A comparison of methadone treatment services throughout Australia indicates that there are many areas of commonality between the States and Territories in regard to the philosophy adopted in methadone treatment. The principles of methadone maintenance treatment underpin all services, and reflect international experience in the use of maintenance therapy as an effective treatment for opioid dependence. The various State guidelines for treatment are similar in their content, and provide for comparable treatment regimens across State boundaries.
However, there are considerable differences across jurisdictions in Australia in regard to their history of methadone program development, and the mechanisms by which those services are provided. For example, the extent of centralised versus decentralised control, the different roles of the public and private sectors, and the extent to which methadone services are provided by larger specialist clinics compared to private practitioners as part of their general practice are evident in different degrees.
Thus, while the principles of methadone maintenance treatment are embodied in all programs throughout Australia, the means by which those services are delivered vary considerably. In combination, these factors demonstrate that the delivery of methadone programs on a national basis operates in a complex environment.
The general view expressed by the majority of persons consulted in the course of this study is that the quality of services provided in methadone programs in Australia is of a very high standard. While some abuse of the payment system is evident, there is no evidence to demonstrate that such abuse is widespread, nor that clients themselves are disadvantaged to a significant degree.
Growth in the total number of clients participating in methadone programs has been associated with an expanded role for the private sector. This has been particularly evident in New South Wales and Victoria. The trend in this approach at a national level from 1986 to 1994 is shown in Table 12 below.
Expressing the levels of participation from 1986 to 1994 as rates per thousand of population aged between 15 and 44 years (the primary age group of opioid dependent persons) results in the following statistics:
The data illustrate that the overall participation rate in Australia tripled from 0.59 persons per thousand in the target population group in 1986 to 1.82 persons in 1994. Public sector participation rates have increased from 0.36 to 0.79 persons, while private sector participation rates have increased from 0.23 persons to 1.02 persons per thousand in 1994. This has largely been due to the growth in the private sector in New South Wales and Victoria.
In those States where there is currently no private sector participation, State health authorities are looking at strategies where the private sector will become involved in the future. This is expected to further affect the distribution of clients between the public and private sectors, and the participation rates evident across these sectors.
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A comparison of the relative participation rates between States is illustrated in the following statistics:
The data illustrate that only New South Wales has consistently had higher participation rates than the Australian average, although the ACT has exceeded the Australian average in the last two years. With 55 to 60 per cent of all methadone clients in Australia being located in New South Wales, the participation rate in that State exerts a major influence on the overall Australian participation rate.
Table 12: Number of clients in public and private methadone programs, Australia, June 1986 and 1994