Most people (80 per cent) in opioid agonist treatment in New South Wales are managed by a small amount (20 per cent) of mature prescribers, which poses a serious weakness in the health system says new report.

The report by researchers at the National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, highlights the vulnerability of the health system which has a high volume of OAT patients, managed by a small number of prescribers that have been prescribing for over 17 years.

Lead author, Nicola Jones said, “The findings are concerning as a large and growing population of opioid dependent people are also being treated by this low number of prescribers.”

The report examined all people in NSW who were prescribed OAT between 2001 – 2018 (approx. 48,000), and clinicians who prescribe OAT (approx. 2000).

“Reducing future reliance on a narrow band of experienced practitioners while incorporating an appropriate system of training, support and succession planning to meet the needs of the growing client population requires assessment,” said Ms Jones.

The report states that growing the number of mid-volume prescribers would increase the robustness of the system, relieving the reliance on a small number of high-volume prescribers, as well as providing the client with more choice.

“There could be an opportunity to look further into the impact on treatment retention when a prescriber ceases to prescribe, as this would be considered a high risk event,” said Ms. Jones.

OAT is the most effective treatment for opioid dependence with methadone, a full opioid agonist, and buprenorphine, a partial opioid agonist, being the most used medications.

“The risk of death is halved while on OAT as compared to out-of-treatment, survival benefits increase with cumulative exposure to treatment, and the risk of overdose death is reduced by 70 per cent,” said Ms Jones.

“Risks of HIV and hepatitis C acquisition also halved and hospitalisations and emergency department presentations are also significantly reduced when people are retained in treatment.”

The report also found that between 2001 and 2017, the percentage of OAT prescribers ceasing to prescribe increased four-fold from three per cent (n = 14) to 12 per cent (n = 126), an overall average across the period of 10 per cent.

“Most (47 per cent) of prescribers are working in private practices, over time this group has seen the largest growth which makes OAT more accessible, in more recent years, the retention of this group has declined,” Ms Jones said.

“There are several barriers to prescribing in the community; remuneration, stigma and the potential requirement of the support of other services to name a few.  Addressing these barriers should help retain and grow the accessibility of OAT in the community.”  

“These findings are relevant internationally, especially for those countries such as the US and Canada who are expanding the provision of OAT into primary care settings.”

You can read the full report online here.