Introduction

Opioid drugs

Opioids are chemical substances that have a morphine-type action in the body. They are most commonly used for pain relief, but they are addictive and can lead to drug dependence. They include:

  • opiates-drugs naturally derived from the opium poppy, such as codeine and heroin
  • semi-synthetic opiates, such as hydromorphone and oxycodone
  • opioids, such as fentanyl and methadone.

Opioid drugs can be:

  • illicit opioids, predominantly heroin [7]
  • prescription opioids (whether prescribed for the person or obtained illicitly) such as morphine and oxycodone [5]
  • over-the-counter opioids in which the opioid drug codeine is combined with a non‑opioid analgesic such as paracetamol or ibuprofen [4].

Opioid drug dependence

Dependence on opioid drugs such as heroin or morphine is associated with a range of health and social problems that affect individual drug users, their family and friends, and the wider public. Opioid dependence can lead to many problems such as overdose, medical and psychological complications, social and family disruption, harms to child welfare, violence and drug-related crime, and the spread of bloodborne diseases. It is considered a serious public health issue [7].

Drug dependence is characterised by drug seeking and using, but people experience it in various ways. The International statistical classification of diseases and related health problems, 10th revision (ICD-10) [6] 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).'

In 2013, it was estimated that about 3% of Australians had used opioids for non‑medical reasons over their lifetime, while 1.2% had used heroin (see [1] for further details). Among those Australian seeking treatment for drug and alcohol problems in 2013-14, opioids were a drug of concern in about 1 in 9 (11%) treatment episodes (see [2] for further details).

Opioid pharmacotherapy treatment

Opioid pharmacotherapy treatment is one of the main treatment types used for opioid drug dependence and involves replacing the opioid drug of dependence with a legally obtained, longer-lasting opioid that is taken orally.

In Australia, 3 medications are registered for long-term maintenance treatment for opioid-dependent people:

  • methadone
  • buprenorphine
  • buprenorphine-naloxone.

These drugs, known as opioid pharmacotherapies, reduce withdrawal symptoms, the desire to take opioids, and the euphoric effect of taking opioids. Treatment with these drugs is administered according to the law of the relevant state or territory, and within a framework which includes medical, social and psychological treatment.

The Australian Government Department of Health, as part of the National Drug Strategy, published the National guidelines for medication-assisted treatment of opioid dependence [3] to provide a broad policy context and framework for state and territory policies and guidelines that are concerned with the medication-assisted treatment of opioid dependence.

The NOPSAD collection

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection is a set of jurisdictional data that includes information about:

  • clients accessing pharmacotherapy for the treatment of opioid dependence;
  • prescribers participating in the delivery of pharmacotherapy treatment; and
  • dosing sites providing pharmacotherapy drugs to clients.

References

  1. AIHW (Australian Institute of Health and Welfare) 2014. National Drug Strategy Household Survey detailed report: 2013. Drug statistics series no. 28. Cat. no. PHE 183. Canberra: AIHW.
  2. AIHW 2015. Alcohol and other drug treatment services in Australia 2013-14. Drug treatment series no. 25. Cat. no. HSE 158. Canberra: AIHW.
  3. DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoHA for National Drug Strategy. Viewed 16 February 2016.
  4. Nielsen S, Cameron J & Pahoki S 2010. Over the counter codeine dependence: final report 2010. Melbourne: Turning Point Alcohol and Drug Centre.
  5. Roxburgh A, Bruno R, Larance B & Burns L 2011. Prescription of opioid analgesics and related harms in Australia. Medical Journal of Australia 195:280–284.
  6. WHO (World Health Organization) 2010. Mental and behavioural disorder due to the use of opioids: dependence syndrome. ICD-10: International statistical classification of diseases and related health problems. Accessed 15 February 2016.
  7. WHO 2013. Management of substance abuse: opiates. Geneva: WHO. Accessed 15 February 2016.