Prescribers

Medical personnel, such as general practitioners and medical specialists, prescribe opioid pharmacotherapy. Each state and territory has a registration process through which prescribers can undergo training and become registered or authorised to prescribe opioid pharmacotherapy to clients.

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. These 3 jurisdictions have prescribers who prescribe in more than 1 location, and as such are counted more than once. This will lead to slightly reduced client to prescriber ratios. For more details about the collection, refer to Table T2 in the Technical notes.


What were the numbers and types of opioid pharmacotherapy prescribers?

Most prescribers were authorised to prescribe more than one type of opioid pharmacotherapy drug.

On a snapshot day in 2021, there were 2,673 authorised prescribers of opioid pharmacotherapy drugs in Australia (excluding Queensland). Of these prescribers:

  • Almost 3 in 5 (56% or 1,509 prescribers) were authorised to prescribe more than 1 type of drug.
  • Around 1 in 5 (18% or 488 prescribers) were authorised to prescribe buprenorphine-naloxone only.
  • Over 1 in 7 prescribers were authorised to prescribe buprenorphine only (14% or 374 prescribers) or methadone only (11% or 302) (Figure PRESCRIBER1, Tables S15 and S16).

Figure PRESCRIBER1: Number of prescribers by pharmacotherapy drug type, 2011 to 2021

Between 2011 and 2021, most prescribers were registered to prescribe more than 1 drug type (1,509 prescribers in 2021). Between 2011 and 2021, the number of prescribers prescribing methadone only decreased. Conversely, the number of prescribers prescribing buprenorphine only or buprenorphine-naloxone only increased. Data for 2021 exclude Queensland.

Refer to the Data tables for more information.

Between 2011 and 2020, there was a 121% increase in the total number of authorised prescribers (from 1,549 prescribers to 3,422) (Figure PRESCRIBER1; Table S16). Across this period:

  • The number of prescribers authorised to prescribe buprenorphine-naloxone only, buprenorphine only or more than 1 type of drug increased overall, though this fluctuated over time.
  • The number of prescribers authorised to prescribe methadone only was lower in 2020 (322 prescribers) than in 2011 (346).

In 2021, the total number of prescribers was lower than in 2020, in part due to the exclusion of Queensland from the 2021 collection.


Where did opioid pharmacotherapy prescribers work?

Most opioid pharmacotherapy prescribers worked in the private sector.

Prescribers are classified according to the sector in which they are working when prescribing pharmacotherapy drugs to clients:

  • Private prescribers work in organisations that are not part of government, such as private general practice clinics.
  • Public prescribers work in organisations that are part of government or are government-controlled, such as public drug and alcohol clinics and public hospitals.
  • Correctional facility prescribers work in prisons or other correctional services.

On a snapshot day in 2021, over 4 in 5 prescribers (83% or 2,206 prescribers) worked in the private sector (excluding data for Queensland). The remainder worked in the public sector (13% or 351 prescribers), correctional facilities (4.3% or 114), or a combination of sectors (less than 1%) (Table PRESCRIBER1).

Table PRESCRIBER1: Prescriber types, by state/territory, 2021
Prescriber type NSW Vic Qld WA SA Tas ACT NT Total
Public prescriber 247 n.a. 38 30 13 9 14 351
Private prescriber 775 1,043 n.a. 71 242 27 47 1 2,206
Public/private prescriber n.a. 1 1 2
Correctional facility 56 16 n.a. 23 8 3 7 1 114
Total 1,078 1,059 n.a. 132 280 44 64 16 2,673

—  Nil or rounded to zero.

n.a. Not available.

Notes

  1. 'Public/private prescriber' relates to prescribing that cannot be separated into a single prescriber type.
  2. The states and territories have different guidelines and policies regarding training and registration to prescribe opioid pharmacotherapy types. Refer to the Technical notes for more information.
  3. Data for Qld were not available in 2021. Total excludes Qld.

Source: AIHW National Opioid Pharmacotherapy Statistics Annual Data collection. Table S15.

