Understanding opioid pharmacotherapy

Opioid pharmacotherapy is the use of medications (such as methadone or buprenorphine) to treat opioid dependence.¹

While it’s safe and effective – and has been used to reduce harms from opioids for over 50 years¹ - many people accessing pharmacotherapy can experience stigma from:

• family and friends
• health professionals
• media and news outlets
• themselves (self-stigma)
• the community – especially if they’re in a small town where everyone knows each other.²

“I have more than one friend who stopped their bupe because of shame and later overdosed – good people who would likely be alive today if they didn’t feel compelled to stop taking their life-saving medication. Stigma kills.”– Josh³

Drug dependence, including opioid dependence, is the most stigmatised health condition globally.⁴

Stigma stops people from seeking the help they want or need, which can negatively impact their health and wellbeing.⁵

It can be caused by a lack of understanding about pharmacotherapy, including:

• its benefits
• the strategies in place to reduce any related risks
• the ‘type’ of person who is on opioid pharmacotherapy (there is no one kind of person who experiences opioid dependence).

Here, we explore these topics to better understand the benefits of opioid pharmacotherapy and why it’s needed.

You can learn more about how opioid pharmacotherapy works and how to access it in our accessing opioid pharmacotherapy in Australia article.

How does opioid pharmacotherapy help people?

Opioid pharmacotherapies can reduce opioid withdrawal symptoms and help with cravings.

Lessening these symptoms and cravings improves:

• satisfaction and engagement with treatment
• the likelihood a person will reduce/stop using other short-acting opioids (such as heroin or oxycodone).¹

This can reduce:

• opioid-related overdose risk, which is especially important with potent synthetic opioids like nitazenes and fentanyl being found in other drugs in Australia¹
• engagement with the criminal justice system (linked with illegal opioids)¹
• risk of contracting HIV or other bloodborne viruses for people who inject opioids.

These benefits help people to stabilise and experience long term benefits, including improvements in:

• physical, mental and overall health and wellbeing
• social functioning and relationships with friends and family
• ability to gain and maintain employment
• managing their financial situation
• securing and maintaining adequate housing.^1,6

How are the risks of opioid pharmacotherapy reduced?

The use of any drug, including prescribed medications, can carry risks and unintended effects.

To reduce these risks, Australia has national guidelines. Most states and territories also have their own opioid pharmacotherapy guidelines and resources that complement the national guidelines.

All pharmacotherapy prescribers are also registered and monitored by Australian Health Practitioner Regulation Agency (AHPRA).

The risk of harm from opioid pharmacotherapy is significantly reduced through these guidelines and accreditations. Health professionals are also involved in each stage of prescription, administration and ongoing use.¹

What happens when someone starts on methadone or buprenorphine?

The prescriber will usually increase the opioid pharmacotherapy dose slowly, managing any side effects that may come up and working to find the right dose for the client.

Most people on opioid pharmacotherapy don’t experience significant or harmful side effects, but one of the more common side effects is feeling tired or drowsy.¹

Because of this, the prescribing doctor and dispensing pharmacist will usually advise the person not to drive, operate heavy machinery or engage in any other potentially risky activities for a little while.¹

This gives time:

• for the person to get used to the medication’s effects
• for the prescribing doctor to adjust the dose if required
• to see what, if any, side effects are experienced.

To learn more about the effects and side effects of opioid pharmacotherapy medications, check out our Drug Facts pages:

• Methadone
• Buprenorphine
• Buprenorphine – Long Acting Injectable.

Overdose

Like any other opioid, a person can overdose if they take too much methadone or buprenorphine. Opioid overdose can cause death.

If you or someone else starts experiencing symptoms of overdose, call an ambulance straight away by dialling triple zero (000).

Overdose is more likely if the person:

• is just starting on pharmacotherapy
• has a low opioid tolerance
• has not taken it as prescribed
• has taken other opioids or depressants (this includes before, after, and at the same time, as they can slow breathing and heart rate for many hours after taking them).¹

The risk of overdose causing death can be reduced by access to naloxone, which temporarily reverse an opioid overdose.⁷

Naloxone should be carried by anyone who is currently taking opioids (including pharmacotherapy), and their friends and family.

