Opioid pharmacotherapy prescribers

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

Number and type of prescribers

On the snapshot day in 2018, there were 3,168 authorised prescribers of opioid pharmacotherapy drugs (Table S15).

Just over two-thirds (68%) of prescribers were authorised to prescribe more than one type of drug. A further 14% were authorised to prescribe buprenorphine-naloxone only, and 10% were authorised to prescribe methadone only. The remaining 7% were located in New South Wales and Victoria and were authorised to prescribe buprenorphine only; however, NSW reported both buprenorphine and buprenorphine-naloxone as ‘buprenorphine only’ (Figure P1).

All prescribers in Queensland, Western Australia and the Australian Capital Territory were registered to prescribe more than one type of drug in 2018 (Table S16).

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

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 collection. Data table [Table S16].

Most prescribers worked in the private sector

The majority of prescribers worked in the private sector (84%) 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, 2018

Prescriber type

NSW

Vic

Qld

WA

SA

Tas

ACT

NT

Total

Public prescriber

220

93

20

35

10

6

6

390

Private prescriber

644

1,500

113

87

232

22

55

2

2,655

Public/private prescriber

2

1

3

Correctional facility

38

12

7

17

     7

2

6

1

90

Total

902

1,512

243

124

274

36

68

9

3,168

Notes:

— Nil or rounded to zero.

  1. The states and territories have different guidelines and policies regarding training and registration to prescribe opioid pharmacotherapy types. Refer to the Technical notes for more information.
  2. The Qld total includes 30 prescribers who have a prescriber type of 'Not stated'.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 collection. Data table [Table S15].

Victoria had the highest proportion of private prescribers (99%), followed by South Australia with 85%. The Northern Territory had the highest proportion of public prescribers (67%), followed by Queensland with 38%.

Of the 50,597 clients receiving pharmacotherapy treatment in Australia on a snapshot day in 2018, 67% received treatment from a private prescriber, 27% 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 2014 and 2018, the number of clients per prescriber decreased in all jurisdictions. In relative terms, the Northern Territory had the largest decrease (from 26 to 16 clients per prescriber). Between 2017 and 2018, the number of clients per prescriber remained relatively steady in most jurisdictions, (Figure P2).

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 2018, 170 prescribers registered under the MATOD-SOSP treated a total of 276 clients, while the remaining 104 prescribers treated a total of 2,867 clients.

Source: National opioid pharmacotherapy statistics annual data (NOPSAD) 2018 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). Overall, in 2018, Queensland had the highest number of clients per prescriber (28), while Victoria had the lowest (10).

Client to prescriber ratios in both the private and public sectors remained stable between 2017 and 2018 (13 and 34 clients per prescriber respectively).

The Australian Capital Territory had the highest ratio of clients to prescribers in the public sector (80) followed by Western Australia (65). Queensland had the highest ratio of clients to prescribers in the private sector (30). Private prescribers had a lower average number of clients than public prescribers in all jurisdictions except Victoria (where there were no public prescribers) and Tasmania.

Nationally, prescribers working in correctional facilities had an average of 38 clients, but at a state and territory level this varied widely, from 7 clients per prescriber in Tasmania to 70 in Victoria (Table S22).

The majority (46%) 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 from 15% in Queensland to 76% in South Australia. Twenty-six per cent of prescribers were not treating any clients on the snapshot day (Table S19).

Treatment varies between sectors

In 2018, methadone was the most commonly prescribed drug across all sectors (Table S12). However, prescribers in correctional facilities were far more likely to prescribe methadone (86% of clients) when compared with private (63%) and public prescribers (57%). Private prescribers were more likely to prescribe buprenorphine-naloxone (24%) compared with public (22%) and correctional facility (4%) prescribers. Given that clients prescribed buprenorphine-naloxone in New South Wales are reported as receiving buprenorphine, the proportion of clients receiving buprenorphine-naloxone nationally is likely to be an underestimate.

Based on 2018 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.