Clients

How many people received opioid pharmacotherapy treatment?

Around 47,500 people received opioid pharmacotherapy treatment in 2021.

On a snapshot day in 2021, 47,563 people were receiving pharmacotherapy treatment for their opioid dependence across Australia (excluding data for Queensland). This is a rate of 23 pharmacotherapy clients per 10,000 people (Figure CLIENTS1; Tables S1 and S2).

Between 2011 and 2020, the number of clients receiving treatment increased by 14% (from 46,446 to 53,316 clients) (Table S1). Adjusting for population growth, the rate of clients remained relatively stable nationally over the same period (between 20 and 21 clients per 10,000 people each year). The lower client number and higher client rate in 2021 are likely due to the exclusion of Queensland data, as data were unavailable at the time of reporting. Refer to the Technical notes for information on the impacts of COVID-19 on population estimates and effects on rates in 2021.

Figure CLIENTS1: Clients receiving pharmacotherapy treatment on a snapshot day, by state/territory, 2011 to 2021

On a snapshot day in 2021, 23 clients per 10,000 population received pharmacotherapy treatment in Australia (excluding data for Queensland). This ranged from 7 clients per 10,000 population in the Northern Territory to 30 clients per 10,000 in New South Wales.

Refer to the Data tables for more information.

In 2021, consistent with previous years:

  • New South Wales had the highest rate of clients receiving treatment (30 clients per 10,000 people or 24,340 clients). This is an increase from 28 clients per 10,000 people in 2020.
  • The Northern Territory remained the jurisdiction with the lowest rate of clients (7 per 10,000 people or 183 clients) (Figure CLIENTS1; Table S2).

Client numbers have fluctuated over time within jurisdictions (Table S1). Variation in client numbers may be influenced by system changes, coding practices and changes in treatment policies or capacity within jurisdictions.

In both 2020 and 2021, there were increases in client numbers in New South Wales. These increases may be due to the introduction of buprenorphine LAI, particularly in correctional facilities, which may have contributed to additional prescribing of buprenorphine in correctional facilities. Some New South Wales Local Health Districts also reported an increased capacity to take on new patients following the introduction of buprenorphine LAI.

Who received opioid pharmacotherapy treatment?

Age and sex of clients

The median age of opioid pharmacotherapy clients was 44 years.

On a snapshot day in 2021, the median age of clients across all pharmacotherapy drug types in Australia was 44 years (excluding Queensland). This remained stable from 2020, but is an increase from 38 years in 2011. Clients in Western Australia and South Australia had the highest median age (45 years), while clients in Tasmania had the lowest median age (42 years) (Table S5).

In 2021, just over 1 in 3 clients (36% or 16,963 clients) were aged 40–49 years, the highest proportion of any age group. A further 24% (11,479 clients) were aged 30–39 years and 22% (10,276) were aged 50–59 years (Figure CLIENTS2; Table S6).

Since 2011, the proportion of clients aged under 30 or 30–39 has decreased (from 15% and 40% in 2011 to 8.0% and 24% in 2021, respectively). Conversely, the proportion of clients in the older age groups (40–49, 50–59 and 60 and over) has increased since 2011 (Figure CLIENTS2; Table S6).

Figure CLIENTS2: Proportion of clients receiving pharmacotherapy treatment on a snapshot day, by pharmacotherapy drug type and age group, 2011 to 2021

On a snapshot day in 2021, most clients were aged 40–49 years (36% of clients), 30–39 years (24%) or 50–59 years (22%). Between 2011 and 2021, there was an increase in the proportion of clients aged 40 and over. In the same period, there was a decline in the proportion of clients aged 39 years and under.

Refer to the Data tables for more information.

