Opioid pharmacotherapy prescribers

Medical personnel, such as general practitioners and medical specialists, prescribe opioid pharmacotherapies. Methadone and buprenorphine are controlled drugs and health professionals require authorisation to prescribe them to clients. Registration processes exist in each state and territory through which prescribers may undergo training to become registered/authorised to prescribe opioid pharmacotherapies to clients.

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides information on prescribers participating in the delivery of pharmacotherapy treatment on a snapshot day in June 2016.

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

Note: 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 (see Table T2 of the Technical notes for further details). New South Wales (41), Western Australia (3) and South Australia (6) 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.

2016 data were unavailable for Victoria and the Australian Capital Territory for this release.

Number and type of prescribers

Within the states and territories for which data were available, there were 1,472 authorised prescribers of opioid pharmacotherapy drugs in 2016 (Table S15).

Almost two-thirds (61%) of prescribers were authorised to prescribe more than one type of drug. A further 19% were authorised to prescribe methadone only, and 9% were authorised to prescribe buprenorphine-naloxone only. The remaining 12% were located in New South Wales and were authorised to prescribe buprenorphine and/or buprenorphine-naloxone; however, NSW report both buprenorphine and buprenorphine-naloxone as ‘buprenorphine only’ (Figure P1).

All prescribers in Queensland, Western Australia, and the Northern Territory were registered to prescribe more than one type of drug in 2016 (Table S16).

National trend data has been affected by data being unavailable for Victoria and the Australian Capital Territory for 2016 for this release. Historically, Victorian prescribers have been mainly registered to prescribe more than 1 type of drug.

Figure P1: Prescribers, by pharmacotherapy type, 2007 to 2016

The line chart shows the number of prescribers registered to prescribe more than 1 pharmacotherapy drug type increased from 606 in 2007 to 1,471 in 2016. Buprenorphine-naloxone-only prescribers rose from 0 in 2006 to 131 in 2016. Numbers of buprenorphine-only and methadone-only prescribers remained relatively stable since 2007. Victorian and ACT data were not available for this analysis.

Notes  

  1. NSW counts 'buprenorphine-naloxone' as 'buprenorphine'. See the Technical notes for further details.
  2. Caution should be used when interpreting trend data. Data are not available for Victoria and the Australian Capital Territory for 2016 for this release; therefore results are likely to be an undercount of the national picture. Historically, most Victorian prescribers have been registered to prescribe more than 1 type of drug.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2016 collection. Data table [Table S16].

Most prescribers worked in the private sector

The majority of prescribers worked in the private sector (69%) with the remainder working in the public sector (25%), correctional facilities (4%), or a combination of sectors (less than 1%) (Table P1). Note the change in trends for these results are likely affected by the unavailability of Victorian and ACT data for this release.

Table P1: Prescriber types, states and territories, 2016

Prescriber type NSW Vic Qld WA SA Tas ACT NT Aust
Public prescriber 209 84 21 25 17 12 368
Private prescriber 596 124 74 192 23 1 1,010
Public/private prescriber
Correctional facility 29 7 18 8 1 2 65
Total 834 244 113 225 41 15 1,472

— Nil or rounded to zero.

Notes

  1. The states and territories have different guidelines and policies regarding training and registration to prescribe opioid pharmacotherapy types. See the Technical notes for more information.
  2. Data for Victoria and the Australian Capital Territory were unavailable for this release.
  3. Total does not include 29 prescribers who have a prescriber type of 'Not stated'.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2016 collection. Data table [Table S15].

Among the states and territories for which data were available, South Australia had the highest proportion of private prescribers (85%), followed by New South Wales with 72%. The Northern Territory had the highest proportion of public prescribers (80%), followed by Tasmania with 42%.

These proportions are likely to be affected by the unavailability of data from Victoria and the Australian Capital Territory for this release. Historically, Victoria has had no public prescribers, and therefore has had the highest proportion of private prescribers (98% in 2015).

Of the 33,988 clients receiving pharmacotherapy treatment in Australia on the snapshot day in June 2016, 56% received treatment from a private prescriber, 37% 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, Western Australia, South Australia, and Tasmania. Public prescribers treated the majority of clients in Queensland and the Northern Territory (Table S3).

Prescribers treated an average of 23 clients on a snapshot day

Between 2015 and 2016, the number of clients per prescriber fell in most jurisdictions that supplied data, and remained steady in Western Australia (31). In relative terms, the Northern Territory had the largest decrease (from 20 to 10 clients per prescriber).

Figure P2: Clients per prescriber, states and territories, 2012 to 2016

The grouped vertical bar chart shows the average number of clients per prescriber varied greatly by state and territory. Nationally, the number of clients per prescriber has dropped from 30 in 2012 to 23 in 2016. In 2016, Western Australia had the highest number of clients per prescriber, with 31, while the Northern Territory had the lowest, with 10. Victorian and ACT data were not available for this analysis.

Notes

  1. 2016 data for Victoria and the Australian Capital Territory were unavailable for this release. Only 4 years of data are available for these jurisdictions for this comparison.
  2. In South Australia, the decline in clients per prescriber is attributed to the introduction of the Suboxone® Opioid Substitution Program (SOSP). On a snapshot day in 2016, 131 prescribers registered under the SOSP treated a total of 200 clients, while the remaining 93 prescribers treated a total of 2,810 clients.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2016 collection. Data table [Table S21].

Prescribers working in the public sector had, on average, almost twice as many clients as prescribers in the private sector (34 clients per prescriber compared with 19). Among the states and territories that reported in 2016, Western Australia had the highest number of clients per prescriber (31), while the Northern Territory had the lowest (10).

The private sector saw an increase in client ratios between 2015 and 2016 with ratios for private prescribers rising from 15 in 2015 to 19 in 2016. The ratio of clients to public prescribers decreased to 34 in 2016 from a ratio or 42 clients per prescriber in 2015. Note these results are likely to be affected by the unavailability of Victorian and ACT data for this release.

Western Australia had the highest ratio of clients to public prescribers (69), Queensland had the highest ratio of private prescribers (25), and New South Wales had the highest ratio of correctional facility prescribers (55) (Table S22).

Prescribers working in correctional facilities had an average of 35 clients, but at a state and territory level this varied widely, from 1 client per prescriber in the Northern Territory and Tasmania to 55 in New South Wales (Table S22).

The majority (53%) of prescribers treated between 1 and 5 clients, with only 14% treating more than 50 clients. Ten per cent of prescribers were not treating any clients on the snapshot day. Across states and territories, the proportion of pharmacotherapy prescribers treating between 1 and 5 clients ranged between 15% in Queensland and 72% in South Australia (Table S19).

Treatment varies between sectors

In 2016, methadone was the most commonly prescribed drug across all sectors (Table S12). However, prescribers in correctional facilities were far more likely to prescribe methadone (87% of clients) when compared with private (66%) and public prescribers (59%). Public prescribers were the most likely to prescribe buprenorphine-naloxone (21%) compared with private (14%) and correctional facility (4%) prescribers. Given that clients prescribed buprenorphine-naloxone in New South Wales are reported as receiving buprenorphine, the proportion of clients actually receiving buprenorphine-naloxone nationally is likely to be an underestimate.

Based on 2016 unit record data from 5 states and territories (excludes data from Victoria, Queensland and the Australia Capital Territory), on a snapshot day, prescribers in correctional facilities were more likely to treat:

  • younger clients (Table S27)—correctional facilities treated clients aged under 30 at over twice the rate seen for all prescribers. Public and private prescribers treated similar client groups.
  • 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.