Introduction

Dependence on opioid drugs (including codeine, oxycodone and heroin) is associated with a range of health and social harms that affect people who use drugs, their family and friends, and the wider community. Opioid pharmacotherapy treatment can help reduce harm by providing regular dosing with a safer, legally obtained, longer-lasting opioid. This can reduce cravings for other opioids, help clients to manage the effects of drug dependence and improve overall quality of life.

The NOPSAD report provides information about clients receiving opioid pharmacotherapy in Australia, as well as health professionals who prescribe opioid pharmacotherapy and dosing points (such as pharmacies) where clients receive treatment.


What is opioid drug dependence?

Opioid drugs are substances that have a similar action to morphine in the brain (ADF 2021). They can be prescription pain medicines (such as codeine and oxycodone) or illicit drugs (such as heroin). These include:

  • Opiates, which are naturally derived from the opium poppy (such as codeine and heroin).
  • Semi-synthetic opioids, which are modified versions of natural opiates (such as oxycodone).
  • Synthetic opioids, which are fully synthesised from precursor compounds (such as fentanyl and methadone) (ADF 2021).

Opioids are often prescribed for the management of strong pain. However, they can produce euphoria and are sometimes used for non-medical reasons. Long-term or non-medical use of opioids can lead to health problems such as drug dependence and overdose (WHO 2021).

Since 1 February 2018, access to all opioid pain medicines has required a prescription in Australia. Prior to this, medicines containing low doses of codeine were available over the counter at pharmacies (ADF 2021). Prescription opioids may also be obtained illicitly.

When people use opioids regularly or over a long period of time, they are at an increased risk of developing opioid drug dependence (ADF 2021). Opioid dependence is characterised by a strong desire to use opioids and loss of control over use.

The International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) (WHO 2019) 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).'


What are the impacts of opioid dependence?

Opioid dependence is linked to a range of health and social harms, for both individuals who use opioids and the wider community. These include:

  • Loss of life through overdose.
  • Medical and mental health impacts, including transmission of hepatitis C, hepatitis B and HIV, and depression.
  • Social impacts, including on relationships, employment, education, housing, parenting, finances and crime.
  • Financial costs related to health and social services and judicial systems (NSW Ministry of Health 2018).

What treatment is available?

Treatments for opioid use disorders aim to reduce the harms associated with dependence (NSW Ministry of Health 2018). Opioid pharmacotherapy treatment, also known as opioid agonist therapy, is one of the most common treatments used for opioid drug dependence in Australia. Opioid pharmacotherapy involves replacing the opioid drug of dependence with a longer-lasting, medically-prescribed opioid.

Opioid pharmacotherapy can reduce drug cravings and other withdrawal symptoms  in clients (Gowing et al. 2014). Pharmacotherapy can also have positive impacts on physical and mental health, social functioning and economic participation, and reduce drug-related crime (Ritter and Chalmers 2009).

Clients can receive pharmacotherapy for dependence on a range of opioids, including illicit drugs (such as heroin) and pharmaceutical opioids (such as codeine and oxycodone) (AIHW 2018).

In Australia, 4 medications are registered as pharmacotherapy treatment for people with opioid dependence (Table INTRO1). Refer to Buprenorphine long-acting injections and the Glossary for more information on opioid pharmacotherapy medications in Australia.

Table INTRO1: Types of opioid pharmacotherapy medications
Pharmacotherapy drug type Administration method Dosing frequency Brand names
Methadone Oral (taken as liquid) Daily

Methadone Syrup®

Biodone Forte Solution®
Buprenorphine Oral (taken as tablet or sublingual film) Once every 1–3 days

Subutex®

Buprenorphine-naloxone Oral (taken as tablet or sublingual film) Once every 1–3 days Suboxone®
Buprenorphine long-acting injections (LAI) Subcutaneous injection Weekly or monthly

Buvidal®

Sublocade®

Opioid pharmacotherapy treatment is administered according to the law of the relevant state or territory, and within a framework that includes medical, social and psychological treatment. The Australian Government Department of Health has published National guidelines for medication-assisted treatment of opioid dependence (Gowing et al. 2014). These guidelines provide a broad policy context and framework for states and territories when developing their own policies and guidelines for the medication-assisted treatment of opioid dependence. However, policies differ between states and territories.

Buprenorphine long-acting injections

Recently, two depot forms of buprenorphine (Buvidal® and Sublocade®) were registered for use in the treatment of opioid dependence across Australia. These long-acting injections (described in this report as buprenorphine LAI) were reported where possible for the first time in the NOPSAD 2020 collection.

While jurisdictional differences in the delivery of buprenorphine LAI do apply, there are potential benefits of this treatment in the context of COVID-19. This is because buprenorphine LAI is injected into the tissue under the skin either weekly or monthly, reducing the need for patients to visit their dosing site on a daily basis.


What is the NOPSAD collection?

For more information on the NOPSAD collection, see also:

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection is compiled from jurisdictional data and provides information about:

  • clients receiving opioid pharmacotherapy treatment;
  • the health professionals prescribing opioid pharmacotherapy drugs; and
  • the dosing points (such as pharmacies) that clients attend to receive their medication.

Data are reported on a snapshot day in June each year. The snapshot day varies across jurisdictions, as each state and territory uses a slightly different method to collect data. These methodological differences are primarily due to jurisdictional variations in legislation, client management systems and resources. Caution should be exercised when comparing one jurisdiction to another. In 2021, data for Queensland were unavailable and have not been included in this report.


Impacts of COVID-19 on opioid pharmacotherapy treatment

Since March 2020, a series of measures have been put in place across Australia to reduce the transmission of COVID-19 (Department of Health 2020). These include social distancing and hygiene measures, isolation measures for those with COVID-19 or identified as close contacts, and the shutdown of non-essential businesses, public gatherings and travel. Many of these restrictions continued into 2021, and introduced several challenges for prescribers and people accessing opioid pharmacotherapy treatment including:

  • maintaining effective social distancing measures, particularly where people are required to visit their dosing site daily
  • regulatory changes to support treatment delivery.

In response to these restrictions, jurisdictions made temporary changes to opioid pharmacotherapy treatment guidelines and regulations. The aim was to support flexible treatment delivery and maintain the health and safety of patients and prescribers. While the implementation of these amended guidelines and regulations vary across jurisdictions, changes to pharmacotherapy treatment in the context of COVID-19 have included:

  • extending prescription duration
  • increasing the number of takeaway doses
  • arranging home delivery of medication
  • considering changing clients to buprenorphine LAI wherever appropriate
  • a transition to online delivery modes for pharmacist training and education on administering opioid pharmacotherapy treatment
  • the commencement of buprenorphine LAI under online supervision (with dosing administered in person at a pharmacy)
  • introducing third party collections for clients who may require self-isolation
  • alleviating permit requirements for doctors taking over scripts for other doctors.

It is not yet known how COVID-19 will impact opioid pharmacotherapy treatment long-term.