Australian Institute of Health and Welfare 2021. National Opioid Pharmacotherapy Statistics Annual Data collection. Cat. no. PHE 266. Canberra: AIHW. Viewed 24 April 2021, https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics
Australian Institute of Health and Welfare. (2021). National Opioid Pharmacotherapy Statistics Annual Data collection. Retrieved from https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics
National Opioid Pharmacotherapy Statistics Annual Data collection. Australian Institute of Health and Welfare, 31 March 2021, https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics
Australian Institute of Health and Welfare. National Opioid Pharmacotherapy Statistics Annual Data collection [Internet]. Canberra: Australian Institute of Health and Welfare, 2021 [cited 2021 Apr. 24]. Available from: https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics
Australian Institute of Health and Welfare (AIHW) 2021, National Opioid Pharmacotherapy Statistics Annual Data collection, viewed 24 April 2021, https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/national-opioid-pharmacotherapy-statistics
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On a snapshot day in 2020, over 53,300 clients received pharmacotherapy treatment for their opioid dependence at 3,084 dosing points across Australia. There were 3,422 authorised prescribers of opioid pharmacotherapy drugs.
On average, 16 opioid pharmacotherapy clients were treated by each prescriber
Around 1 in 10 opioid pharmacotherapy clients identified as being Aboriginal and/or Torres Strait Islander
The median age of opioid pharmacotherapy clients was 44 years
53,316 clients received opioid pharmacotherapy treatment nationally
The contributions, comments and advice of the NOPSAD collection Working Group are gratefully acknowledged.
The Australian Government Department of Health provided funding for this report.
Thanks are extended to the data managers and staff in the following departments:
Age is calculated as at 30 June of the collection year.
Dosing points have been classified according to their remoteness area (RA) as defined by the Australian Statistical Geography Standard (ASGS) Remoteness Structure (ABS 2016). This structure allows areas that share common characteristics of remoteness to be classified into broad geographic regions of Australia. These areas are:
The Remoteness Structure divides each state and territory into several regions on the basis of their relative access to services.
Examples of places that are considered Major cities in the ASGS classification include Sydney, Canberra and Newcastle. Hobart and Bendigo are Inner regional areas and Cairns and Darwin are Outer regional areas. Katherine and Mount Isa are Remote areas and Tennant Creek and Meekatharra are Very remote.
Using this classification, dosing points were assigned to an RA based on their recorded Statistical Areas Level 2 (SA2) code.
Some SAs are split between multiple remoteness areas. Where this was the case, the data were weighted according to the proportion of the population of the SA2 in each remoteness area.
All rates in this report, including historical rates, have been calculated using population estimates based on the 2016 Census. All Indigenous rates in this report are calculated using the Indigenous population estimates and projections, based on the 2016 Census.
Crude rates are calculated using the Australian Bureau of Statistics estimated resident population (ERP) as at 30 June of each collection year. Rates for 2020 data were calculated using the preliminary ERP at 30 June 2020, with the exception of remoteness rates which were calculated using the preliminary ERP at 30 June 2019.
Trend data may differ from data published in previous versions of National opioid statistics in Australia due to data revisions.
Buprenorphine (Subutex®): Buprenorphine acts in a similar way to methadone, but is longer lasting and may be taken daily or every second or third day. Two buprenorphine preparations are registered in Australia for the treatment of opioid dependence: a product containing buprenorphine only, and a combined product containing buprenorphine and naloxone. The buprenorphine only product is available as a tablet containing buprenorphine hydrochloride that is administered sublingually (by dissolving under the tongue) (DoH 2014).
Buprenorphine-naloxone (Suboxone®): The combination buprenorphine-naloxone product is a sublingual tablet or film containing buprenorphine hydrochloride and naloxone hydrochloride (DoH 2014). It is recommended that buprenorphine-naloxone should be prescribed in preference to buprenorphine for most clients (DoH 2014). This is because, when taken as intended by dissolving the tablet or film under the tongue, the combined product acts as if it was buprenorphine alone. However, if the combined product is injected, naloxone can block the effects of buprenorphine and increases opioid withdrawal symptoms. This reduces the risk that those receiving buprenorphine naloxone as a takeaway dose will inject it or sell it to others to inject (Chapleo CB & Walter DS 1997), (DoH 2014), (Dunlop A 2007)
Buprenorphine long acting injection (LAI): Buprenorphine LAI is injected into the tissue under the skin either weekly or monthly. Two depot forms of buprenorphine (Buvidal ® and Sublocade®) are now registered for use in Australia. Buprenorphine LAI is unlikely to be dispensed at pharmacies or dosing points as the approved prescriber has to administer, or supervise administration of, the injection.
client: A person registered as receiving opioid pharmacotherapy treatment on the snapshot day.
correctional facility prescribers: Prescribers who work in prisons or other correctional services.
dosing point site: A place at which a client is provided a pharmacotherapy drug. Sites include public and private clinics, pharmacies, correctional facilities, hospitals (admitted patients and outpatients) and other locations such as community health centres and doctors’ surgeries.
