Technical notes

Acknowledgments

The contributions, comments and advice of the NOPSAD collection Working Group are gratefully acknowledged.

The Australian Government Department of Health provided funding for this report.

Thanks are extended to the data managers and staff in the following departments:

  • Department of Health, Australian Government
  • Ministry of Health, New South Wales
  • Department of Health and Human Services, Victoria
  • Department of Health, Queensland
  • Department of Health, Western Australia
  • Department for Health and Ageing, South Australia
  • Department of Health and Human Services, Tasmania
  • Health Directorate, Australian Capital Territory
  • Department of Health, Northern Territory.

Age

Age is calculated as at 30 June of the collection year.

Agency remoteness area

Dosing points have been classified according to their remoteness area (RA) as defined by the Australian Statistical Geography Standard (ASGS) Remoteness Structure (ABS 2012). This structure allows areas that share common characteristics of remoteness to be classified into broad geographic regions of Australia. These areas are:

  • Major cities
  • Inner regional
  • Outer regional
  • Remote
  • Very remote.

The Remoteness Structure divides each state and territory into several regions on the basis of their relative access to services.

Examples of places that are considered Major cities in the ASGS classification include Sydney, Canberra and Newcastle. Hobart and Bendigo are Inner regional areas and Cairns and Darwin are Outer regional areas. Katherine and Mount Isa are Remote areas and Tennant Creek and Meekatharra are Very remote.

Using this classification, dosing points were assigned to an RA based on their recorded Statistical Areas Level 2 (SA2) code.

Some SAs are split between multiple remoteness areas. Where this was the case, the data were weighted according to the proportion of the population of the SA2 in each remoteness area.

Average annual rates of change

The average annual rates of change or growth rates have been calculated as geometric rates:

Average rate of change = ((Pn/Po)^(1/n) -1) x 100

where:

Pn= value in the later time period

Po= value in the earlier time period

n = number of years between the 2 time periods.

Confidentiality

The Australian Institute of Health and Welfare (AIHW) has strict confidentiality policies which have their basis in section 29 of the Australian Institute of Health and Welfare Act 1987 (the AIHW Act) and the Privacy Act 1988 (the Privacy Act). Cells in supplementary tables may be suppressed for either confidentiality reasons or where estimates are based on small numbers, resulting in low reliability. Information that results in attribute disclosure will be suppressed unless agreement from the particular data provider to publish the data has been reached. Information on the AIHW's Privacy policy is available on the privacy page.

Population estimates used for rates calculations

All rates in this report, including historical rates, have been calculated using population estimates based on the 2011 Census. All Indigenous rates in this report are calculated using the Indigenous population estimates and projections, based on the 2011 Census.

Population rates

Crude rates are calculated using the Australian Bureau of Statistics estimated resident population (ERP) as at 30 June of each collection year. Rates for 2018 data were calculated using the preliminary ERP at 30 June 2018, with the exception of remoteness rates which were calculated using the preliminary ERP at 30 June 2017.

Trends

Trend data may differ from data published in previous versions of National opioid statistics in Australia due to data revisions.

National opioid pharmacotherapy statistics 2018 glossary

Concept

Definition

Buprenorphine (Subutex®)

Buprenorphine acts in a similar way to methadone, but is longer lasting and may be taken daily or every second or third day. Two buprenorphine preparations are registered in Australia for the treatment of opioid dependence: a product containing buprenorphine only, and a combined product containing buprenorphine and naloxone. The buprenorphine only product is available as a tablet containing buprenorphine hydrochloride that is administered sublingually (by dissolving under the tongue) (DoH 2014).

Buprenorphine-naloxone (Suboxone®)

The combination buprenorphine-naloxone product is a sublingual tablet or film containing buprenorphine hydrochloride and naloxone hydrochloride (DoH 2014). It is recommended that buprenorphine-naloxone should be prescribed in preference to buprenorphine for most clients (DoH 2014). This is because, when taken as intended by dissolving the tablet or film under the tongue, the combined product acts as if it was buprenorphine alone. However, if the combined product is injected, naloxone can block the effects of buprenorphine and increases opioid withdrawal symptoms. This reduces the risk that those receiving buprenorphine naloxone as a takeaway dose will inject it or sell it to others to inject (Chapleo CB & Walter DS 1997), (DoH 2014), (Dunlop A 2007)

client

A person registered as receiving opioid pharmacotherapy treatment on the snapshot day.

correctional facility prescribers

Prescribers who work in prisons or other correctional services.

dosing point site

A place at which a client is provided a pharmacotherapy drug. Sites include public and private clinics (such as methadone clinics), pharmacies, correctional facilities, hospitals (admitted patients and outpatients) and other locations such as community health centres and doctors’ surgeries.

