Opioid medicines dispensing, all ages, from 2016–17 to 2020–21

This report examines opioid medicines dispensing in the community across Australia from 2016–17 to 2020–21. It reports trends at national, state and territory, Primary Health Network and local area levels, building on data in the Third Australian Atlas of Healthcare Variation.

Why is this important?

Opioid medicines are used to manage severe acute pain and cancer pain. They are not recommended for chronic non-cancer pain unless there are exceptional circumstances because there is evidence of little or no benefit, high potential for dependence and risk of harms.

Monitoring the use of opioid medicines in Australia is important because inappropriate prescribing and misuse can result in dependence, accidental overdose, poor treatment outcomes, hospitalisation or death.

What we found

There was an 18% reduction in opioid medicines dispensing rates nationally between 2016–17 and 2020–21, reversing the trend for the period 2013–14 to 2016–17 seen in the Third Australian Atlas of Healthcare Variation. There was a 30% reduction in the overall volume of opioid medicines dispensed.

The reduction in dispensing rates occurred despite all codeine-containing products becoming available on prescription only in February 2018 – a change that was expected to increase prescribing. Dispensing rates were generally higher in regional areas than in major cities or remote areas and rates increased in areas with socioeconomic disadvantage for each of the five years. There was little change in the magnitude of variation between 2016–17 and 2020–­21: the number of prescriptions dispensed was around five times higher in the area with the highest rate compared to the area with the lowest rate.

What has changed in the past five years?

National and state initiatives, including regulatory changes to reduce the amount of opioid medicines supplied on each prescription, changes in clinical practice, prescription monitoring and medication stewardship programs, and educational programs highlighting new ways to manage pain, are likely to have contributed to the decrease in opioid medicines use.

What more can be done?

Initiatives to further reduce the inappropriate use of opioid medicines include: building shared care between GPs and pain clinics; shared decision-making between prescribers and consumers; prescriber and consumer education; real time prescription monitoring and increased access to multidisciplinary care. Efforts to reduce use of opioid medicines for chronic non-cancer pain should ensure prescribers use evidence-based strategies for de-prescribing.

Interactive graphs and data

Data show variation in rates by geographic location of patient residence. To use the interactive maps and graphs:

  • Hover or click on maps and graphs for details of data points
  • Use the dropdown boxes at the bottom of graphs to select states and territories, SA3s or PHNs

Learn more about using the interactive Atlas

National, state and territory and local trends

National overview

State and territory rates across the years

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Consistently high or low local areas

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National overview

State and territory rates across the years

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Consistently high or low local areas

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Remoteness and socioeconomic status

Rates for 2020-21

Rates across the years

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Rates for 2020-21

Rates across the years

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Primary Health Network trends

PHN overview

PHN table

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Consistently high or low local areas by PHN

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PHN overview

PHN table

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Consistently high or low local areas by PHN

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Patient and volume trends

Patient rate

Volume (defined daily dose)

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Patient rate

Volume (defined daily dose)

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Technical resources

Technical note

Summary

This technical note accompanies the report: Opioid medicines dispensing all ages, 2016-17 to 2020-21 and builds on reporting in the Third Australian Atlas of Healthcare Variation. Information regarding data from 2013–14 to 2016–17 is available in the Technical Supplement for the third Atlas.

This time series report provides statistics identifying variation across Australia for opioid medicines dispensing for all ages, 2016–17 to 2020–21. Rates are presented by local areas using Statistical Area Level 3 (SA3) geography defined by the Australian Bureau of Statistics (ABS), as well as Primary Health Network (PHN) areas defined by the Australian Government Department of Health and Aged Care, at state and territory, and national levels.

About the data

Data are sourced from the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) database. The PBS and RPBS are the two main Australian Government subsidy schemes for medicines managed by the Department of Health and Aged Care and the Department of Veterans’ Affairs respectively. Both programs are administered by Services Australia.

The scheme is available to all Australian residents who hold a current Medicare card and overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement. Data are from claim records of prescriptions dispensed under the PBS or RPBS where either:

  • The Australian Government paid a subsidy, or
  • The prescription was dispensed at a price less than the relevant patient co-payment (under co-payment prescriptions) and did not attract a subsidy.

The PBS/RPBS data cover all prescriptions dispensed by approved suppliers, including community pharmacies, public and private hospital pharmacies, and dispensing doctors. 

Data exclusions:

The PBS /RPBS do not include:

  • Over-the-counter purchases (non-prescription)
  • Private prescriptions 
  • Medicines supplied to admitted patients in public hospitals (although discharge prescriptions dispensed in all states and territories except New South Wales and the Australian Capital Territory are included).

Patient characteristics (date of birth and sex) were sourced from the patient's Medicare enrolment details at date of supply as recorded in the PBS claim (extracted on 11 October 2021). Details were taken from the latest available claim record for each patient and applied for all that patient's records to ensure that each patient had unique characteristics for the whole period of analysis. Geographic analysis was based on the patient’s Medicare enrolment postcode at date of supply as recorded in the PBS claim, not the place of the prescriber or dispensing pharmacy. If the postcode could not be mapped to a SA3 using the concordance file, the postcode was replaced with the postcode of the dispensing pharmacy.

