Opioid pharmacotherapy clients

Over 48,000 Australians were on a course of pharmacotherapy treatment for their opioid dependence on a snapshot day in June 2015.

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides information on clients accessing pharmacotherapy for the treatment of opioid dependence on a snapshot day in June 2015. For more details about the collection, refer to the Technical notes.

Growth in the number of people receiving pharmacotherapy treatment has slowed

The number of people receiving opioid pharmacotherapy treatment almost doubled between 1998 (24,657 people) and 2015 (48,522 people). Growth in client numbers has continued in recent years, but at a slower rate—with an overall increase of 5% over the 5-year period from 2010 compared to an average increase of 5% each year between 1998 and 2010.

Nationally, the number of clients per 10,000 people in the population increased from 13 in 1998 to 21 in 2010, where it remained until it dropped to 20 in 2015 (Table S1). New South Wales had the highest rate of people receiving opioid pharmacotherapy (26 clients per 10,000 people), while the Northern Territory had the lowest (6 clients per 10,000 people) (Figure C1).

Figure C1: Clients receiving pharmacotherapy treatment on a snapshot day, per 10,000 population, 2015

The vertical bar chart shows the national rate (per 10,000 population) of clients receiving treatment on a snapshot day was 20. The states and territories ranged from 6 in the Northern Territory to 26 in New South Wales.

Note: Australian population estimates for June 2015sourced from ABS Australian Demographic Statistics, June 2015 (ABS cat. no. 3101.0)were used to produce this figure.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S2]. 

The relatively low rate of clients in the Northern Territory may be partially attributable to the limited availability of heroin [1], the impact of remote locations on treatment delivery, and a highly mobile population. Rates for all states and territories have remained relatively stable over the last 5 years.

The median age of opioid pharmacotherapy clients is increasing

Around two-thirds (68%) of clients in 2015 were aged 30–49 and this proportion has been fairly consistent since 2006 (Figure C2). However, over the 10-year period from 2006, the proportion of clients aged under 30 fell by nearly two-thirds (from 28% to 10%) and the proportion of clients aged 50 and over more than doubled (from 8% to 22%). These trends suggest an ageing cohort of people in opioid pharmacotherapy treatment which is consistent with that found in other drug treatment services and may be due to:

  • methadone treatment having been available 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.

In 2015, clients ranged in age from their mid-teens to 93. The median age of clients across all pharmacotherapy types was 40 in 2013, 2014 and 2015, compared with 39 in 2012 and 38 in 2011 (the first year single-year age data were collected).

Figure C2: Clients receiving pharmacotherapy treatment on a snapshot day, by age group, 2006 to 2015

The line chart shows the proportion of opioid pharmacotherapy clients aged 30 to 49 years rose from 64% in 2006 to 68% in 2015. Over the same period, the proportion of clients aged less than 30 years dropped from 28% to 10% and the proportion aged 50 years and over increased from 8% to 22%.

Note: Collection of age group began in 2006.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S6]. 

Clients in Victoria had the youngest median age (38 years) and clients in New South Wales and South Australia the oldest (42 years).

Methadone was the most commonly prescribed pharmacotherapy type across all age groups. Older clients were more likely to receive methadone and less likely to receive buprenorphine and buprenorphine-naloxone than younger clients (Figure C3).

Figure C3: Clients receiving pharmacotherapy on a snapshot day, by age group and pharmacotherapy type, 2015

The stacked vertical bar chart shows the proportion of opioid pharmacotherapy clients receiving methadone was larger for older age groups. For clients aged under 30 years, 54% received methadone, compared to 75% of clients aged 50–59 and 76% aged 60 years and over. As client age rose, the proportion of each age group receiving either buprenorphine or buprenorphine-naloxone dropped. These figures exclude Victoria who does not report age by pharmacotherapy type.

Notes

  1. NSW reports 'buprenorphine-naloxone' as 'buprenorphine'.
  2. Excludes data for Victoria who cannot provide age breakdowns by pharmacotherapy type.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S6]. 

Males were more likely to receive treatment than females

Around two-thirds (65%) of clients receiving pharmacotherapy in June 2015 were male. This proportion was similar across states and territories for each of the 3 pharmacotherapy types (methadone, buprenorphine and buprenorphine-naloxone), and has remained stable over the 10-year period since 2006.

The rate of people receiving pharmacotherapy was highest between ages spanning the early 30s to mid-50s for both males and females (Figure C4). The rate peaked at the age of 37 for males and 35 for females (84 clients per 10,000 males aged 37 in the population, and 47 clients per 10,000 females aged 35). Males were generally more likely—and in some cases about twice as likely—to be receiving pharmacotherapy than females of the same age.

Figure C4: Clients receiving pharmacotherapy treatment on a snapshot day, by age and sex, 2015

The line chart shows the rate of males and females receiving opioid pharmacotherapy in 2015 per 10,000 population rose between the ages of 15 to the late-30s. The rate of pharmacotherapy clients peaked at the age of 37 for males and 35 for females, with 84 clients for every 10,000 males aged 37 and 47 clients for every 10,000 females aged 35.