Methadone (Methadone Syrup®, Biodone Forte®)

A synthetic opioid used to treat heroin and other opioid dependence. It reduces opioid withdrawal symptoms, the desire to take opioids and the euphoric effect when opioids are used. It is taken orally on a daily basis (DoH 2014).

prescriber

A prescriber who held an authority to prescribe a pharmacotherapy drug and who has not been recorded as ceasing this authority before the snapshot day. Refer to the Table T1 for information about the counting of prescribers for each state and territory.

prescriber type

The sector (public or private) in which the prescriber is practising when prescribing pharmacotherapy drugs.

private prescribers

Prescribers who work in organisations that are not controlled by government, such as private general practice clinics.

public prescribers

Prescribers who work in organisations that are part of government or are government controlled, such as public drug and alcohol clinics and public hospitals.

Schedule 4 drug

Prescription only medicine—substances, the use or supply of which, should be by, or on the order of, persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.

Schedule 8 drug

A controlled drug—substances which should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence. Methadone and buprenorphine are examples of Schedule 8 drugs.

specified or snapshot day

A particular day, usually in June each year, on which clients are counted for the NOPSAD collection. The snapshot day varies between states and territories, but allows the number of clients to be estimated at a single point in time. Refer to the Table T2 for information about the use of the snapshot day for each state and territory.

Data collection by states and territories

State and territory governments use different methods to collect data about the clients, prescribers and dosing points associated with the opioid pharmacotherapy system. These methods are driven by differences between the states and territories in relation to legislation, information technology systems and resources. Caution should be taken when comparing one state or territory with another. Information on these differences is detailed in the following tables:

Table T1: Administrative features of the NOPSAD collection in each state and territory

State/territory

Administrative features

New South Wales

Treatment for a client under the NSW Opioid Treatment Program (OTP) must be initiated by an accredited OTP prescriber. A NSW medical practitioner who has not received accreditation as a NSW OTP prescriber may be authorised by the Ministry of Health to prescribe methadone for up to ten (10) low-risk patients who are being transferred from an accredited prescriber. Unaccredited medical practitioners cannot initiate patients on methadone. With buprenorphine or buprenorphine-naloxone, unaccredited medical practitioners may be authorised to initiate up to twenty (20) buprenorphine or buprenorphine-naloxone patients. The total number of patients that an unaccredited prescriber may obtain authority to prescribe for, at any one time, is thirty (30) with a maximum of 10 of these patients being for methadone. To participate in the NSW OTP, community pharmacies must register with the Ministry of Health and comply with the protocol for community pharmacy dosing points issued by the Ministry.

Victoria

The Victorian pharmacotherapy system is essentially community‑based, other than inpatients in hospitals and in prisons. Although a small number of services receive government funding, services are independent bodies and the government does not manage them directly.

Since the release of the 2013 policy, general practitioners have been able to prescribe buprenorphine‑naloxone for up to 5 patients without the need to attend specific training (Vic Health 2013). Victoria’s Policy for maintenance pharmacotherapy for opioid dependence was revised in 2016.

Queensland

The Queensland Opioid Treatment Program is essentially community based, other than for inpatients in hospitals and correctional facilities. Prescribers attend training provided by Medicines Regulation and Quality Unit (Queensland Department of Health) and the Chief Executive Officer provides authorisation to commence prescribing on successful completion of the training program. Prescriber training is provided for all pharmacotherapies currently available.

Western Australia

The Western Australian pharmacotherapy program is community‑based, other than inpatients in hospitals, prisons and the public clinic. Prescribers attend training provided by the Mental Health Commission (MHC) and the Chief Executive Officer of Health provides authorisation under the Medicines and Poisons Regulations 2016, the legislative instrument. Prescriber training is provided for all pharmacotherapies currently available and now includes prescriber training for practitioners wishing to prescribe Suboxone® to up to 5 patients.

Community pharmacies are authorised to participate in the Community Program for Opioid Pharmacotherapy (CPOP). The Pharmacist with overall responsibility is required to ensure that all pharmacists dosing clients have completed the pharmacist online training module on the MHC website.

