A key purpose of this book is to document the contribution that opioid agonist therapy (OAT) has made to public health and to the life of individuals in Australia. As with many fields of endeavour, OAT began from relatively rudimentary beginnings in Australia and has developed as the evidence base concerning effective practice grew. It is noteworthy that Australia made a substantial contribution to the development of this evidence base. The development of OAT programs has varied significantly between Australian jurisdictions. So too, there are significant variations between jurisdictions in current patterns of OAT provision. The federated nature of Australia’s system of government has contributed to these variations, and as such, this system is described in Chapter One. Other contributors to these differences include differing profiles of drug problems, differing funding models and at times, happenstance.

This flexibility in service provision is characteristic of the development of OAT in Australia. One of the great strengths of the Australian approach to OAT has been that no attempt has been made to dictate to prescribers that they must utilise one OAT medicine for all clients. As a result, the OAT system in Australia has developed based on providing flexibility concerning the OAT medicines that best suit the needs of individual clients.

Opioid agonist therapy in Australia faces a number of challenges, including:

• a relatively narrow and diminishing prescribing base
• stigma (both clients and service providers)
• dispensing costs to clients.

These problems notwithstanding, OAT coverage in Australia is relatively good and compares favourably with other countries.

Note: On occasions, throughout the book, the term addict is used. While recognising that this is no longer acceptable terminology, the term is retained in some instances because this was used in historical references that have been cited.