Opioid Agonist Therapy in Australia: A History

July 2022
A new NCETA publication aims to document the substantial contribution that opioid agonist therapy (OAT) has made to public health and to the life of individual Australians.

As with many fields of endeavour in the alcohol and other drugs field, OAT began from relatively rudimentary beginnings in Australia and developed as the evidence base concerning effective practice grew. It is also noteworthy that Australia made a substantial contribution to the development of this international evidence base.

The development of OAT programs has varied significantly between Australian jurisdictions. So too, there are significant variations between jurisdictions in current patterns of OAT provision. The federated nature of Australia’s system of government has contributed to these variations. Other contributors include differing profiles of drug use, differing funding models and at times, happenstance.

This flexibility in service provision across the country is characteristic of the development of OAT in Australia. One of the great strengths of the Australian approach to OAT is that prescribers have not been told they must utilise one OAT medicine for all clients. As a result, the OAT system in Australia has developed based on providing flexibility concerning the OAT medicines that best suit the needs of individual clients.

Opioid agonist therapy in Australia still faces a number of challenges, including:

  • a relatively narrow and diminishing prescribing base
  • dispensing costs to clients
  • complex regulatory arrangements associated with OAT provision.

One of the greatest challenges facing OAT in Australia is the associated stigma. Illicit drug (particularly heroin) use is a stigmatised activity. Consequently, OAT is also stigmatised. The stigma associated with opioid dependence impacts on a diverse range of issues from treatment retention through to the willingness of healthcare professionals to provide services to clients and stigmatisation of OAT staff.

These problems notwithstanding, OAT coverage in Australia is relatively widespread compared with other countries.

The book explores the discovery of methadone and buprenorphine and the development of OAT in Australia as a whole and in individual jurisdictions. In addition, OAT programs in some international jurisdictions are also described. It is available here.