Opioid pharmacotherapy clients

On a snapshot day in mid-2017, nearly 50,000 people in Australia were on a course of pharmacotherapy treatment for their opioid dependence.

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides information on clients accessing pharmacotherapy for the treatment of opioid dependence. Data were collected on a snapshot day in June 2017, with the exception of Western Australia where data were collected on a snapshot day in May 2017.

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

The number of people receiving pharmacotherapy treatment has remained stable

Both the number of people (49,792) and the rate of people per (20 clients per 10,000 people) receiving pharmacotherapy treatment have remained relatively stable since 2010, with most states recording small increases during this time.

New South Wales remains the state with the highest rate of people receiving opioid pharmacotherapy treatment (26 clients per 10,000 people). Victoria was the only state to report a rise in the rate of people receiving treatment in 2017 (23 clients per 10,000 people, up from 22 clients per 10,000 in 2016). See Figure C1.

Figure C1: Clients receiving pharmacotherapy treatment on a snapshot day, per 10,000 population, 2017

The vertical bar chart shows the 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.

Notes:

  1. The relatively low rate of clients in the Northern Territory may be attributable to the limited availability of heroin [4], the impact of remote locations on treatment delivery, and a highly mobile population.
  2. Australian population estimates for June 2017—sourced from ABS Australian Demographic Statistics, June 2017 (ABS cat. no. 3101.0)—were used to produce this figure.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S2].

The median age of opioid pharmacotherapy clients is increasing

In 2017, clients ranged in age from their late teens to 87 years. The median age across all pharmacotherapy types in 2017 was 42 years, unchanged from 2016. This is an increase from 38 years in 2011, 39 years in 2012 and 40 years in 2013, 2014 and 2015. The first year in which single-year age data were collected was 2011.

Almost two-thirds (66%) of clients in 2017 were aged 30–49 years. The proportion of clients aged under 30 has declined each year since 2006 (28% of clients in 2006 falling to 7% of clients in 2017).  

The number of clients aged 60 years and over continued to increase slowly, from 223 (1% of total clients) in 2008 to 3,192 in 2017 (6% of total clients).

This continues the trend of an ageing cohort in opioid pharmacotherapy treatment and is consistent with the pattern observed in other drug treatment services [1, 2]. This may be due to:

  • methadone treatment being available in Australia 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.

Figure C2: Clients receiving pharmacotherapy treatment on a snapshot day, by age group, 2008 to 2017

The line chart shows the proportion of opioid pharmacotherapy clients aged 30 to 49 years remained relatively stable between 2007 (67%25) and 2017 (66%25). Over the same period, the proportion of clients aged less than 30 years dropped from 28%25 to 7%25 and the proportion aged 50 years and over increased from 8%25 to 27%25.

Note: Collection of age groups began in 2006.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S6].

Clients using services in New South Wales and South Australia had the highest median age (44 years) while clients in Victoria, Tasmania and the Australian Capital Territory had the lowest median age (41 years).

Methadone was the most commonly prescribed pharmacotherapy type across all age groups, followed by buprenorphine-naloxone and buprenorphine. This is the first time since 2011 that buprenorphine-naloxone has been prescribed more often than buprenorphine. Older clients were more likely to receive methadone and less likely to receive buprenorphine and buprenorphine-naloxone than younger clients (see Figure C3).

Figure C3: Clients receiving pharmacotherapy on a snapshot day, by age group and pharmacotherapy type, 2017

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, 50%25 received methadone, compared to 71%25 of clients aged 50–59 and 74%25 aged 60 years and over. As client age rose, the proportion of each age group receiving either buprenorphine or buprenorphine-naloxone dropped.

Note: NSW reports 'buprenorphine-naloxone' as 'buprenorphine'.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S6].

Males were more likely to receive treatment than females

Around two-thirds (66%) of clients receiving pharmacotherapy on the snapshot day in 2017 were male. This proportion was similar for each of the 3 pharmacotherapy types (methadone, buprenorphine and buprenorphine-naloxone), and has remained stable over the 10 years since 2008.

The rate of receiving pharmacotherapy was highest for people in the 40-49 age group for both males and females (see Figure C4). The rate peaked at age 39 for males and 38 for females (87 clients per 10,000 males aged 39 in the population, and 49 clients per 10,000 females aged 38). Males were generally more likely to receive pharmacotherapy than females of the same age—and in some cases about twice as likely.

Figure C4: Clients receiving pharmacotherapy treatment on a snapshot day, by age and sex, 2017

The line chart shows the rate of males and females receiving opioid pharmacotherapy in 2017 per 10,000 population rose between the ages of 15 to the late-30s. The rate of pharmacotherapy clients peaked at the age of 39 years for males and 38 years for females, with 88 clients for every 10,000 males aged 39 and 49 clients for every 10,000 females aged 38.

