State and territory data quality

COVID-19 impacts

In March 2020, a series of measures were put in place across Australia to reduce the transmission of COVID-19 (Department of Health 2020). These included social distancing and hygiene measures, isolation measures for those with COVID-19 or close contacts, and the shutdown of non-essential businesses, public gatherings and travel. Many of these restrictions continued into 2021 and 2022.

In response to these restrictions, jurisdictions made changes to opioid pharmacotherapy treatment guidelines and regulations to support flexible treatment delivery and maintain the health and safety of patients and prescribers. Implementation of amended guidelines and regulations varied across jurisdictions. Changes to pharmacotherapy treatment in the context of COVID-19 included:

  • extending prescription duration 
  • increasing the number of takeaway doses 
  • arranging home delivery of medication, including third party collections for clients who may require self-isolation
  • a transition to online training and education for pharmacists on administering opioid pharmacotherapy treatment
  • the commencement of buprenorphine LAI under online supervision (with dosing administered in person at a pharmacy)
  • alleviating permit requirements for doctors taking over scripts for other doctors.

There was little change in dosing trends between 2021 and 2022 due to COVID-19 related restrictions. However, the following applied for 2022:

  • New South Wales and Victoria were impacted by issues with workforce shortages and capacity across all healthcare settings.
  • South Australia continued to show an increase in buprenorphine LAI uptake, resulting in decreased need to present for treatment.
  • Western Australia continued to provide the option of third-party pickups for those clients in isolation.
  • The Australian Capital Territory continued to provide the option of home delivery until mid-December 2022.

Administrative features and policy context

Opioid pharmacotherapy treatment is administered according to the law of the relevant state or territory, and within a framework that includes medical, social and psychological treatment. The Australian Government has released national guidelines for medication-assisted treatment of opioid dependence, but individual policies differ between states and territories. This has resulted in differences in administrative features of the NOPSAD collection across states and territories. See Table T1 for jurisdictional features and policy documents.

Table T1: Administrative features of the NOPSAD collection by state and territory
State/territoryAdministrative features

New South Wales

To enrol a patient on the NSW Opioid Treatment Program (OTP), authorisation from the NSW Ministry of Health is required. 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) 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 or prescribe for 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. Accredited nurse practitioners can prescribe methadone, buprenorphine and buprenorphine-naloxone under the OTP. 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.

For more information, see:

Victoria

The Victorian Pharmacotherapy Program is a community-based system of Medical Practitioners, Nurse Practitioners (with relevant notation) and Pharmacists. Permits are issued by the Department of Health under the Drugs, Poisons and Controlled Substances Regulations 2017. 

Medically Assisted Treatment for Opioid Dependence (MATOD) training is recommended for all pharmacotherapy practitioners. A practitioner is authorised to prescribe Buprenorphine/Naloxone and Long-Acting Injectable Buprenorphine (LAIB) for up to 10 patients without undergoing MATOD training. Approval from the Department of Health is required for more than 10 patients. 

SafeScript, introduced in April 2020, is a mandatory recording system for all General Practitioners and Pharmacists that monitors most drugs of dependence, including all Schedule 8 medicines such as Buprenorphine. 

For more information, see:

Queensland

The Queensland Opioid Treatment Program is essentially community based, other than for inpatients in hospitals and correctional facilities.  Prescribers undertake training provided by Queensland Health, and the Department provides approval to commence prescribing on successful completion of the training program. Prescriber training is provided for all pharmacotherapies currently available.

No approval is required for community pharmacies to supply opioid treatment drugs, as this is within the endorsement of registered pharmacists.

For more information, see Queensland Opioid Treatment Program | Queensland Health.

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 includes online training modules for practitioners wishing to prescribe Suboxone® to up to 5 patients or practitioners requiring addition of depot buprenorphine formulations to a current accreditation.

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 relevant pharmacist online training module on the MHC website (general pharmacist and depot buprenorphine online training modules are available).

For more information, see:

South Australia

All medical practitioners and nurse practitioners (within their scope of practice) can prescribe buprenorphine-naloxone film to treat opioid drug dependence for up to 10 patients, without completing specialised MATOD training. A medical practitioner must become accredited to treat more than 10 patients or to prescribe methadone liquid or buprenorphine as a single agent.  Authorisation under the Controlled Substances Act 1984 must be obtained prior to prescribing any pharmacotherapy to treat opioid drug dependence.