Methadone (Methadone Syrup®, Biodone Forte®): A synthetic opioid used to treat heroin and other opioid dependence. It reduces opioid withdrawal symptoms, the desire to take opioids and the euphoric effect when opioids are used. It is taken orally on a daily basis (DoH 2014).
prescriber: A prescriber who held an authority to prescribe a pharmacotherapy drug and who has not been recorded as ceasing this authority before the snapshot day. Refer to the Table T1 for information about the counting of prescribers for each state and territory.
prescriber type: The sector (public or private) in which the prescriber is practising when prescribing pharmacotherapy drugs.
private prescribers: Prescribers who work in organisations that are not controlled by government, such as private general practice clinics.
public prescribers: Prescribers who work in organisations that are part of government or are government controlled, such as public drug and alcohol clinics and public hospitals.
Schedule 4 drug: Prescription only medicine—substances, the use or supply of which, should be by, or on the order of, persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.
Schedule 8 drug: A controlled drug—substances which should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence. Methadone and buprenorphine are examples of Schedule 8 drugs.
specified or snapshot day: A particular day, usually in June each year, on which clients are counted for the NOPSAD collection. The snapshot day varies between states and territories, but allows the number of clients to be estimated at a single point in time. Refer to the Table T2 for information about the use of the snapshot day for each state and territory.
State and territory governments use different methods to collect data about the clients, prescribers and dosing points associated with the opioid pharmacotherapy system. These methods are driven by differences between the states and territories in relation to legislation, information technology systems and resources. Caution should be taken when comparing one state or territory with another. Information on these differences is detailed in the following tables:
Table T1—Administrative features of the NOPSAD collection in each state and territory
Table T2—Methodological differences for the NOPSAD collection in each state and territory
Table T3—Policies and guidelines for opioid pharmacotherapy
Table T4—History of data reported for the NOPSAD collection, 2005 to 2020
New South Wales
Treatment for a client under the NSW Opioid Treatment Program (OTP) must be initiated by an accredited OTP prescriber. A NSW medical practitioner who has not received accreditation as a NSW OTP prescriber may be authorised by the Ministry of Health to prescribe methadone for up to ten (10) low-risk patients who are being transferred from an accredited prescriber. Unaccredited medical practitioners cannot initiate patients on methadone. With buprenorphine or buprenorphine-naloxone, unaccredited medical practitioners may be authorised to initiate up to twenty (20) buprenorphine or buprenorphine-naloxone patients. The total number of patients that an unaccredited prescriber may obtain authority to prescribe for, at any one time, is thirty (30) with a maximum of 10 of these patients being for methadone. To participate in the NSW OTP, community pharmacies must register with the Ministry of Health and comply with the protocol for community pharmacy dosing points issued by the Ministry.
The Victorian pharmacotherapy system is essentially community‑based, other than inpatients in hospitals and in prisons. Although a small number of services receive government funding, services are independent bodies and the government does not manage them directly.
Since the release of the 2013 policy, general practitioners have been able to prescribe buprenorphine‑naloxone for up to 5 patients without the need to attend specific training (Vic Health 2013). Victoria’s Policy for maintenance pharmacotherapy for opioid dependence was revised in 2016.
The Queensland Opioid Treatment Program is essentially community based, other than for inpatients in hospitals and correctional facilities. Prescribers undertake training provided by Queensland Health, and the Department provides approval to commence prescribing on successful completion of the training program. Prescriber training is provided for all pharmacotherapies currently available.
No approval is required for community pharmacies to supply opioid treatment drugs, as this is within the endorsement of registered pharmacists.
The Western Australian pharmacotherapy program is community‑based, other than inpatients in hospitals, prisons and the public clinic. Prescribers attend training provided by the Mental Health Commission (MHC) and the Chief Executive Officer of Health provides authorisation under the Medicines and Poisons Regulations 2016, the legislative instrument. Prescriber training is provided for all pharmacotherapies currently available and now includes prescriber training for practitioners wishing to prescribe Suboxone® to up to 5 patients.
