This report offers a comprehensive analysis of the state of the Australian opioid pharmacotherapy system and offers valuable recommendations to stabilise and build a more effective system.
Opioid pharmacotherapy is an essential, life-saving treatment. There is overwhelming evidence that treatment prevents death and significantly improves health and wellbeing. The evidence of its cost effectiveness is equally compelling.
This is why the Australian opioid pharmacotherapy system is so frustrating. There are few drug treatments backed by as much evidence. Yet we have produced a system that at best muddles through, and at worst denies access to medication that can help some of the most vulnerable people in our communities.
This report began with a narrow focus. However, on the advice of the expert advisory committee, it was expanded to consider system-wide issues in light of the extreme fragility of the pharmacotherapy system, which concerns consumers, experts and providers alike.
As the report makes clear, there is good and bad news about pharmacotherapy in Australia – and a frightening spectre looming that should make us all pay attention.
Let’s start with the positive. There has been tangible progress in recent years in drug formulations, care models, and health policy. The development of long-acting medications has offered huge gains in flexibility for many patients. Healthcare providers are finding innovative ways to implement person-centred care, including mobile services and more meaningful engagement and collaboration with people with lived experience.
Most notably, after many years of demands by people on pharmacotherapy, Penington Institute and others, this year the Commonwealth Government finally added pharmacotherapy drugs to the Pharmaceutical Benefits Scheme (PBS). The new system replaces the uncapped private dosing fees that had imposed a huge, debilitating economic burden on an already marginalised group of people – a reform many decades overdue.
But this overdue victory must not delude us into thinking that the system is fixed. Nothing is simple in pharmacotherapy policy, and implementation of the 2023 reforms must be closely monitored to make sure access to pharmacy-based dosing remains robust. And unless other bottlenecks and systemic flaws are fixed, we will fail to seize the opportunity provided by these reforms to substantially improve patient outcomes.
This includes the risk of missing our best chance to stabilise many of the people who will be most vulnerable should powerful synthetic opioids enter the illicit drug supply, as has been seen in North America – a development for which many experts consider us to be wholly unprepared.
Fixing the pharmacotherapy system requires a multi-pronged approach. One problem is very clear: not nearly enough potential prescribers offer this life-changing treatment, leaving the system prone to repeated mini-crises when prescribers with large patient loads retire or fall under regulatory scrutiny.
Some of the causes of this deficit are clear. Medicare reimbursement rates do not reflect the complexity of pharmacotherapy services, particularly during the initial phases. Nor is there nearly enough attention to substance use issues in training programs for aspiring doctors, nurses, and allied health professionals.
We must also be bold in reaching people frustrated by or excluded from the current system, including emergency department initiation and expanded care during and after periods of incarceration.
We also know from other parts of the world, like Canada and several European countries, that short-acting alternative medications like hydromorphone can safely play a valuable role in helping people manage opioid dependence. Yet, we have been far too timid in applying this knowledge to our own shores.
Pharmacotherapy medications offer stability. However, many people need more help beyond medications, particularly between pharmacotherapy prescribers, mental health services, as well as links to social service providers. Now is the time to back our commitments with resources from governments at all levels, working much more collaboratively than has been the case in the past toward an accessible and effective pharmacotherapy system that works.
Thank you to the expert advisory committee and the team at Penington Institute, particularly Dr Jake Dizard and Emma Richards, whose combined efforts have resulted in this notably important publication.