The increases in client median age since 2011 and the growing proportion of clients in older age groups continues the trend of an ageing cohort in opioid pharmacotherapy treatment. This is consistent with the pattern observed in other drug treatment services (AIHW 2021). This may be due to:

  • Methadone treatment being available in Australia 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.
  • Declines in heroin use among people who inject drugs and the general population in Australia since the early 2000s (AIHW 2020; Sutherland et al. 2021).
  • Australia’s ageing population and the emergence of an ageing cohort of people who use drugs (AIHW 2020; Nicholas and Roche 2014; NSW Ministry of Health 2015).

While methadone was the most commonly prescribed pharmacotherapy drug across all age groups, the proportion of clients who received methadone increased with age. The median age was also higher for clients receiving methadone (46 years) compared to overall (44 years) (Table S5). Conversely, the proportion of clients who received buprenorphine decreased with age (Figure CLIENTS3).

Figure CLIENTS3: Proportion of clients receiving pharmacotherapy treatment on a snapshot day, by age group and pharmacotherapy drug type, 2016 to 2021

On a snapshot day in 2021, the proportion of opioid pharmacotherapy clients receiving methadone was higher for older age groups. Over 3 in 4 clients (77%) aged 60 and over received methadone as pharmacotherapy, compared to 42% of clients aged under 30. By comparison, 41% of clients aged under 30 received buprenorphine as pharmacotherapy compared to 17% of clients aged 60 and over.

Refer to the Data tables for more information.

More males than females received opioid pharmacotherapy treatment.

On a snapshot day in 2021, over 2 in 3 clients (68% or 32,576 clients) receiving pharmacotherapy treatment were male (excluding data for Queensland). This proportion was similar for each of the 4 pharmacotherapy drug types (methadone, buprenorphine, buprenorphine-naloxone and buprenorphine LAI). This has remained stable since 2011 (Table S7). The sex classification of ‘Other’ was included in the NOPSAD collection for the first time in 2021, but was not reported in text due to small cell sizes. Refer to the Technical notes for more information.

The rate of clients receiving pharmacotherapy treatment was highest among those aged between 40 and 49, peaking at 41 years for males and 42 for females (excluding data for Victoria and Queensland). Notably, the peak rate for males (97 clients per 10,000 people) was more than twice as high as the peak for females (45 per 10,000) (Figure CLIENTS4; Table S24).

Figure CLIENTS4: Crude rate of clients receiving pharmacotherapy treatment on a snapshot day, by sex and age, selected states and territories, 2016 to 2021

On a snapshot day in 2021, the rate of pharmacotherapy clients per 10,000 population peaked at the age of 41 years for males (96 clients per 10,000 population) and 42 years for females (45 clients per 10,000 population).

Refer to the Data tables for more information.

Aboriginal and Torres Strait Islander people

Almost half of all Aboriginal and Torres Strait Islander clients receiving opioid pharmacotherapy treatment were treated with methadone.

On a snapshot day in June 2021, there were 5,715 Aboriginal and Torres Strait Islander clients receiving pharmacotherapy treatment in Australia (excluding data for Queensland) (Table S9). This represents 12% of all clients and is a rate of 90 clients per 10,000 Indigenous Australians.

Of those Indigenous Australian clients whose pharmacotherapy drug type was reported (82% or 4,679 clients), almost half (48% or 2,267 clients) were treated with methadone in 2021 (excluding data for Queensland and Victoria). The remaining Indigenous Australian clients were treated with buprenorphine (43% or 2,026 clients), buprenorphine-naloxone (7% or 305 clients) or buprenorphine LAI (2% or 81 clients). Victoria provides the total number of clients receiving opioid pharmacotherapy but does not provide pharmacotherapy drug type by Indigenous status (Table S9).

From 2016 to 2021, the proportion of Indigenous clients receiving treatment with:

  • Methadone fell from around 7 in 10 clients (67% or 2,238 clients) to 5 in 10 (48%).
  • Buprenorphine doubled from around 2 in 10 clients (22% or 728 clients) to 4 in 10 (43%).
  • Buprenorphine-naloxone fluctuated slightly, ranging from 7% to 13% of Indigenous clients across selected states/territories in a given year.