Notes:

  1. Unit record data were used to produce this figure. Records were available for 58% of clients receiving pharmacotherapy on a snapshot day in 2017. Unit record data for Victoria and Queensland data were not available.
  2. Australian population estimates for June 2017—sourced from ABS Australian Demographic Statistics, June 2017 (ABS cat. no. 3101.0)—were used to produce this figure.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S24].

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

Where reported, about 1 in 10 (9% in 2017) clients identified as being Aboriginal and/or Torres Strait Islander. Indigenous Australians (70 clients per 10,000 Indigenous Australians) were around 3 times as likely to have received pharmacotherapy treatment as the non-Indigenous population (26 clients per 10,000) (Table S9). Indigenous clients were more likely to be treated with methadone (54%) than non-Indigenous pharmacotherapy clients (41%).

Among the states and territories for which data were available, the Australian Capital Territory and Victoria had the highest rates of Indigenous clients (134 and 125 clients per 10,000 Indigenous Australians respectively). The Northern Territory had the lowest rate of Indigenous clients with 3 clients per 10,000 Indigenous Australians.

  • Western Australia did not report the Indigenous status of their clients.
  • Victoria did not provide a breakdown by pharmacotherapy type for Indigenous clients.

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 available by prescription (such as oxycodone), over-the-counter (such as codeine-paracetamol combinations) or through illicit means. Opioids in the form of codeine and codeine combinations were still available over the counter on the snapshot day. Data for opioid drug of dependence should be used with caution due to the high proportion of clients with ‘Not stated/not reported’ as their opioid drug of dependence (38% of clients in 2017).

Nationally in 2017, 38% of clients reported heroin as their opioid drug of dependence. Oxycodone (5%) was the next most commonly reported drug of dependence followed by morphine, codeine and methadone (all 4%).

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.

Pharmacotherapy drugs may be subject to misreporting if a client’s treatment drug is reported instead of the opioid drug of dependence which led to the client seeking treatment.

Methadone continued to be the most commonly prescribed drug

Almost two-thirds (60%) of clients were treated with methadone in 2017 and the remaining 40% were treated with buprenorphine, either alone or in combination with naloxone, which is added to deter administration by injection (see the buprenorphine-naloxone entry in the Glossary for further details).

From 2008 to 2017, treatment with:

  • methadone fell (from 70% of clients to 60%)
  • buprenorphine remained stable (15%), and
  • buprenorphine-naloxone increased (from 16% of clients to 25%).

Previous trend data has shown that buprenorphine-naloxone prescription is replacing buprenorphine prescription. This is in keeping with the national guidelines [3] 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 2017, methadone was the most common pharmacotherapy drug in all jurisdictions except for the Northern Territory (where 69% 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 19% of clients in the Northern Territory to 76% of clients in the Australian Capital Territory (see Figure C5).

Figure C5: Clients receiving pharmacotherapy on a snapshot day, by pharmacotherapy type, states and territories, 2017

The stacked vertical bar chart shows methadone was the most common pharmacotherapy drug type in each state and territory except the Northern Territory. The Australian Capital Territory had the largest proportion of clients receiving methadone, with 76%25. In the Northern Territory, buprenorphine-naloxone was the most common pharmacotherapy drug, with 69%25 of clients receiving it.

Note:

NSW reports ‘buprenorphine-naloxone’ as ‘buprenorphine’. When New South Wales data are excluded, in the rest of Australia 52% of clients received methadone, 5% received buprenorphine, and 43% received buprenorphine naloxone.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 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, Western Australia, Tasmania, the Australian Capital Territory and the Northern Territory. In these jurisdictions, the majority of clients (58%) were classed as ongoing (see Figure C6).

Figure C6: Clients receiving pharmacotherapy on a snapshot day, by client status, states and territories, 2017

This stacked vertical bar chart shows the majority of clients were classed as ongoing in all states and territories. This ranged from 98%25 in Tasmania to 56%25 in Victoria. The proportion of clients re-entering treatment ranged from 23%25 in Victoria to less than 1%25 in Tasmania. New clients comprised 19%25 of clients in Victoria and 14%25 in the Northern Territory. Data were only available from Victoria, WA, Tasmania, ACT and the NT in this analysis.

Note: NSW, Qld and SA do not report client status.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S11].

References

  1. ABS (Australian Bureau of Statistics) 2012. The ASGS remoteness structure. Canberra: ABS. Viewed 12 January 2017.
  2. AIHW (Australian Institute of Health and Welfare) 2016. National Drug Strategy Household Survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW.
  3. DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH. Viewed 24 January 2018.
  4. 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.