South Australia

In 2011 a program to allow any medical practitioner to prescribe buprenorphine-naloxone film for up to 5 patients for the treatment of opioid drug dependence was introduced. This program is known as the Suboxone® Opioid Substitution Program (SOSP). Authorities granted by the Drugs of Dependence Unit are still required to be held before starting treatment with buprenorphine-naloxone, and the usual program rules for all pharmacotherapy programs remain in force. Buprenorphine-naloxone film is the only drug option authorised for this program. A prescriber can treat up to 5 patients with buprenorphine-naloxone film before having to undertake accreditation by Drug and Alcohol Services South Australia and formal approval by the Drugs of Dependence Unit to be an accredited prescriber via the Opioid Dependence Substitution Program (ODSP). A prescriber cannot provide treatment with buprenorphine alone or methadone liquid without first being accredited.

Tasmania

In Tasmania, pharmacotherapy training is provided separately for each pharmacotherapy drug.

Australian Capital Territory

All pharmacists are required to attend training in ‘Risk Management of the Process of Dosing Opioid Dependent Consumers’ before they start dosing clients. The Canberra Hospital Pharmacy Services conducts this training.

Northern Territory

All opioid substitution treatment prescribers are required to undergo pharmacotherapy training. Accredited prescribers must complete an ‘Application for authority to prescribe a restricted Schedule 8 substance for the treatment of addiction’ for each and submit the form to the Department of Health, Medicines and Poisons Control.  The application information is recorded in the Drug Monitoring System database. The prescriber is not permitted to prescribe until they receive a signed authorisation document. The prescriber must notify Medicines and Poisons Control within 14 days of cessation of treatment.

Table T2: Methodological issues of note for the NOPSAD collection in each state and territory 

State/territory

Methodological issues

National

While the standard snapshot day is set in June of any given year, it varies between states and territories. Despite this variance, it allows the number of clients to be estimated at a single point in time. Data collected for a snapshot day are likely to result in an underestimate of total clients receiving pharmacotherapy within a year. In general, all clients receiving their pharmacotherapy dose in person on the snapshot day are counted.

New South Wales

The NSW Electronic Recording and Reporting of Controlled Drugs (ERRCD) system is used in the administration of the New South Wales Opioid Treatment Program. It replaced the legacy Pharmaceutical Drugs of Addiction System (PHDAS) in September 2016. The ERRCD system is used to record authorisations to prescribe as part of the New South Wales Opioid Treatment Program. It also records client admissions to, and exits from, treatment, as well as details of prescribers and dosing points. For these reasons, the ERRCD system is characterised by continual fluctuations and data extracted at different times for the same period may not be the same. However, while delays in reporting entries to the program, exits from the program and changes in the status of dosing points cause short-term fluctuations in the database, these flatten out over time.

Clients prescribed buprenorphine-naloxone are counted under ‘buprenorphine’.

Similarly, New South Wales data collection does not differentiate between prescribers who are authorised to prescribe buprenorphine and those authorised to prescribe buprenorphine-naloxone.

Data on prescribers refer to prescribers who were treating at least 1 client on the snapshot day.

Data on dosing point sites relate to sites that had at least 1 client receiving treatment on the snapshot day.

Client data are reported in New South Wales as at 30 June.

Victoria

Data are collected from 2 sources: a yearly census of pharmacists who are requested to report the actual number of clients being dosed on a snapshot day, and the permit database, which records information about prescribers authorised to prescribe pharmacotherapy drugs, as well as demographic information about clients accessing pharmacotherapy treatment. These 2 data sources cannot be linked.

The number of clients receiving pharmacotherapy treatment is reported on a snapshot day in June.

The number of prescribers in Victoria is determined by adding the number of prescribers registered for that year to the number of existing prescribers.

Victoria has commenced reporting of age and sex data by individual pharmacotherapy drug type. Prior to 2013, Victoria estimated these data.

Victoria has commenced collecting the Indigenous status of clients. Data for 2016 to 2018 included Indigenous status for totals.

Client data are reported in Victoria on a snapshot day in June.

Queensland

Data are collected monthly from pharmacists and entered into a central database that Medicines Regulation and Quality manages. Data are also collected from administrative ‘Admission’ and ‘Discharge’ forms. Queensland totals may vary slightly due to these data source differences. For example, a client may be counted as registered and having received a dose on the snapshot day, but a dosing point cannot be assigned because the dose consumed on that day was a takeaway dose.

The total number of prescribers for Queensland includes those from private practice, public clinics, correctional facilities and government medical offices.

Client data are reported in Queensland on a snapshot day in June.

