Notes

  • Technical notes 06 Apr 2016

    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 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 (AIHW Act) and the Privacy Act 1988 (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 AIHW's Privacy policy is available at Privacy of data.

    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 2015 data were calculated using the preliminary ERP at 30 June 2015, with the exception of remoteness rates, which were calculated using the preliminary ERP at 30 June 2014.

    Trends

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

    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 Non-accredited/approved medical practitioners may prescribe for up to 5 clinically stable patients; but they cannot induct a person onto treatment. Medical practitioners who manage up to 5 patients do not require an approval to prescribe drugs of addiction under Section 28A of the Poisons and Therapeutic Goods Act 1966 (NSW) and are not required to complete pharmacotherapy training.
    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 2013, general practitioners can prescribe buprenorphine‑naloxone for up to 5 patients without the need to attend specific training (Vic Health 2013). In addition, changes have been made to allow greater flexibility for prescribers to make collaborative decisions with pharmacists regarding takeaway pharmacotherapy doses. The takeaway doses policy is currently under review.
    Queensland The Queensland Opioid Treatment Program is essentially community based, other than 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 Poisons Regulations 1965, the legislative instrument. Prescriber training is provided for all pharmacotherapies currently available.

    Community pharmacies are authorised to participate in the Community Program for Opioid Pharmacotherapy (CPOP). The licence holder is responsible for ensuring 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 Principal Pharmacist within the Health Directorate's Alcohol and Drug Service conducts this training.
    Northern Territory Accredited prescribers complete an 'Application for authority to prescribe a restricted Schedule 8 substance for the treatment of addiction' and submit the form with a photograph of the client to the Department of Health, Medicines and Poisons Control. A contract between the client, prescriber and supplying pharmacy is also required for all applications for maintenance treatments. 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; however, not all states/territories are able to count clients receiving a takeaway dose on the snapshot day.
    New South Wales The Pharmaceutical Drugs of Addiction System (PHDAS) is used primarily in the administration of the New South Wales Opioid Treatment Program. The database is used to record the authorisation of doctors to prescribe as part of the New South Wales Opioid Treatment Program. The PHDAS also records client admissions to, and exits from, treatment, as well as details of approved prescribers and dosing points. For these reasons, the PHDAS 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 the course of a full year.

    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 relating to prescribers refer to active prescribers only.

    In New South Wales approved and accredited prescribers can prescribe both methadone and buprenorphine (including buprenorphine-naloxone). The numbers provided in Table S15 for New South Wales represent the type of drugs prescribed by active prescribers on 30 June rather than the number of prescribers approved to prescribe each drug type.

    Data on dosing point sites relate to sites that were dosing at least 1 client as at 30 June 2015.

    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 July.

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

    In 2015, data were not provided for age and sex by individual pharmacotherapy drug type. Age and sex data for all pharmacotherapy drugs (combined) were provided. Prior to 2013, Victoria estimated these data.

    In Victoria, data relating to the Indigenous status of clients are not available.

    Client data are reported in Victoria on a snapshot day in July.
    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 Pharmaceutical Services 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 includes those treating at least 1 client as at 30 June 2015 in private practice, public clinics and correctional facilities.

    In Western Australia, data relating to the Indigenous status of clients are not available. Progress has been made towards collecting Indigenous status but it is unlikely to be available in the near future.

    Client data are 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 active prescribers only.
    Tasmania Dosing data are collected monthly from all pharmacies participating in the Tasmanian Opioid Pharmacotherapy Program (TOPP). The data is housed in the Drug and Poisons Information System (DAPIS) which is managed by the Pharmaceutical Services Branch (PSB). The system manages client registration, dosing activity, 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 requesting/requiring drugs of a high abuse potential.

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

    For the NOPSAD collection, Tasmania provides data using the following methodology:
    • Client dosing data is derived from a snapshot for the month of June. However, clients are counted only once—if they change pharmacies during the month, the pharmacy that administered the greater number of doses is attributed the activity.
    • Active prescriber totals are determined from the June snapshot.
    • Dosing location totals are determined from the June snapshot.
    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 active clients 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
    National
    New South Wales
    Victoria
    Queensland
    Western Australia
    South Australia

    The following documents are available via the SA Opioid Dependence Substitution Program:

    Tasmania
    Australian Capital Territory
    Northern Territory
    • Code of Practice: Schedule 8 Substances

    Table T4: History of data reported for the NOPSAD collection, 2005 to 2015

  • Acknowledgments 06 Apr 2016

    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.
  • Glossary 06 Apr 2016

    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 & Walter 1997; DoH 2014; Dunlop 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 at least 1 client is provided a pharmacotherapy drug on the snapshot day. 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 registered prescriber who is accredited and/or authorised to prescribe a pharmacotherapy drug and who has not been recorded as ceasing this registration before the snapshot day. More specifically, prescribers are included in the count if they are registered or active prescribers, that is, prescribers who are scripting at least 1 client during the reporting period (that is, each financial year).
    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. See the Technical notes for information about the use of the snapshot day for each state and territory.