The previous extraction for opioid medicines dispensed in 2016–17 reported in the Third Australian Atlas of Healthcare Variation omitted prescriptions corresponding to PBS extemporaneous item 7530H (ATC R05DA) in error. This resulted in a 1% difference in the overall number of prescriptions dispensed during the reporting period, including 2016–17, compared with later extractions for this year.

In previous versions of the Atlas of Healthcare Variation, postcode 7001 Hobart PO Boxes has been mapped by the ABS to SA3 of either Hobart Inner or Central Highlands. Consistent with the treatment of other capital city PO Boxes, postcode 7001 has now been excluded from the SA3 and PHN level analysis but included in state/territory and national level analysis. This will result in a decrease in script volume for either Hobart Inner or Central Highlands from numbers reported in earlier versions.  

Defined daily dose

Number of defined daily doses (DDD) was calculated using the defined daily dose amounts 2021 sourced from the Department of Health. Defined daily dose (DDD) is the average maintenance dose per day for a medicine used for its main indication in adults, defined by the WHO. DDDs are assigned to medicines by the WHO Collaborating Centre for Drug Statistics Methodology. Using DDDs allows comparisons of medicine dispensing independent of price, preparation and quantity per prescription. Medicine dispensing expressed in DDDs per thousand people per day (DDDs/1,000/day) allows data for medicines with differing daily doses to be aggregated. However, the DDD is only a unit of measurement and does not necessarily reflect the recommended or average prescribed dose. DDDs are not established for all medicines. More information on DDD is available at https://www.who.int/tools/atc-ddd-toolkit

Data specifications

Technical note

Summary

This technical note accompanies the report: Opioid medicines dispensing all ages, 2016-17 to 2020-21 and builds on reporting in the Third Australian Atlas of Healthcare Variation. Information regarding data from 2013–14 to 2016–17 is available in the Technical Supplement for the third Atlas.

This time series report provides statistics identifying variation across Australia for opioid medicines dispensing for all ages, 2016–17 to 2020–21. Rates are presented by local areas using Statistical Area Level 3 (SA3) geography defined by the Australian Bureau of Statistics (ABS), as well as Primary Health Network (PHN) areas defined by the Australian Government Department of Health and Aged Care, at state and territory, and national levels.

About the data

Data are sourced from the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) database. The PBS and RPBS are the two main Australian Government subsidy schemes for medicines managed by the Department of Health and Aged Care and the Department of Veterans’ Affairs respectively. Both programs are administered by Services Australia.

The scheme is available to all Australian residents who hold a current Medicare card and overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement. Data are from claim records of prescriptions dispensed under the PBS or RPBS where either:

  • The Australian Government paid a subsidy, or
  • The prescription was dispensed at a price less than the relevant patient co-payment (under co-payment prescriptions) and did not attract a subsidy.

The PBS/RPBS data cover all prescriptions dispensed by approved suppliers, including community pharmacies, public and private hospital pharmacies, and dispensing doctors. 

Data exclusions:

The PBS /RPBS do not include:

  • Over-the-counter purchases (non-prescription)
  • Private prescriptions 
  • Medicines supplied to admitted patients in public hospitals (although discharge prescriptions dispensed in all states and territories except New South Wales and the Australian Capital Territory are included).

Patient characteristics (date of birth and sex) were sourced from the patient's Medicare enrolment details at date of supply as recorded in the PBS claim (extracted on 11 October 2021). Details were taken from the latest available claim record for each patient and applied for all that patient's records to ensure that each patient had unique characteristics for the whole period of analysis. Geographic analysis was based on the patient’s Medicare enrolment postcode at date of supply as recorded in the PBS claim, not the place of the prescriber or dispensing pharmacy. If the postcode could not be mapped to a SA3 using the concordance file, the postcode was replaced with the postcode of the dispensing pharmacy.

The previous extraction for opioid medicines dispensed in 2016–17 reported in the Third Australian Atlas of Healthcare Variation omitted prescriptions corresponding to PBS extemporaneous item 7530H (ATC R05DA) in error. This resulted in a 1% difference in the overall number of prescriptions dispensed during the reporting period, including 2016–17, compared with later extractions for this year.

In previous versions of the Atlas of Healthcare Variation, postcode 7001 Hobart PO Boxes has been mapped by the ABS to SA3 of either Hobart Inner or Central Highlands. Consistent with the treatment of other capital city PO Boxes, postcode 7001 has now been excluded from the SA3 and PHN level analysis but included in state/territory and national level analysis. This will result in a decrease in script volume for either Hobart Inner or Central Highlands from numbers reported in earlier versions.  

Defined daily dose

Number of defined daily doses (DDD) was calculated using the defined daily dose amounts 2021 sourced from the Department of Health. Defined daily dose (DDD) is the average maintenance dose per day for a medicine used for its main indication in adults, defined by the WHO. DDDs are assigned to medicines by the WHO Collaborating Centre for Drug Statistics Methodology. Using DDDs allows comparisons of medicine dispensing independent of price, preparation and quantity per prescription. Medicine dispensing expressed in DDDs per thousand people per day (DDDs/1,000/day) allows data for medicines with differing daily doses to be aggregated. However, the DDD is only a unit of measurement and does not necessarily reflect the recommended or average prescribed dose. DDDs are not established for all medicines. More information on DDD is available at https://www.who.int/tools/atc-ddd-toolkit

Data specifications