The deaths of Heath Ledger and Michael Jackson have thrown a spotlight on the growing problem of prescription drug abuse in Australia, says a senior specialist.
Dr Penelope Briscoe, dean of the faculty of pain medicine at Australia and New Zealand College of Anaesthetists (ANZCA), says reform is needed to curb the illicit use and sale of powerful prescription medicines.
Dr Briscoe says US figures show that seven million Americans abuse prescription drugs - more than the number abusing cocaine, heroin, hallucinogens, Ecstasy and inhalants combined.
"Australia is heading down a similar path with the rate of oxycodone and morphine prescriptions similar to those in the US," Dr Briscoe says in an article published in the quarterly ANZCA Bulletin.
"This aligns with reports that oxycodone - nicknamed hillbilly heroin - is the drug of choice in the injecting room in Kings Cross." Dr Briscoe backs a prescription opioid policy prepared by the Royal Australasian College of Physicians, which calls on the federal Government to undertake a review of how opiates are prescribed and dispensed.
She said while a comprehensive study into the scope of the problem in Australia was yet to be produced, worrying anecdotal evidence was emerging. "The use of oral morphine [tablets] in Australia has increased 40 times since 1990, and we have seen a four times increase in the oxycodone supply."
Clouding these figures, however, was a research-based change in practices as doctors ended their resistance to prescribing opiates to people with chronic pain.
Dr Briscoe said a new oversight mechanism for pain management was needed to ensure people in real need had help, but it should be sensitive enough to raise a red flag in cases of abuse.
This would ease pressure on doctors who had been "trained all our lives to believe our patients ... and take things at face value".
"[We're] now being asked to become suspicious."
Perth-born Ledger died in his New York apartment last year from an accidental overdose of prescription drugs, while forensic tests on Jackson show a mix of prescription and other drugs caused his death in June.