Notes

  1. Unit record data were used to produce this figure. Records were available for 58% of total clients receiving pharmacotherapy on a snapshot day in 2015. Vic and Qld data were not available.
  2. Australian population estimates for June 2015—sourced from ABS Australian Demographic Statistics, June 2015 (ABS cat. no. 3101.0)—were used to produce this figure.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S24]. 

Aboriginal and Torres Strait Islander people were over‑represented in pharmacotherapy treatment

Where reported, about 1 in 10 clients identified as Aboriginal and/or Torres Strait Islander. Indigenous Australians (55 clients per 10,000 Indigenous Australians) were around 3 times as likely to have received pharmacotherapy treatment as the non‑Indigenous population (17 clients per 10,000) (Table S9). Indigenous clients were slightly more likely to be treated with methadone (67%) than non‑Indigenous pharmacotherapy clients (64%).

Among the states and territories for which data were available, the Australian Capital Territory and New South Wales had the highest rates of Indigenous clients (138 and 102 clients per 10,000 Indigenous Australians respectively), and Tasmania, Queensland and the Northern Territory the lowest, consistent with their low overall rate of pharmacotherapy (23, 22 and 3 clients per 10,000 respectively).

Note: These data should be interpreted with caution due to the following:

  • the high proportion of clients (42%) for whom Indigenous status was either not reported or not stated
  • Victoria and Western Australia did not report the Indigenous status of their clients.
  • the Australian Capital Territory has a small Indigenous Australian population.

See the National Opioid Pharmacotherapy Statistics Annual Data collection data quality statement for more information.

Heroin was by far the most common opioid drug of dependence for clients

Clients receive pharmacotherapy treatment for a range of opioid drugs. These include illicit opioids (such as heroin), and pharmaceutical opioids, which are available by prescription (such as oxycodone), over-the-counter (such as codeine-paracetamol combinations) or through illicit means.

Nationally in 2015, clients were nearly twice as likely to report heroin (45%) as an opioid drug of dependence as they were for all opioid pharmaceuticals combined (25%) (Table S10).

Methadone (6%), oxycodone (5%), and morphine (5%) were the next most commonly reported drugs of dependence; however, pharmacotherapy drugs may be subject to misreporting if a client's treatment drug is reported in place of the opioid drug of dependence leading a client to seek treatment.

Heroin was the most common drug of dependence in all states and territories, except Tasmania and the Northern Territory, where morphine was the most common.

Methadone continued to be the most commonly prescribed drug

Two-thirds (66%) of clients were treated with methadone in 2015 and the remaining third (34%) were treated with buprenorphine, either alone or in combination with naloxone, which is added to deter administration by injection (see the Glossary entry for buprenorphine-naloxone for further details).

From 2008 to 2015, treatment with:

  • methadone fell (from 70% of clients to 66%)
  • buprenorphine remained stable (from 15% to 14%)
  • buprenorphine-naloxone rose (from 16% to 21%).

These data indicate that buprenorphine-naloxone prescription is replacing buprenorphine prescription to some extent. This is in keeping with the national guidelines (DoH 2014), which 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 to inject).

In 2015, methadone was the most common pharmacotherapy drug in all jurisdictions except for the Northern Territory (where 61% of clients received buprenorphine‑naloxone). Buprenorphine-naloxone is the default treatment drug for the main pharmacotherapy program in the Northern Territory. Treatment with methadone ranged from 31% of clients in the Northern Territory to 79% of clients in the Australian Capital Territory (Figure C5).

Figure C5: Clients receiving pharmacotherapy on a snapshot day, by pharmacotherapy type, states and territories, 2015

The stacked vertical bar chart shows methadone was the most common pharmacotherapy drug type in each state and territory except the Northern Territory. The ACT had the largest proportion of clients receiving methadone, with 79%. In the Northern Territory, buprenorphine-naloxone was the most common pharmacotherapy drug, with 61% of clients receiving it.

Note: NSW reports 'buprenorphine-naloxone' as 'buprenorphine'. When New South Wales data are excluded, in the rest of Australia 61% of clients received methadone, 5% received buprenorphine, and 35% received buprenorphine‑naloxone.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S4]. 

Most clients are continuing 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 (new);
  • re-entering treatment after a lapse (re-admission);
  • continuing treatment (ongoing); or
  • transferring from another state/territory (interstate transfer).

Client status data were available for Victoria, Queensland, Western Australia, Tasmania and the Northern Territory (Figure C6). In these 5 jurisdictions, the majority of clients were classed as ongoing.

Figure C6: Clients receiving pharmacotherapy on a snapshot day, by client status, states and territories, 2015

This stacked vertical bar chart shows the majority of clients were classed as ongoing in all states and territories. This ranged from 98% in Tasmania (98%) to 65% in Queensland. The proportion of clients re-entering treatment ranged from 27% in Queensland to less than 1% in Tasmania. New clients comprised 17% of clients in the Northern Territory, but only a small proportion in the remaining 4 jurisdictions (no greater than 10%).

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S11]. 

References

  1. Moon, C 2014. Northern Territory drug trends 2013: Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trends Series No. 116. Sydney: National Drug and Alcohol Research Centre.