Opioid substitution therapy in Australia: The history, current status and future of a great public health intervention

Introduction and Aims: Opioid substitution therapy (OST) has been a pivotal strategy in the reduction of harm associated with illicit and pharmaceutical opioid use since its introduction in Australia in the 1970s. To date, this contribution has not been comprehensively assessed or documented. This paper presents findings from a qualitative study examining the history and development.

Design and Methods: A mixed methods approach examined current arrangements, gaps, access barriers and future directions, with comparisons to other countries. Interviews were conducted with 20+ policy makers and/or clinical who played pivotal roles in OST development. Current/historical policy documents, clinical guidelines, and key research and evaluation reports were examined. Relevant data were examined to assess trends in OST practices and utilisation trends.

Results: OST has made a significant contribution to public health outcomes. Programs started from small innovative programs and evolved over time and varied across jurisdictions. Factors impacting OST dissemination and uptake included evidence of clinical efficacy, public health threats (e.g. blood borne diseases), influential policy makers and clinicians, and serendipitous events. Despite evidence of efficacy, considerable unmet demand remains.

Discussions and Conclusions: The contribution of OST programs to public health outcomes, and to reducing opioid‐related harms remains largely undocumented. Its public health contribution has not been quantified or fully recognised. Programs were often developed in hostile or indifferent political and community environments. Greater acknowledgement of the role played by pioneers and contributions to the evidence‐based practice warranted. Nevertheless, there remains significant gaps in services provision and a range of barriers to access.