Of the 47,563 clients receiving pharmacotherapy treatment in Australia in 2021 (excluding data for Queensland), almost 2 in 3 (65% or 30,678 clients) received treatment from a private prescriber. A further 25% (11,752 clients) received treatment from a public prescriber and 11% (5,012) from a correctional facility prescriber (Table S12).

Across most jurisdictions with available data, the most common prescriber type among clients receiving pharmacotherapy was private prescriber (ranging from 46% of clients in the Australian Capital Territory to 91% in Victoria). The exception to this was the Northern Territory, where 9 in 10 clients (92%) were treated by public prescribers (Table S3).


How many clients did opioid pharmacotherapy prescribers treat?

On a snapshot day in 2021, prescribers treated an average of 18 opioid pharmacotherapy clients each.

On a snapshot day in 2021, prescribers treated an average of 18 clients each nationally (excluding data for Queensland). Western Australia had the highest number of clients per prescriber (24 clients), while the Northern Territory had the lowest (11) (Figure PRESCRIBER2).

Between 2016 and 2021, the ratio of clients per prescriber decreased in all jurisdictions (excluding data for Queensland), with the exception of Victoria, the Australian Capital Territory and the Northern Territory (Figure PRESCRIBER2; Table S21). Western Australia had the largest decrease (from 31 to 24 clients per prescriber).

Figure PRESCRIBER2: Number of clients per prescriber, by state/territory, 2016 to 2021

The ratio of clients per prescriber varied by state and territory. Nationally (excluding data for Queensland), the number of clients per prescriber increased from 16 in 2016 to 18 in 2021. On a snapshot day in 2021, Western Australia had the highest number of clients per prescriber (24 clients), while the Northern Territory had the lowest (11 clients).

Refer to the Data tables for more information.

On average, prescribers working in the public sector had more than twice as many clients as prescribers in the private sector (33 and 14 clients per prescriber, respectively) (Table S22).

Ratio of clients to prescriber

Nationally (excluding data for Queensland in 2021), client to prescriber ratios in private sectors remained relatively stable between 2019 and 2021 (Table S22). In 2021, private prescribers had a lower average number of clients than public prescribers in all jurisdictions except Tasmania. Victoria had no public prescribers.

Nationally (excluding data for Queensland), prescribers working in correctional facilities had an average of 44 clients each in 2021. This varies widely at the state and territory level, from 11 clients per prescriber in Western Australia and the Northern Territory to 77 in Victoria (Table PRESCRIBER2).

In the public sector, the Australian Capital Territory had the highest ratio of clients to prescribers (53 clients) followed by Western Australia (37). In the private sector, Western Australia had the highest ratio of clients to prescribers (21 clients per prescriber).

Table PRESCRIBER2: Ratio of clients to prescriber, by prescriber type and state/territory, 2021
Prescriber type NSW Vic Qld WA SA Tas ACT NT Total
Public prescriber 34.4 n.a. 37.0 32.7 13.4 52.7 12.1 33.5
Private prescriber 16.4 13.0 n.a. 20.9 8.6 13.4 10.4 3.0 13.9
Public/private prescriber n.a. 121.0 60.5
Correctional facility 55.4 76.9 n.a. 10.7 33.8 18.0 13.9 11.0 44.0
Total 22.6 14.0 n.a. 23.7 11.9 16.2 16.5 11.4 17.8

— Nil or rounded to zero.

n.a. Not available.
Notes

  1. This ratio was calculated using the formula: number of clients by prescriber type and state/territory (Table S3) divided by registered prescribers by prescriber type and state/territory (Table S15).
  2. WA and SA have prescribers who prescribe in more than 1 location, and as such are counted more than once. This will lead to slightly deflated client to prescriber ratios in these jurisdictions.
  3. Data for Qld were not available in 2021. Total excludes Qld.

Source: National Opioid Pharmacotherapy Statistics Annual Data collection. Table S22.

 

On a snapshot day in 2021, over 6 in 10 prescribers (63% or 1,692 prescribers) treated 1–5 clients (excluding Queensland). In Victoria, data for 2021 include prescribers with 0 clients in the ‘1–5 clients’ category, as these data were not able to be presented separately. Just over 1 in 10 prescribers (12% or 310) treated more than 50 clients. Most of these prescribers were in New South Wales and Victoria (Table S19).