It’s available for free over the counter from most local pharmacies and can be administered by anyone.⁸

Find naloxone near you

Takeaway/unsupervised doses – balancing access with risk

People who receive opioid pharmacotherapy must regularly attend a dosing point to take their medication while supervised by a pharmacist or other health professional. This helps to further reduce the risk of overdose.¹

In some cases, they may qualify for takeaway doses, also called unsupervised dosing.¹ Each jurisdiction has guidelines around patient eligibility for takeaway doses.

Takeaway doses are an important step for a lot of people. This is because attending a clinic or pharmacy daily can be a barrier to getting treatment for those living in a rural or regional area or who have work and/or family commitments.²

Before authorising takeaway doses, the prescribing doctor will complete a risk assessment to make sure there’s a low chance of overdose.¹

If someone is eligible for takeaway doses, they’ve achieved treatment stability, which is when someone:

• is on the correct dose – the dose has not needed to be changed for several weeks to months, depending on the treatment type
• is not missing doses of their opioid pharmacotherapy
• is not missing appointments with the opioid pharmacotherapy prescriber
• feels like the treatment is ‘working’ for them - usually indicated by significantly reducing or stopping their use of shorter-acting opioids like heroin or oxycodone
• feels more ‘in control of their life’ - or example, addressing housing needs, maintaining positive relationships with friends/family, eating regularly and getting help for any other health conditions.¹

The pharmacist or other health professional dispensing the medication can also decide at any time to refuse to dispense takeaway doses if they believe the person isn’t able to safely manage them.¹

Does opioid pharmacotherapy work for everyone?

Sometimes people try pharmacotherapy and find it doesn’t meet their needs.³

This may be a sign that they:

• need their dose adjusted
• should consider trying a different medication
• need different or additional supports, such as medical, social, housing or financial.¹

The barriers to access, such as limited prescribers and the need for regular dosing, can also make pharmacotherapy a less realistic option, especially for those in rural or regional areas.³

In some cases, pharmacotherapy just isn’t the person’s preference – and that’s okay. People shouldn’t be forced into a treatment they don’t want or don’t feel comfortable with.

Whether opioid pharmacotherapy is the best option for a person, which medication should be prescribed and the ideal dose is a decision made by the individual and their prescriber together, informed by the individual’s preferences and treatment goals.¹

Who receives opioid pharmacotherapy in Australia?

People experiencing opioid dependence, and those on opioid pharmacotherapy programs, are the same as anyone else who needs medication to manage a health condition and they shouldn’t be treated any differently.⁹

Opioid use in Australia

There is no one type of person who uses opioids in Australia.

Over 1.2 million Australians have used an opioid for a non-medical purpose at some point in their life, and 500,000 have done so in the past 12 months.^10,11 The average age is 45 years.¹²

Codeine and oxycodone were the most commonly used opioids.¹¹

People who have used illicit opioids in the past year experience:

• very high rates of diagnosed mental health conditions (32%) and psychological distress (35%)¹¹
• more physical health harms than the general population, including overdoses (5.4%) or injuries (4.6%) that require hospital or medical attention.¹¹

Overall, the proportion of Australians who use opioids has been declining in recent years, both for ever having used and for past year use.¹¹

This is almost entirely because men are using less.¹¹

Now, males and females have similar rates of use, where before, men were more likely than women to have used opioids for non-medical purposes.¹¹ And there’s also been an increase in non-medical use of opioid medications by young women (aged 14-19) between 2019 and 2022-23.¹¹

Opioid pharmacotherapy in Australia

On a snapshot day, more than 55,700 Australians received opioid pharmacotherapy.¹³

Out of those, 2 in 3 identified as male and the median age was 46 years, up from 38 years in 2011.¹³

Since 2011, there’s been a decrease in the proportion of clients aged in their 30s or under.^11,13

However, in general, the rate of people receiving opioid pharmacotherapy in Australia has stayed stable over the last decade.¹³

Where can someone go to access opioid pharmacotherapy?

For information, support or advice on opioid pharmacotherapy, most Australian jurisdictions have services specifically funded to help people access prescribers and dosing points.

Call the National AOD Hotline or visit AIVL’s website for a table of services and contact details.

This article is based on our opioid pharmacotherapy guide, which was developed in collaboration with Pharmacotherapy Advocacy Mediation Support (PAMS).