Community pharmacies are authorised to participate in the Community Program for Opioid Pharmacotherapy (CPOP). The Pharmacist with overall responsibility is required to ensure that all pharmacists dosing clients have completed the pharmacist online training module on the MHC website.
All medical practitioners and nurse practitioners (within their scope of practice) can prescribe buprenorphine-naloxone film to treat opioid drug dependence for up to 10 patients, without completing specialised MATOD training. A medical practitioner must become accredited to treat more than 10 patients or to prescribe methadone liquid or buprenorphine as a single agent. Authorisation under the Controlled Substances Act 1984 must be obtained prior to prescribing any pharmacotherapy to treat opioid drug dependence.
In Tasmania, pharmacotherapy training is provided separately for each pharmacotherapy drug.
Australian Capital Territory
All pharmacists are required to attend training in ‘Treatment of Opioid Dependence for General Practitioners, Pharmacists and Health Professionals’ before they start dosing clients. Canberra Health Services Pharmacy in collaboration with Alcohol & Drug Services conducts this training.
All opioid substitution treatment prescribers are required to undergo pharmacotherapy training. Accredited prescribers must complete an ‘Application for authority to prescribe a restricted Schedule 8 substance for the treatment of addiction’ for each and submit the form to the Department of Health, Medicines and Poisons Control. The application information is recorded in the Drug Monitoring System database. The prescriber is not permitted to prescribe until they receive a signed authorisation document. The prescriber must notify Medicines and Poisons Control within 14 days of cessation of treatment.
While the standard snapshot day is set in June of any given year, it varies between states and territories. Despite this variance, it allows the number of clients to be estimated at a single point in time. Data collected for a snapshot day are likely to result in an underestimate of total clients receiving pharmacotherapy within a year. In general, all clients receiving their pharmacotherapy dose in person on the snapshot day are counted.
The NSW Electronic Recording and Reporting of Controlled Drugs (ERRCD) system is used in the administration of the New South Wales Opioid Treatment Program. It replaced the legacy Pharmaceutical Drugs of Addiction System (PHDAS) in September 2016. The ERRCD system is used to record authorisations to prescribe as part of the New South Wales Opioid Treatment Program. It also records client admissions to, and exits from, treatment, as well as details of prescribers and dosing points. For these reasons, the ERRCD system is characterised by continual fluctuations and data extracted at different times for the same period may not be the same. However, while delays in reporting entries to the program, exits from the program and changes in the status of dosing points cause short-term fluctuations in the database, these flatten out over time.
Clients prescribed buprenorphine-naloxone are counted under ‘buprenorphine’.
Similarly, New South Wales data collection does not differentiate between prescribers who are authorised to prescribe buprenorphine and those authorised to prescribe buprenorphine-naloxone or buprenorphine LAI.
Data on prescribers refer to prescribers who were treating at least 1 client on the snapshot day.
Data on dosing point sites relate to sites that had at least 1 client receiving treatment on the snapshot day.
Client data are reported in New South Wales as at 30 June.
Data are collected from 2 sources: a yearly census of pharmacists who are requested to report the actual number of clients being dosed on a snapshot day, and the permit database, which records information about prescribers authorised to prescribe pharmacotherapy drugs, as well as demographic information about clients accessing pharmacotherapy treatment. These 2 data sources cannot be linked.
The number of clients receiving pharmacotherapy treatment is reported on a snapshot day in June.
The number of prescribers in Victoria is determined by adding the number of prescribers registered for that year to the number of existing prescribers.
Victoria has commenced reporting of age and sex data by individual pharmacotherapy drug type. Prior to 2013, Victoria estimated these data.
Victoria has commenced collecting the Indigenous status of clients. Data for 2016 to 2018 included Indigenous status for totals.
Client data are reported in Victoria on a snapshot day in June.
Medicine supply data is collected monthly from pharmacists and entered into a central database that the Queensland Health maintains. Data are also collected from administrative ‘admission’ and ‘discharge’ forms. Queensland totals may vary slightly due to these data source differences. For example, a client may be counted as registered and considered in treatment on the snapshot day, but a dosing point might not be able to be assigned because the client was not actually dosing. The total number of prescribers for Queensland includes those from private practice, public clinics, correctional facilities and government medical offices. Client data are reported in Queensland on a snapshot day in June.
Data are collected from the monthly reports received from pharmacies and other dosing sites authorised to participate in the Community Program for Opioid Pharmacotherapy (CPOP). The dosing data are entered into the Medicines and Poisons Regulation Branch’s Monitoring of Drugs of Dependence System (MODDS) database. Data are also collected from the ‘Application for authority’, ‘Authority to prescribe’ and ‘Termination of treatment’ forms. The number of clients receiving pharmacotherapy treatment is reported through the month of June.