Across states and territories (excluding data for Queensland), the proportion of pharmacotherapy prescribers treating 1–5 clients ranged from 36% (23 prescribers) in the Australian Capital Territory to 74% (206 prescribers) in South Australia. Less than 1% of prescribers were not treating any clients on the snapshot day, noting that prescribers with 0 clients were included in the ‘1–5 clients’ category for Victoria in 2021 (Tables PRESCRIBER3 and S19).

Table PRESCRIBER3: Number of prescribers, by number of pharmacotherapy clients treated on a snapshot day and state/territory, 2021
Clients per prescriber NSW Vic Qld WA SA Tas ACT NT Total Total (%)
0 pharmacotherapy clients n.a. 12 12 0.4
1–5 pharmacotherapy clients 679 698 n.a. 62 206 17 23 7 1,692 63.3
6–10 pharmacotherapy clients 91 88 n.a. 16 17 9 7 3 231 8.6
11–15 pharmacotherapy clients 40 44 n.a. 9 8 3 3 2 109 4.1
16–20 pharmacotherapy clients 29 24 n.a. 3 9 2 5 3 75 2.8
21–25 pharmacotherapy clients 25 29 n.a. 9 6 3 2 74 2.8
26–50 pharmacotherapy clients 70 60 n.a. 8 18 9 5 170 6.4
51–100 pharmacotherapy clients 65 47 n.a. 19 8 5 1 145 5.4
101+ pharmacotherapy clients 79 69 n.a. 6 8 1 2 165 6.2
Total 1,078 1,059 n.a. 132 280 44 64 16 2,673 100.0

— Nil or rounded to zero.

n.a. Not available.

Notes

  1. Prescribers classified as treating '0 pharmacotherapy clients' on a snapshot day must have held an authority to prescribe and had a client who was receiving treatment during the collection year.
  2. Data for Vic include prescribers with 0 clients in the ‘1–5 clients’ category.
  3. Data for Qld were not available in 2021. Totals exclude Qld.

Source: National Opioid Pharmacotherapy Statistics Annual Data collection. Table S19.


Did pharmacotherapy drug treatment vary between prescriber types?

Opioid pharmacotherapy treatment varied between prescriber types.

Pharmacotherapy treatment type

In 2021, methadone was the most commonly prescribed drug across all prescriber types except for public/private prescribers. However, there were some differences in the proportion of clients receiving each pharmacotherapy drug type by prescriber type:

  • A higher proportion of clients of private prescribers were prescribed methadone (62% or 18,916 clients) compared to clients of public prescribers (53% or 6,184 clients) and clients in correctional facilities (52% or 2,597 clients).
  • A higher proportion of clients in correctional facilities were prescribed buprenorphine (41% or 2,059 clients) compared to clients of public (34% or 4,035 clients) or private prescribers (16% or 4,890 clients) (Table S12).

In New South Wales, clients prescribed buprenorphine-naloxone or buprenorphine LAI are reported as receiving buprenorphine. As such, the proportion of clients receiving buprenorphine nationally is likely to be overestimated.

Client characteristics

In 2021, unit record data was available for 6 states and territories (excluding data for Victoria and Queensland). These data indicate that, compared to clients of public or private prescribers, clients of prescribers in correctional facilities were more likely to be:

  • Younger: correctional facilities treated clients aged under 30 at 3.0 times the rate of public prescribers and 3.9 times that of private prescribers.
    • Correctional facilities treated clients aged 30–39 years at 1.6 times the rate of public prescribers and 1.9 times the rate of private prescribers. This has remained relatively stable since 2016.
    • Around 1 in 10 (11.0%) clients treated in correctional facilities were aged 50 years and over, compared to over 3 in 10 clients treated by public prescribers (34%) and 4 in 10 by private prescribers (40%) (Table S27).
  • Male: correctional facilities treated about 9 males for every female. Public and private prescriber types each treated about twice as many males as females (Table S28).