Leah McLeod's life was spiralling out of control.
She was working four jobs, was three months behind in rent, and she was pregnant.
She was also addicted to heroin.
Then her doctor gave her some frank advice that changed the course of her life.
"He told me, 'If you don't go on methadone today, the chances of you leaving the hospital with your baby is slim'," Ms McLeod said.
That was 20 years ago. She followed his advice and has been taking the prescription medication ever since.
Methadone, and other similar opioid replacement therapies (ORT), have been used for decades in countries including Australia, and are designed to reduce craving and withdrawals associated with opioid dependence.
"Sometimes I say it was my child that saved my life. But maybe it was methadone. That first morning that you wake up and you're not sick is magic," Ms McLeod said.
Now, frontline health workers have warned many Australians who live with opioid addiction are struggling to access support and the ORTs that could save their lives.
People waiting years for a prescription
Ms McLeod is worried about the length of time it takes some people just to find a prescriber who can get them onto those therapies.
It is also a concern for doctors, who are especially worried for people in regional areas who have to wait years, or cannot access ORT locally at all.
That is according to addiction medicine specialist Hester Wilson, the chairperson of the Special Interest Group in Addiction with the Royal Australian College of General Practitioners (RACGP).
She said many of the GPs who have been prescribing the medications for decades are now retiring, and not enough new doctors are registering to prescribe the therapies because it is expensive and time consuming.
"It's an extraordinary situation, that for us in a first-world country with such good access to health care, that people can't access this treatment, which is evidence based. We know it improves people's outcomes," Dr Wilson said.
The revelations come as data released by the Penington Institute shows overdose deaths in Australia are being driven by opioids and the misuse of prescription medications.
It shows that 2,220 people died of an overdose in Australia in 2020 and three-quarters of those were accidental. But the 2020 figure is likely to increase due to delays in the reporting of drug-related deaths through the coroner's court.
John Ryan, the chief executive of the Penington Institute, said it was troubling that Australia still lacked a national overdose prevention strategy, despite years of advocates calling for such a measure.
"We've now got to 35,000 deaths in Australia from overdose since 2001," he said.
"It's very confronting to realise that the overdose toll has exceeded the road toll since 2014.
"While Australia implements a National Road Safety Strategy … thousands of Aussies continue to die of an overdose in virtual silence."
Mr Ryan said the prescription drugs most routinely implicated in overdose deaths were opiate painkillers, benzodiazepines, and anti-anxiety and sleeping pills — which are often used in combination with alcohol.
Addiction an issue 'right across the country'
Opioids were the most common drug group associated with unintentional drug-induced deaths in 2020, contributing to more than 51 per cent of them. The report also found women were far more likely than men to die from an overdose of a prescription opioid than from an illicit opiate like heroin.
Mr Ryan is critical of the lack of support available to people who develop a dependence, saying better access to treatments and support could reduce overdoses and fatalities.
"We're seeing considerable delays for people accessing evidence-based treatment like opioid substitution treatment: methadone, buprenorphine. There's really no excuse for that because we've had this problem for years and it hasn't been addressed," he said.
"We've got a problem in terms of perception, I think, where people think overdose is a city problem — in the alleyways of the big cities. That's completely incorrect.
"It's actually happening in people's homes, in suburbia and in regional and rural areas right across the country."
Angelo Pricolo, a Melbourne pharmacist who has been involved in harm minimisation for 30 years, said people living with addiction needed more ways to access help.
"There are really very few [doctors] across the country that are willing to write a prescription for methadone or buprenorphine, which is disappointing because most of those are quite happy to see patients and write prescriptions for prescription opioids to treat pain," said Mr Pricolo, who is also a member of the Pharmacy Guild of Australia.
"The number of people that get into trouble with opioid drugs tends to now stem from prescription opioids. And therefore, it is a real concern that we [pharmacists] can't offer them the treatment for the problem that is coming out of my safe at work."
Ms McLeod said patients were also having to prove they were committed to the therapies, sometimes calling a doctor every day to beg to be seen.
"What other health treatment do you have to prove yourself? 'Oh, I'm sorry. You can't be on insulin or, you know, beta blockers until you prove how keen you are'. We don't do that to anybody else," she said.
Dr Wilson agrees stigma and stereotypes are still significant issues, even as the misuse of prescription medications rise.
She fears many people do not understand the potency of some prescription medications, or how lethal some can be if they are mixed with other medications or alcohol.
"We don't want to talk about it. We don't want to mainstream it. This idea this is a 'special' group of people. They're not," she said.
"Probably 100,000 people in Australia have opioid dependency. It's not uncommon. Some of the research has shown perhaps 5 per cent of people who are on prescription opioids have a dependency."
Is there a fix?
As the Penington Institute overdose report shows, an increasing percentage of people need help as a result of pharmaceutical misuse and many experts fear that, without action, Australia will head in the same direction as the United States, which is in the grips of an opioid crisis.
Mr Pricolo thinks improved funding and, somewhat controversially, allowing pharmacists to prescribe ORT medications could help to unclog the system.
"There's a lot of pushback to that in Australia from the big doctor groups," he said.
"I think that that is really providing a disservice to our patients. I have no problem with doctors prescribing, but they need to put their hands up and work in this area and if they're not going to, then they need to not stand in the way."
The RACGP's Dr Wilson is on board with the concept.
"I think there's merit in it," she said.
"I think there are some pharmacists who absolutely would put the energy into getting the skills, have the pharmacy set up in such a way where they've got a private consultation room, who will do it extremely well. I don't have an issue with that at all.
"I would also really encourage my pharmacist colleagues to consider being the administration sites."
The Federal Health Minister was contacted for comment.
