Opioid pharmacotherapy prescribers

Medical personnel, such as general practitioners and medical specialists, prescribe opioid pharmacotherapies. Methadone and buprenorphine are controlled drugs and health professionals require authorisation to prescribe them to clients. Registration processes exist in each state and territory through which prescribers may undergo training to become registered/authorised to prescribe opioid pharmacotherapies to clients.

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides information on prescribers participating in the delivery of pharmacotherapy treatment on a snapshot day in June 2015.

For more details about the collection, refer to the Technical notes.

Note: 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 (see Table T2 of the Technical notes for further details). New South Wales (41), Western Australia (3) and South Australia (6) have prescribers who prescribe in more than 1 location, and as such are counted twice. This will lead to slightly deflated client to prescriber ratios.

Prescriber numbers have increased

Nationally, there were 2,556 authorised prescribers of opioid pharmacotherapy drugs in 2015, an increase of 9% from 2014 (Table S15). The increase occurred mainly in Victoria and is likely due to the creation of Pharmacotherapy Networks in early 2014—with one of their main roles being to increase the numbers of providers in Victoria.

Almost three-quarters (73%) of prescribers were authorised to prescribe more than one type of drug. A further 11% were authorised to prescribe methadone only, and 10% were authorised to prescribe buprenorphine-naloxone only. The remaining 6% were located in New South Wales and were authorised to prescribe buprenorphine and/or buprenorphine‑naloxone, but reported as 'buprenorphine only' (Figure P1). While the number of prescribers authorised to prescribe more than one drug type has increased by 66% over the last 5 years, the proportion of these prescribers relative to all prescribers has remained consistent over the same period.

All prescribers in Queensland, Western Australia, the Australian Capital Territory and the Northern Territory were registered to prescribe more than one type of drug in 2015  (Table S16).

Figure P1: Prescribers, by pharmacotherapy type, 2006 to 2015

The line chart shows the number of prescribers registered to prescribe more than 1 pharmacotherapy drug type increased from 606 in 2006 to 1,871 in 2015. Buprenorphine-naloxone-only prescribers rose from 0 in 2006 to 261 in 2015. Numbers of buprenorphine-only and methadone-only prescribers remained relatively stable since 2007.

Note: NSW counts 'buprenorphine-naloxone' as 'buprenorphine'. See the Technical notes for further details.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S16]. 

Most prescribers worked in the private sector

The majority of prescribers worked in the private sector (85%) with the remainder working in the public sector (12%), correctional facilities (3%), or a combination of sectors (less than 1%) (Table P1).

Table P1: Prescriber types, states and territories, 2015

Prescriber type NSW Vic Qld WA SA Tas ACT NT Aust
Public prescriber 186 66 23 15 14 5 7 316
Private prescriber 568 1,115 125 68 200 20 66 2,162
Public/private prescriber(a) 2 2
Correctional facility 23 20 5 20 4 2 1 1 76
Total 779 1,135 196 111 219 36 72 8 2,556

— Nil or rounded to zero.

  1. In NSW, these numbers relate to prescribing that cannot be separated into a single prescriber type.

Note: The states and territories have different guidelines and policies regarding training and registration to prescribe opioid pharmacotherapy types. In South Australia, for example, 143 out of 219 prescribers treat a total of 224 clients (under the Suboxone® Opioid Substitution Program). See the Technical notes for more information.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S15]. 

In 2015, Victoria had no public prescribers, and therefore had the highest proportion of private prescribers (98%). It was followed by the Australian Capital Territory (92%) and South Australia (91%). The Northern Territory had the highest proportion of public prescribers (88%), followed by Tasmania (39%) and Queensland (34%).

Of the 48,522 clients receiving pharmacotherapy treatment in Australia on the snapshot day in June 2015, 65% received treatment from a private prescriber, 27% received treatment from a public prescriber, and 7% from a correctional facility prescriber (Table S12). These proportions have remained stable over the 10 years since 2006.