The total number of prescribers usually includes those treating at least 1 client as at 30 June 2018 in private practice, public clinics and correctional facilities.
In Western Australia, data relating to the Indigenous status of clients is now being collected from new ‘Application to prescribe opioid substitution treatment’ forms but not at the time of renewal for patients continuing in treatment.
Client data are usually reported in Western Australia for the entire month of June. Specifically, pharmacies supply information at the end of June relating to the last dose supplied to the patient for the month of June. If a patient changes pharmacies mid-month, it is possible that they appear on more than 1 pharmacy’s monthly transaction reports and are counted more than once.
Before 2005, Western Australia reported clients over a year.
Data are collected from the ‘Authority Application MATOD Program (Medication Assisted Treatment for Opioid Dependence) form, which are entered into a central database system at the Drugs of Dependence Unit (DDU), SA Health. Information from dispensed prescriptions is also collected electronically from the majority of pharmacies on a monthly basis.
From 2011, data have been collected via a half-yearly survey that pharmacists completed and reported on a snapshot day in June. From 2014, this survey has been conducted annually. Other data are drawn from the DDU database and are about those clients registered for treatment on the snapshot day (but who may not actually receive treatment on that day).
Clients who did not enter a dosing point on the snapshot day are reported as ‘other’ when describing clients by dosing point site.
In South Australia, data relating to prescribers refer to prescribers who were treating at least 1 client on the snapshot day.
Data are collected monthly from all pharmacies participating in the Tasmanian Opioid Pharmacotherapy Program (TOPP), and entered into the Drugs and Poisons Information System (DAPIS). This system is administered by the Pharmaceutical Services Branch (PSB) and manages client registration, dosing activity, dosing sites, authority to prescribe and dispensing information relating to drugs of high abuse potential. The system also makes available limited information to relevant medical practitioners and pharmacists, both within and external to the Department to assist safe treatment of patients requiring drugs of a high abuse potential.
Data from DAPIS are made available for management style reporting from a Qlikview-based intranet dashboard.
Client data in Tasmania are reported from a snapshot for the month of June. However, clients are counted only once—if they change dosing point site during the month, the dosing point site that administered the greater number of doses is attributed the activity.
Data on prescribers refer to prescribers who were treating at least 1 client during the month of June.
Data on dosing points refer to dosing points that had a client receiving treatment during the month of June.
Client participation data are collected manually from the Canberra Health Services, Alcohol and Drug Services spreadsheets and from Medication Administration Chart (MAC) Sheets which the community pharmacies provide every month. Client participation data are also collected via iDose which is a Canberra Health Service database that contains client dosing information in real time. General practitioner and pharmacy participation data are also collated from the MAC Sheets.
Client data are reported on clients receiving treatment in the Australian Capital Territory on a snapshot day in June.
Data are generated from the current active authorisations in the Drug Monitoring System database on the snapshot day in June. The data are audited against current Schedule 8 prescription data also within the database.
National pharmacotherapy policy for people dependent on opioids 2007
The following guidelines were current on the collection day of 30 June 2020
Full version: NSW Clinical Guidelines: Treatment of Opioid Dependence
Abbreviated: NSW Clinical Guidelines: Treatment of Opioid Dependence - Abbreviated Version
Policy for maintenance pharmacotherapy for opioid dependence
Queensland Opioid Treatment Program: clinical guidelines 2018
Western Australian Community Program for Opioid Pharmacotherapy (CPOP): clinical policies and procedures for the use of methadone and buprenorphine in the treatment of opioid dependence—3rd Edition
Operational Directive 0598/15 Management of Community Program for Opioid Pharmacotherapy (CPOP) patients in a hospital setting
GP Program - Medication assisted treatment for opioid dependence
Tasmanian Opioid Pharmacotherapy Policy and Clinical Practice Standards
Opioid Maintenance Treatment in the ACT: Local Policies and Procedures
Code of Practice: Schedule 8 Substances
ABS (Australian Bureau of Statistics) 2016. The ASGS remoteness structure. Canberra: ABS. Viewed 20 January 2021.
ABS (Australian Bureau of Statistics) 2016. Statistical area level 2 (sa2). Canberra: ABS. Viewed 27 January 2021.
Chapleo CB & Walter DS 1997. The buprenorphine naloxone combination product. Research and Clinical Forums
DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH. Viewed 20 January 2021.
Dunlop A 2007. From Subutex to Suboxone: the Australian experience. Viewed 20 January 2021.
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