Opioid pharmacotherapy clients

On a snapshot day in June 2018, just over 50,000 people in Australia were on a course of pharmacotherapy treatment for their opioid dependence

The number of people receiving pharmacotherapy treatment has remained stable

Both the number of people (50,597) and the rate of people (20 clients per 10,000 people) receiving pharmacotherapy treatment have remained relatively stable since 2010, with most states recording small increases in client numbers 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). The Northern Territory remains the state with the lowest rate of people receiving treatment (6 clients per 10,000 people) (Figure C1).

Notes

  1. The relatively low rate of clients in the Northern Territory may be attributable to the limited availability of heroin (Moon 2018), the impact of remote locations on treatment delivery, and a highly mobile population.

  2. Australian population estimates for June 2018—sourced from ABS Australian Demographic Statistics, June 2018 (ABS cat. no. 3101.0)—were used to produce this figure.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 collection. Data table [Table S2].

The median age of opioid pharmacotherapy clients is increasing

In 2018, clients ranged in age from their late teens to 88 years. The median age across all pharmacotherapy types in 2018 was 43 years. This is an increase from 38 years in 2011, 39 years in 2012, 40 years in 2013, 2014 and 2015 and 42 years in 2016 and 2017. The first year in which single-year age data were collected was 2011.

Almost two-thirds (65%) of clients in 2018 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 and 2018). 

The number of clients aged 60 years and over has continued to increase slowly, from 223 (1% of total clients) in 2008 to 3,635 in 2018 (7% 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 (AIHW 2016). 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.

Note: Collection of age groups began in 2006.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 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 Tasmania 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. Older clients (those aged over 40 years) were more likely to receive methadone and less likely to receive buprenorphine and buprenorphine-naloxone than younger clients (Figure C3).

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

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 collection. Data table [Table S6].

Males were more likely to receive treatment than females

Around two-thirds (65%) of clients receiving pharmacotherapy on the snapshot day in 2018 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 2009.

The rate of receiving pharmacotherapy was highest for people in the 40-49 age group for both males and females (Figure C4). The rate peaked at age 40 for males (88 clients per 10,000 population). The rate for females peaked between the ages of 38 and 40 years (44 clients per 10,000 females aged 38, 39 and 40).

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 2018. Unit record data for Victoria and Queensland data were not available.
  2. Australian population estimates for June 2018—sourced from ABS Australian Demographic Statistics, June 2018 (ABS cat. no. 3101.0)—were used to produce this figure.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 collection. Data table [Table S24].

Aboriginal and Torres Strait Islander people receiving opioid pharmacotherapy treatment

In 2018, for the first time, all states and territories were able to report Indigenous status of clients receiving opioid pharmacotherapy. There were 4,691 Indigenous Australians receiving pharmacotherapy treatment on the snapshot day in June 2018.

Indigenous Australians (76 clients per 10,000 Indigenous Australians) were almost 3 times as likely to have received opioid pharmacotherapy treatment as the non-Indigenous population (27 clients per 10,000) (Table S9).

Of those Indigenous Australian clients with pharmacotherapy type provided, almost two-thirds (62%) were treated with methadone in 2018. The remaining 38% were treated with buprenorphine, either alone or in combination with naloxone, which is added to deter administration by injection (refer to the buprenorphine-naloxone entry in the Glossary for further details). Victoria provides pharmacotherapy type as a total for Indigenous clients.

From 2014 to 2018, treatment with:

  • methadone fell (from 70% of Indigenous clients to 62%)
  • buprenorphine increased (from 19% of Indigenous clients to 24%), and
  • buprenorphine-naloxone rose slightly (from 11% of Indigenous clients to 13%).

The Australian Capital Territory had the highest rates of Indigenous Australian clients (140 clients per 10,000 Indigenous Australians). This was followed by New South Wales and Victoria with 117 and 114 clients per 10,000 Indigenous Australians respectively). Northern Territory had the lowest rate of Indigenous clients with 3 clients per 10,000 Indigenous Australians. Western Australia reported Indigenous status of clients for the first time in 2018.

While methadone is the most common opioid pharmacotherapy treatment overall, Indigenous clients were more likely to be treated with methadone (54%) than non-Indigenous pharmacotherapy clients (41%).

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), or through illicit means. From 1 February 2018, all formerly over-the-counter (non-prescription) codeine-containing medicines for pain relief, cough and colds became available by prescription only.

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 (39% of clients in 2018).

Nationally in 2018, 37% of clients reported heroin as their opioid drug of dependence. Oxycodone (6%) was the next most commonly reported drug of dependence followed by codeine (5%), morphine, methadone and buprenorphine (all 4%).

For the 61% of clients with a reported opioid drug of dependence, heroin was the most commonly reported drug of dependence (60%) followed by oxycodone and codeine (9% and 8% respectively). High rates of ‘Not reported’ were shown in New South Wales (65%), Victoria and the Australian Capital Territory (32% and 31% respectively).

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

Just over two-thirds (62%) of clients were treated with methadone in 2018 and the remaining 38% were treated with buprenorphine, either alone or in combination with naloxone.

From 2009 to 2018, treatment with:

  • methadone fell (from 70% of clients to 62%)
  • buprenorphine rose slightly (from 14% of clients to 16%), and
  • buprenorphine-naloxone increased (from 16% of clients to 22%).

Previous trend data has shown that buprenorphine-naloxone prescription is replacing buprenorphine prescription. 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 2018, methadone was the most common pharmacotherapy drug in all jurisdictions except for Queensland and the Northern Territory where buprenorphine-naloxone was the most common pharmacotherapy drug with 47% and 71% of clients respectively being treated with buprenorphine-naloxone. Buprenorphine-naloxone is the default treatment drug for the main pharmacotherapy program in the Northern Territory. Treatment with methadone ranged from 20% of clients in the Northern Territory to 77% of clients in the Australian Capital Territory (Figure C5).

Note: NSW reports ‘buprenorphine-naloxone’ as ‘buprenorphine’. When New South Wales data are excluded, in the rest of Australia 58% of clients received methadone, 5% received buprenorphine, and 38% received buprenorphine naloxone.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 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 (57%) were classed as ongoing (Figure C6).

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

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 collection. Data table [Table S11].

References:

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.

DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH. Viewed 18 January 2019.

Moon, C. (2018). Northern Territory Drug Trends 2017. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trends Series No. 188. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.