The purpose of this project was to summarise what is known internationally, nationally and in NSW about unmet need and unmet demand for OTP in NSW and provide some initial estimates for NSW.
The estimation of the unmet demand for opioid pharmacotherapy maintenance (known as OTP in NSW) is an essential planning element for governments. Currently, there are no reliable estimates of how many more people would enter OTP if there were available places and assuming they meet the intake criteria.
To summarise what is known internationally, nationally and in NSW about unmet need and unmet demand for OTP in NSW and provide some initial estimates for NSW. Unmet need is defined as the proportion of people who meet diagnostic criteria for dependence but who are not in receipt of treatment. This is therefore inclusive of people who may benefit from treatment but do not seek it or request it, those who simply do not want treatment and those who want help via means other than formal treatment. Unmet demand, on the other hand, is defined as the proportion of people who seek treatment but are unable to access it – that is they want treatment and seek it but do not receive treatment. Both unmet need and unmet demand are important estimates in planning for services.
Review of unmet need and unmet demand literature was undertaken. Estimates of unmet need and unmet demand from international studies were compared with the limited available Australian data. Analyses included the National Drug Strategy Household Survey and the National Survey of Mental Health and Wellbeing datasets.
Internationally, there is limited research that estimates unmet need and unmet demand for OTP. However, estimates of unmet need for treatment are generally large for OTP. In benchmark countries such as Canada, UK and USA these figures of unmet treatment need are about 70%; 68% and 80% respectively of the opioid dependent population. Unmet need and unmet demand are most usefully measured at a local or health planning level, rather than at a state or national level. This is because unmet need and demand can vary from location to location, and state-wide figures can mask under-serviced areas. Based on available knowledge, and taking a state-wide perspective, the estimates for unmet need and unmet demand in NSW for OTP vary widely. They may be as low as 10% of the opioid dependent population or as high as 65% of the opioid dependent population. The primary reason for these large ranges is that the underlying prevalence of opioid dependence is not known with any degree of precision. In comparison with international estimates, NSW is performing well: it has the highest rate of met demand relative to 16 European countries. The rate of OTP provision per 100,000 general population is higher than most European countries, Canada and the USA.
A report has been provided to NSW Ministry of Health.
This work contributes to the ability of government to plan adequately for OTP services in NSW.