In 2021, Victoria had the highest rate of Indigenous opioid pharmacotherapy clients (159 clients per 10,000 Indigenous Australians, or 1,036 clients) followed by New South Wales (133 clients per 10,000 Indigenous Australians, or 3,880 clients). The Northern Territory had the lowest rate of Indigenous clients (6 clients per 10,000 Indigenous Australians, or 44 clients) (Table S9). Refer to the Technical notes for more information on rates of Indigenous clients in 2021.

What opioid pharmacotherapy treatments did clients receive?

Methadone continued to be the most commonly prescribed opioid pharmacotherapy drug, but the proportion of pharmacotherapy clients receiving buprenorphine is rising.

On a snapshot day in 2021, around 6 in 10 clients (58% or 27,732 clients) received methadone as pharmacotherapy treatment (excluding data for Queensland). A further 23% (10,991 clients) received buprenorphine (Table S4). The number of clients receiving buprenorphine may be inflated, as New South Wales includes clients receiving buprenorphine-naloxone­ or buprenorphine LAI in the number of clients receiving buprenorphine.

The proportion of clients receiving each of the pharmacotherapies varies across states and territories (Figure CLIENTS5; Table S4). This may be driven by jurisdictional differences in pharmacotherapy guidelines. In 2021:

  • Methadone was the most common pharmacotherapy drug in most jurisdictions, with the exception of Tasmania and the Northern Territory. The Australian Capital Territory and Victoria had the highest proportion of clients receiving methadone (67% and 63% of clients, respectively).
  • Buprenorphine-naloxone was the most common pharmacotherapy drug in Tasmania and the Northern Territory (39% and 37% of clients, respectively) (Figure CLIENTS5; Table S4). Buprenorphine-naloxone is the default treatment drug for the main pharmacotherapy program in the Northern Territory (Table S4).

Figure CLIENTS5: Proportion of clients receiving pharmacotherapy treatment on a snapshot day, by state/territory and pharmacotherapy drug type, 2016 to 2021

On a snapshot day in 2021, almost 2 in 5 (58%) clients received methadone as pharmacotherapy across Australia (excluding data for Queensland). The next most common pharmacotherapy drug type was buprenorphine (23% of clients), followed by buprenorphine-naloxone (15%) and buprenorphine LAI (3.4%). Methadone has remained the most common pharmacotherapy drug type since 2016.

Refer to the Data tables for more information.

Over the past decade, the proportion of clients receiving methadone has fallen, while for buprenorphine it has increased. From 2011 to 2021, treatment with:

  • Methadone fell from 69% of clients to 58%.
  • Buprenorphine increased from 14% of clients to 23%.
  • Buprenorphine-naloxone rose from 18% of clients to a peak of 23% in 2019, then fell to 15% in 2021.
  • Buprenorphine LAI was reported from 2020, increasing from 2.4% of clients to 3.4% in 2021 (Figure CLIENTS5; Table S4).

The number of clients receiving buprenorphine may be inflated, as New South Wales includes clients receiving buprenorphine-naloxone or buprenorphine LAI in the number of clients receiving buprenorphine.

Changes in the proportions of clients receiving each pharmacotherapy drug type likely relate to factors such as clinical guidelines and the availability of new pharmacotherapy drug formulations.

  • The increase in buprenorphine-naloxone prescribing up to 2019 likely reflects the implementation of the National guidelines for medication-assisted treatment of opioid dependence (Gowing et al. 2014). These guidelines 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).
  • Buprenorphine LAI was reported by some jurisdictions for the first time in the 2020 NOPSAD collection. This has impacted the proportion of clients receiving other pharmacotherapy drug types. Specifically, the proportion of clients receiving methadone or buprenorphine-naloxone decreased from 61% and 23% in 2019 to 58% and 15% in 2021, respectively. By contrast, the proportion of clients receiving buprenorphine increased from 17% in 2019 to 23% in 2021. Buprenorphine LAI increased from 2.4% of clients in 2020 to 3.4% in 2021 (Table S4).