Private prescribers treated the majority of clients in New South Wales, Victoria, Western Australia, South Australia and Tasmania. Public prescribers treated the majority of clients in Queensland, the Australian Capital Territory and the Northern Territory (Table S3). This pattern is similar to that observed in previous years for all jurisdictions with the exception of Tasmania, where public prescribers treated the majority of clients in 2013.

Prescribers treated an average of 19 clients on a snapshot day

Low growth in client numbers (less than 1% between 2014 and 2015) coupled with relatively high growth in prescriber numbers (9% between 2014 and 2015) has meant that the client per prescriber ratio fell in 2015. This continues a recent trend, with the client per prescriber ratio falling over the last 5 collection years from 30 clients per prescriber in 2011 to 19 clients in 2015 (Figure P2).

Between 2014 and 2015, the number of clients per prescriber fell in most jurisdictions, but rose in Queensland (from 29 to 33) and Western Australia (from 30 to 31), and remained steady in Tasmania (21). In relative terms, the Australian Capital Territory had a notable drop (from 18 to 14), as did the Northern Territory (from 26 to 20).

Figure P2: Clients per prescriber, states and territories, 2011 to 2015

The grouped vertical bar chart shows the average number of clients per prescriber varied greatly by state and territory. Nationally, the number of clients per prescriber has dropped from 30 in 2011 to 19 in 2015. In 2015, Queensland had the highest number of clients per prescriber, with 33, while Victoria had the lowest, with 12.

Note: In South Australia, the decline in clients per prescriber is attributed to the introduction of the Suboxone® Opioid Substitution Program (SOSP). On a snapshot day in 2015, 143 prescribers registered under the SOSP treated a total of 224 clients, while the remaining 76 prescribers treated a total of 2,862 clients.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2015 collection. Data table [Table S21]. 

Prescribers working in the public sector had, on average, about 2.9 times as many clients as prescribers in the private sector (42 clients per prescriber compared with 15). Queensland had the highest number of clients per prescriber (33), while Victoria had the lowest (12).

The private sector saw a decrease in client ratios from 2013, with ratios for private prescribers dropping from 19 to 15. Public prescribers in the Australian Capital Territory (113 clients), South Australia (65 clients) and Western Australia (61 clients) had a relatively high average number of clients. Private prescribers had a lower average number of clients than public prescribers in all states and territories except Victoria, who had no public prescribers (Table S22).

Nationally, prescribers working in correctional facilities had an average of 42 clients, but at a state and territory level this varied widely, from 2 clients per prescriber in Tasmania to 103 in the Australian Capital Territory (Table S22).

Nationally, on a snapshot day in June 2015, the majority (52%) of prescribers treated between 1 and 20 clients, with only 12% treating more than 50 clients. Forty per cent of prescribers treated between 1 and 5 clients and 26% of prescribers were not treating any clients on the snapshot day. Across states and territories, the proportion of pharmacotherapy prescribers treating between 1 and 5 clients ranged between 0% in the Northern Territory and 74% in South Australia (Table S19).

Treatment varies between sectors

In 2015, methadone was the most commonly prescribed drug across all sectors (Table S12). However, prescribers in correctional facilities were far more likely to prescribe methadone (88% of clients) when compared with private (65%) and public prescribers (61%). Private prescribers were the most likely to prescribe buprenorphine‑naloxone (22%) compared with public (21%) and correctional facility (4%) prescribers. Given that clients prescribed buprenorphine-naloxone in New South Wales are reported as receiving buprenorphine, the proportion of clients actually receiving buprenorphine-naloxone nationally is likely to be an underestimate.

Based on 2015 unit record data from 6 states and territories (excludes data from Victoria and Queensland), on a snapshot day, prescribers in correctional facilities were more likely to treat:

  • younger clients (Table S27)—correctional facilities treated clients aged under 30 at over twice the rate seen for all prescribers. Public and private prescribers treated similar client groups.
  • males (Table S28)—correctional facilities treated about 9 males for every female. Public and private prescriber types were generally similar in terms of the proportion of male and female clients treated, each treating about twice as many males as females.