapy type, 2015

The stacked vertical bar chart shows the proportion of opioid pharmacotherapy clients receiving methadone was larger for older age groups. For clients aged under 30 years, 49%25 received methadone, compared to 73%25 of clients aged 50–59 and 76%25 aged 60 years and over. As client age rose, the proportion of each age group receiving either buprenorphine or buprenorphine-naloxone dropped. Victorian and ACT data were not available for this analysis.

Notes

  1. NSW reports 'buprenorphine-naloxone' as 'buprenorphine'.
  2. Data for Victoria and the Australian Capital Territory were unavailable for this release.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2016 collection. Data table [Table S6].

Males were more likely to receive treatment than females

Around two-thirds (65%) of clients receiving pharmacotherapy in June 2016 were male. This proportion was similar across states and territories for each of the 3 pharmacotherapy types (methadone, buprenorphine and buprenorphine-naloxone), and has remained stable over the 10-year period since 2007.

The rate of receiving pharmacotherapy was highest for people aged from their early 30s to mid-50s for both males and females (Figure C4). The rate peaked at age 38 for males and 36 for females (83 clients per 10,000 males aged 38 in the population, and 46 clients per 10,000 females aged 36). Males were generally more likely—and in some cases about twice as likely—to be receiving pharmacotherapy than females of the same age.

Figure C4: Clients receiving pharmacotherapy treatment on a snapshot day, by age and sex, 2016

The line chart shows the rate of males and females receiving opioid pharmacotherapy in 2016 per 10,000 population rose between the ages of 15 to the late-30s. The rate of pharmacotherapy clients peaked at the age of 36 for both males and females, with 82 clients for every 10,000 males aged 36 and 46 clients for every 10,000 females aged 36.

Notes

  1. Unit record data were used to produce this figure. Records were available for 58% of clients receiving pharmacotherapy on a snapshot day in 2016.
  2. Data for Victoria, Queensland and the Australian Capital Territory were unavailable for this release.
  3. Australian population estimates for June 2016—sourced from ABS Australian Demographic Statistics, June 2015 (ABS cat. no. 3101.0)—were used to produce this figure.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2016 collection. Data table [Table S24].

Aboriginal and Torres Strait Islander people were over-represented in pharmacotherapy treatment

Where reported, about 1 in 10 clients identified as Aboriginal and/or Torres Strait Islander. Indigenous Australians (55 clients per 10,000 Indigenous Australians) were around 3 times as likely to have received pharmacotherapy treatment as the non-Indigenous population (16 clients per 10,000) (Table S9). Indigenous clients were slightly more likely to be treated with methadone (66%) than non-Indigenous pharmacotherapy clients (63%).

Among the states and territories for which data were available, New South Wales and South Australia had the highest rates of Indigenous clients (107 and 69 clients per 10,000 Indigenous Australians respectively). The Northern Territory had the lowest rate of Indigenous clients with 3 clients per 10,000 Indigenous Australians.

Note: These data should be interpreted with caution due to:

  • Western Australia not reporting the Indigenous status of their clients.
  • 2016 data for Victoria and the Australian Capital Territory being unavailable for this release.

See the National Opioid Pharmacotherapy Statistics Annual Data collection data quality statement for more information.

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, which are available by prescription (such as oxycodone), over-the-counter (such as codeine-paracetamol combinations) or through illicit means.

Among the states and territories for which data were available, 36% of clients reported heroin as their opioid drug of dependence in 2016. Oxycodone (6%), morphine (6%) and codeine (5%) were the next most commonly reported drugs of dependence.

Pharmacotherapy drugs may be subject to misreporting if a client’s treatment drug is reported instead of the opioid drug of dependence leading a client to seek treatment.

Methadone continued to be the most commonly prescribed drug

Two-thirds (65%) of clients were treated with methadone in 2016 and the remaining third (35%) were treated with buprenorphine, either alone or in combination with naloxone, which is added to deter administration by injection (see the Glossary entry for buprenorphine-naloxone for further details).

From 2008 to 2016, treatment with:

  • methadone fell (from 70% of clients to 65%)
  • buprenorphine rose (from 15% to 19%)
  • buprenorphine-naloxone remained stable (16%).

Previous trend data has shown that buprenorphine-naloxone prescription is replacing buprenorphine prescription. This is in keeping with the national guidelines (DoH 2014), 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). Trend data is likely to have been affected by data not being available from Victoria and the Australian Capital Territory for this release.

In 2016, methadone was the most common pharmacotherapy drug in all reported jurisdictions except for the Northern Territory (where 67% of clients received buprenorphine-naloxone). Buprenorphine-naloxone is the default treatment drug for the main pharmacotherapy program in the Northern Territory. Among the states and territories for which data were available, treatment with methadone ranged from 26% of clients in the Northern Territory to 72% of clients in New South Wales (Figure C5).

Figure C5: Clients receiving pharmacotherapy on a snapshot day, by pharmacotherapy type, states and territories, 2016

The stacked vertical bar chart shows methadone was the most common pharmacotherapy drug type in each state and territory except the Northern Territory. NSW had the largest proportion of clients receiving methadone, with 72%25. In the Northern Territory, buprenorphine-naloxone was the most common pharmacotherapy drug, with 67%25 of clients receiving it. Victorian and ACT data were not available for this analysis.

Notes

  1. NSW reports ‘buprenorphine-naloxone’ as ‘buprenorphine’. When New South Wales data are excluded, in the rest of Australia 61% of clients received methadone, 5% received buprenorphine, and 35% received buprenorphine naloxone.
  2. Data for Victoria and the Australian Capital Territory were unavailable for this release.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2016 collection. Data table [Table S4].

Most clients are continuing 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).

At the time of publication, client status data were available for Western Australia, Tasmania and the Northern Territory. In these 3 jurisdictions, the majority of clients (57%) were classed as ongoing.

Figure C6: Clients receiving pharmacotherapy on a snapshot day, by client status, states and territories, 2016

This stacked vertical bar chart shows the majority of clients were classed as ongoing in all states and territories. This ranged from 98%25 in Tasmania (98%25) to 63%25 in the Northern Territory. The proportion of clients re-entering treatment ranged from 15%25 in Queensland to less than 1%25 in Tasmania. New clients comprised 18%25 of clients in the Northern Territory, but only a small proportion in the remaining jurisdictions (no greater than 10%25). Data were only available from WA, Tas and NT in this analysis.

Note: NSW, SA and ACT do not report client status. Qld and Vic data were unavailable for 2016.