How did clients interact with the opioid pharmacotherapy treatment system?

Most opioid pharmacotherapy clients were continuing pharmacotherapy 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 in the 12 months since the previous snapshot day (new);
  • re-entering treatment after previously ceasing an episode of care (re-admission);
  • continuing treatment (ongoing); or
  • transferring from another state or territory (interstate transfer).

In 2021, client status data were available for New South Wales, Victoria, Western Australia, Tasmania, the Australian Capital Territory and the Northern Territory (data for Queensland are excluded). Western Australia was not able to record the number of clients who were classed as ongoing or re-entering treatment in 2021 due to system changes; these clients are presented as ‘Not stated’ in this report.

Across jurisdictions with available data, over 2 in 3 clients (68% or 30,132) were classed as ongoing. A further 17% (7,473 clients) were new to treatment in 2021, and 8.7% (3,865) were re-entering treatment (Table S11). The proportion of clients re-entering treatment ranged from 3.7% in New South Wales to 22% in the Australian Capital Territory (Figure CLIENTS6; Table S11).

Figure CLIENTS6: Proportion of clients receiving pharmacotherapy treatment on a snapshot day, by state/territory and client status, selected states and territories, 2016 to 2021

On a snapshot day in 2021, most clients were ongoing in all states and territories except Western Australia. This ranged from 84% in Tasmania to 61% in Victoria. Data were only available from New South Wales, Victoria, Western Australia, Tasmania, the Australian Capital Territory and the Northern Territory.

Refer to the Data tables for more information.

What drug of dependence did clients receive opioid pharmacotherapy treatment for?

Heroin was the most commonly reported opioid drug of dependence for pharmacotherapy clients.

Clients can receive pharmacotherapy treatment for a range of opioid drugs. These include illicit opioids (such as heroin), and pharmaceutical opioids (such as oxycodone) available by prescription or through illicit means. From 1 February 2018, all over-the-counter (non-prescription) codeine-containing medicines for pain relief, cough and colds became available by prescription only.

Data for opioid drug of dependence should be used with caution due to the high proportion of clients with ‘Not stated/not reported’ as their opioid drug of dependence (35% of clients in 2021). In New South Wales, patients who transfer from one program to another (for example, by changing opioid pharmacotherapy drug or prescriber) have a higher rate of ‘Not stated/not reported’ than those clients who do not have program changes.

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

Nationally, around 4 in 10 clients (44% or 21,058 clients) reported heroin as their opioid drug of dependence (excluding data for Queensland). Oxycodone (4.7% or 2,228 clients) was the next most commonly reported drug of dependence, followed by buprenorphine (4.3% or 2,024 clients) and methadone (3.3% or 1,582 clients) (Figure CLIENTS7; Table S10).

Figure CLIENTS7: Proportion of clients receiving pharmacotherapy treatment on a snapshot day, by opioid drug of dependence, 2016 to 2021

Between 2016 and 2021, heroin was the most common opioid drug of dependence among pharmacotherapy clients (excluding Not stated/not reported). The proportion of clients with heroin as the drug of dependence declined from 40% in 2016 to 37% in 2020, before increasing to 44% in 2021. Across the period, there was a high proportion of Not stated/not reported responses (35% in 2021). All other opioid drugs of dependence remained relatively stable.

Refer to the Data tables for more information.

These proportions include ‘Not stated/not reported’ but were similar among the 65% of clients (31,026 clients) with a reported opioid drug of dependence (Table S10). In 2021, high rates of ‘Not stated/not reported’ were recorded in New South Wales (60% of clients), Tasmania (16%) and Western Australia (15%).

Heroin was the most common drug of dependence in all states and territories with available data, except Tasmania and the Northern Territory. In these jurisdictions, morphine was the most common drug of dependence (Table S10).