For more information, see Medication assisted treatment for opioid dependence (MATOD).

Tasmania

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

For more information, see Tasmanian Opioid Pharmacotherapy Policy and Clinical Practice Standards.

Australian Capital Territory

All pharmacists are required to attend training in ‘Treatment of Opioid Dependence for General Practitioners, Pharmacists and Health Professionals’ before they start dosing clients. Canberra Health Services Pharmacy in collaboration with Alcohol & Drug Services conducts this training. 

For more information, see Opioid Maintenance Treatment in the ACT: Local Policies and Procedures.

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 Northern Territory Health, Medicines and Poisons.  The application information is recorded in NTScript. The prescriber is not permitted to prescribe until they receive a signed authorisation document. The prescriber must notify Medicines and Poisons within 14 days of cessation of treatment. 

For more information, see Medical practitioners and schedule 8 medicines.

Methodological issues

There are several methodological issues at the national and state and territory level. 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. Other methodological issues are outlined in Table T2.

Table T2: Methodological issues for the NOPSAD collection by state and territory
State/territoryMethodological issues

New South Wales

The SafeScript NSW system is used in the administration of the New South Wales Opioid Treatment Program. It replaced the legacy Electronic Recording and Reporting of Controlled Drugs system in May 2023. The ERRCD system is used to record authorisations (or ‘approvals’)  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 SafeScript NSW 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.

Data relating to prescribed buprenorphine-naloxone and buprenorphine LAI are based on the drug (formulation) nominated by the prescriber at the time of submitting an application for approval. The approval issued allows the prescriber to change to a different buprenorphine formulation at any time.

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

Victorian NOPSAD data is collected from 2 sources on the snapshot day of 30 June: a yearly census of Pharmacists and Correctional Facilities, who are requested to report the number and demographics of clients being dosed; and the permit database, Drugs and Poisons Information System (DAPIS), which records information about Medical Practitioners authorised to prescribe pharmacotherapy drugs, as well as demographic information about clients accessing pharmacotherapy treatment. 

In 2013, Victoria enhanced data reporting requirements to include detailed age and sex (gender) data by individual pharmacotherapy drug type. Enhancements have also been made to collect Indigenous identity of clients by individual pharmacotherapy drug type. From 2016 to 2018 totals for Indigenous status were reported.

Queensland

Dispensing records for opioid pharmacotherapy medicines are automatically collected via Queensland’s real-time prescription monitoring system, QScript (unless the medicine was dispensed in a public sector hospital). 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 considered in treatment on the snapshot day, but a dosing point might not be able to be assigned because the client was not actually dosing. The total number of prescribers for Queensland includes those from private practice, public clinics andcorrectional facilities. Client data are reported in Queensland on a snapshot day in June. 

Data for Queensland were not available for 2021. See ‘Data coverage’ for more information.

Western Australia

Data for Western Australia were not available for 2023. See ‘Data coverage’ for more information.

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 Electronic Recording and Reporting of Controlled Drugs (ERRCD) 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 ‘Authority Application MATOD Program (Medication Assisted Treatment for Opioid Dependence) form, which are manually entered into a central database system at the Drugs of Dependence Unit (DDU), SA Health. As of 1 July 2021 prescribers may also submit this information directly into the central database via the ScriptCheckSA Health Practitioner portal.  Since 1 November 2020, both the prescribing data and the information from dispensed prescriptions is collected electronically in real time.

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 DDU database 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.

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 potential for harm. 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 that are highly addictive.

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 via Canberra Health Services, Alcohol and Drug Services’ program spreadsheets, and from Medication Administration Chart (MAC) Sheets which the community pharmacies submit each month. Client participation data are also collected via iDose which is a Canberra Health Service and Justice Health database that contains client dosing information in real time. General practitioner and pharmacy participation data are also collated from the MAC Sheets.

Client data is 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 NTScript on the snapshot day in June. The data are audited against current Schedule 8 prescription data also within NTScript.

History of NOPSAD data items

Collection of individual data items has varied nationally and by state or territory for the NOPSAD collection across the period 2005 to 2023. A summary of historical data items is provided in the data download below (Table T3).

Table T3: History of data reported for the NOPSAD collection, 2005 to 2023 (XLSX 23kB)

References

Department of Health (2020) Australian Health Protection Principal Committee (AHPPC) coronavirus (COVID-19) statement on 18 March 2020, Department of Health, accessed 12 January 2023.