The recent seizure of 11 kilograms of the opioid drug fentanyl – the largest amount ever detected in Australia, equivalent to 5.5 million doses – is a powerful reminder of opioid addiction and illicit opioid use in Australia. The Sax Institute is helping policymakers in NSW address the issue with research into innovative approaches to combating opioid addiction.
The NSW Opioid Treatment Program (OTP), where opioid-dependent people are prescribed regular doses of long-acting opioids and can access associated services, has had significant success reducing or stopping illicit drug use. It’s estimated that between 2001 and 2020 the OTP has reduced mortality from drug overdose by 53%.
The OTP still faces challenges such as access to treatment, safety and quality, and program sustainability. To help enhance the OTP across these areas, the NSW Ministry of Health commissioned an Evidence Snapshot from the Sax Institute to identify innovative and cost-effective models of opioid treatment delivery.
This rapid review analysed 26 peer-reviewed papers from the US and other countries as well as grey literature. The authors identified five innovative models of opioid treatment delivery:
- Digital Health. This was the most frequently mentioned method of increasing access to treatment, particularly for rural and hard-to-reach communities. The main model of digital health reported is telemedicine, which was rapidly implemented during the COVID-19 pandemic and eliminated traditional barriers to treatment, such as lack of prescribers, long wait times, lack of transport or childcare, and stigma.
- Primary Care. Care models that leveraged the roles of pharmacists or nurses in OTP (both of which are used already in NSW) helped increase access to treatment. A ‘hub and spoke’ system, where a region’s ‘hub’ is a specialist OTP and a ‘spoke’ is a medical practice, were found to be highly effective for reducing opioid use.
- Low threshold. In some countries like the US there are often high thresholds for entry to opioid treatment programs, such as mandatory abstinence from illicit substances. A low-threshold model removed many barriers to treatment and reduced extensive waiting times to begin treatment.
- Group-based treatment. In contrast to one-on-one treatment services, a group-based model was successful in retaining patients long-term in a rural setting.
- Mobile outreach. This model included home delivery of treatment, as well a mobile treatment unit that is integrated with telemedicine, both of which had positive outcomes for patients.
According to the Penington Institute, there were 1654 unintentional drug-related deaths in Australia in 2020, and opioids contributed to just over half of these. The number of deaths involving opioids has nearly tripled since 2006. Pharmaceutical opioids, including oxycodone, fentanyl and morphine, are the cause of more of these deaths in 2020 than heroin.
Read the full Evidence Snapshot here.
A Sax Institute Evidence Snapshot is a rapid review of the most recent high-level literature to address one question. Find out more here.
Readers seeking support and information about opioid addiction can contact the National Alcohol and Other Drug Hotline on 1800 250 015.