Western Australia

Data are collected from the monthly reports received from pharmacies and other dosing sites authorised to participate in the Community Program for Opioid Pharmacotherapy (CPOP). The dosing data are entered into the Medicines and Poisons Regulation Branch’s Monitoring of Drugs of Dependence System (MODDS) database. Data are also collected from the ‘Application for authority’, ‘Authority to prescribe’ and ‘Termination of treatment’ forms. The number of clients receiving pharmacotherapy treatment is reported through the month of June.

The total number of prescribers usually includes those treating at least 1 client as at 30 June 2018 in private practice, public clinics and correctional facilities.

In Western Australia, data relating to the Indigenous status of clients is now being collected from new ‘Application to prescribe opioid substitution treatment’ forms but not at the time of renewal for patients continuing in treatment.

Client data are usually reported in Western Australia for the entire month of June. Specifically, pharmacies supply information at the end of June relating to the last dose supplied to the patient for the month of June. If a patient changes pharmacies mid-month, it is possible that they appear on more than 1 pharmacy’s monthly transaction reports and are counted more than once.

Before 2005, Western Australia reported clients over a year.

South Australia

Data are collected from the forms ‘Application for authority’, ‘Termination of treatment’ and ‘Request for additional methadone/buprenorphine takeaway’, which are entered into a central database system at the Drugs of Dependence Unit, SA Health. Information from dispensed prescriptions is also collected electronically from the majority of pharmacies on a monthly basis by the Drugs of Dependence Unit.

From 2011, data have been collected via a half-yearly survey that pharmacists completed and reported on a snapshot day in June. From 2014, this survey has been conducted annually. Other data are drawn from the Drugs of Dependence Unit’s Drugs of Misuse Surveillance System and are about those clients registered for treatment on the snapshot day (but who may not actually receive treatment on that day).

Clients who did not enter a dosing point on the snapshot day are reported as ‘other’ when describing clients by dosing point site.

All tables include Opioid Dependence Substitution Program (ODSP) and Suboxone® Opioid Substitution Program (SOSP) clients and prescribers.

In South Australia, data relating to prescribers refer to prescribers who were treating at least 1 client on the snapshot day.

Tasmania

Data are collected monthly from all pharmacies participating in the Tasmanian Opioid Pharmacotherapy Program (TOPP), and entered into the Drugs and Poisons Information System (DAPIS). This system is administered by the Pharmaceutical Services Branch (PSB) and manages client registration, dosing activity, dosing sites, authority to prescribe and dispensing information relating to drugs of high abuse potential. The system also makes available limited information to relevant medical practitioners and pharmacists, both within and external to the Department to assist safe treatment of patients requiring drugs of a high abuse potential.

Data from DAPIS are made available for management style reporting from a Qlikview-based intranet dashboard.

Client data in Tasmania are reported from a snapshot for the month of June. However, clients are counted only once—if they change dosing point site during the month, the dosing point site that administered the greater number of doses is attributed the activity.

Data on prescribers refer to prescribers who were treating at least 1 client during the month of June.

Data on dosing points refer to dosing points that had a client receiving treatment during the month of June.

Australian Capital Territory

Client participation data are collected manually from the Health Directorate’s Alcohol and Drug Services spreadsheets and from Medication Administration Chart (MAC) Sheets which the community pharmacies provide every month. Client participation data are also collected via iDose which is an in-house database that contains client dosing information in real time. General practitioner and pharmacy participation data are also collated from the MAC Sheets.

Client data are reported on clients receiving treatment in the Australian Capital Territory on a snapshot day in June.

Northern Territory

Data are generated from the current active authorisations in the Drug Monitoring System database on the snapshot day in June. The data are audited against current Schedule 8 prescription data also within the database.

Table T3: Policies and guidelines for opioid pharmacotherapy 

State/territory

Policies and guidelines [check links]

National

New South Wales

Victoria

Queensland

Western Australia

South Australia

Tasmania

Australian Capital Territory

Northern Territory

Table T4: History of data reported for the NOPSAD collection, 2005 to 2018

Table T4 (256 KB XLS)

References

ABS (Australian Bureau of Statistics) 2012. The ASGC remoteness structure. Canberra: ABS. Viewed 6 March 2019.

Chapleo CB & Walter DS 1997. The buprenorphine naloxone combination product. Research and Clinical Forums
19(2):55–8.

DoH (Department of Health) 2014. National guidelines for medication-assisted treatment of opioid dependence. Canberra: DoH. Viewed 6 March 2019.

Dunlop A 2007. From Subutex to Suboxone: the Australian experience. Viewed 19 February 2018.