Opioid pharmacotherapy prescribers

The National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection provides information on prescribers delivering pharmacotherapy treatment on a snapshot day in mid-2017.

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, Western Australia and South Australia 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.

Number and type of prescribers

On the snapshot day in 2017, there were 3,074 authorised prescribers of opioid pharmacotherapy drugs (Table S15).

Almost two-thirds (63%) of prescribers were authorised to prescribe more than one type of drug. A further 18% were authorised to prescribe buprenorphine-naloxone only, and 12% were authorised to prescribe methadone only. The remaining 7% were located in New South Wales and Victoria and were authorised to prescribe buprenorphine; however, NSW reported both buprenorphine and buprenorphine-naloxone as ‘buprenorphine only’ (see Figure P1).

All prescribers in Queensland, the Australian Capital Territory and the Northern Territory were registered to prescribe more than one type of drug in 2017 (Table S16).

Figure P1: Prescribers, by pharmacotherapy type, 2008 to 2017

The line chart shows the number of prescribers registered to prescribe more than 1 pharmacotherapy drug type increased from 934 in 2008 to 1,936 in 2017. Buprenorphine-naloxone-only prescribers rose from 6 in 2008 to 545 in 2017. Numbers of Buprenorphine only prescribers increased from 58 in 2008 to 219 in 2017 while methadone-only prescribers remained relatively stable since 2008.

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

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S16].

Most prescribers worked in the private sector

The majority of prescribers worked in the private sector (83%) with the remainder working in the public sector (13%), correctional facilities (3%), or a combination of sectors (less than 1%) (see Table P1).

Table P1: Prescriber types, states and territories, 2017
Prescriber type NSW Vic Qld WA SA Tas ACT NT Total

Public prescriber

212

91

24

29

13

6

14

389

Private prescriber

608

1,454

124

83

203

22

66

2,560

Public/private prescriber

2

1

3

Correctional facility

38

20

7

18

6

1

1

91

Total

858

1,474

253

125

238

38

74

14

3,074

Notes:

— Nil or rounded to zero.

The states and territories have different guidelines and policies regarding training and registration to prescribe opioid pharmacotherapy types. See the Technical notes for more information.

The Qld total includes 31 prescribers who have a prescriber type of 'Not stated'.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S15].

Victoria had the highest proportion of private prescribers (99%), followed by the Australian Capital Territory with 89%. The Northern Territory had the highest proportion of public prescribers (100%), followed by Queensland with 36%.

Of the 49,792 clients receiving pharmacotherapy treatment in Australia on a snapshot day in 2017, 67% received treatment from a private prescriber, 26% received treatment from a public prescriber, and 7% from a correctional facility prescriber (Table S12).

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).

Prescribers treated an average of 16 clients on a snapshot day

Between 2016 and 2017, the number of clients per prescriber remained steady in most jurisdictions. In relative terms, Western Australia had the largest decrease (from 31 to 28 clients per prescriber), followed by South Australia (from 13 to 12 clients per prescriber) (see Figure P2).

Figure P2: Clients per prescriber, states and territories, 2013 to 2017

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 23 in 2013 to 16 in 2017. In 2017, Western Australia had the highest number of clients per prescriber, with 28, while Victoria and the Northern Territory had the lowest, with 10.

Note:

In South Australia, the decline in clients per prescriber is attributed to the introduction of the Medication Assisted Treatment for Opioid Dependence—Suboxone Opioid Substitution Program (MATOD-SOSP). This resulted in an increase in the number of prescribers treating relatively few clients. On a snapshot day in 2017, 137 prescribers registered under the MATOD-SOSP treated a total of 205 clients, while the remaining 101 prescribers treated a total of 2,667 clients.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2017 collection. Data table [Table S21].

Prescribers working in the public sector had, on average, about two and a half times as many clients as prescribers in the private sector (34 clients per prescriber compared with 13). In 2017, Western Australia had the highest number of clients per prescriber (28), while Victoria and the Northern Territory had the lowest (10).

The private sector saw a decrease in client ratios between 2016 and 2017 with ratios for private prescribers falling from 14 in 2016 to 13 in 2017. The ratio of clients to public prescribers decreased to 34 in 2017 from a ratio of 35 clients per prescriber in 2016.

The Australian Capital Territory had the highest ratio of clients to public prescribers (82) followed by Western Australia (59). Queensland had the highest ratio of private prescribers (26). Private prescribers had a lower average number of clients than public prescribers in all jurisdictions except Victoria (who had no public prescribers) and Tasmania.  

Nationally, prescribers working in correctional facilities had an average of 36 clients, but at a state and territory level this varied widely, from 3 clients per prescriber in Tasmania to 126 in the Australian Capital Territory (Table S22).

The majority (43%) of prescribers treated between 1 and 5 clients, with only 10% treating more than 50 clients. Across states and territories, the proportion of pharmacotherapy prescribers treating between 1 and 5 clients ranged between 73% in South Australia and 15% in Queensland. Twenty-nine per cent of prescribers were not treating any clients on the snapshot day (Table S19).

Treatment varies between sectors

In 2017, methadone was the most commonly prescribed drug across all sectors (Table S12). However, prescribers in correctional facilities were far more likely to prescribe methadone (89% of clients) when compared with private (64%) and public prescribers (58%). Private prescribers were the most likely to prescribe buprenorphine-naloxone (23%) compared with public (21%) and correctional facility (3%) 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 2017 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 between 30 and 39 years at almost twice the rate than that of public or private 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 one-third as many males as females.