A Sydney neurosurgeon charged over the cocaine-related deaths of two escorts has been refused bail because of his long-standing drug addiction.

"The protection and welfare of the community, including those who provide sexual services for payment, looms large in this application," Justice Megan Latham said on Tuesday.

The NSW Supreme Court judge concluded that the strength of Suresh Surendranath Nair's cocaine addiction meant it was likely he would commit more serious offences if granted bail.

The 41-year-old is charged with the manslaughter of Victoria McIntyre, 23, to whom he allegedly supplied cocaine at his Elizabeth Bay flat in February 2009.

He also is charged with murdering Suellen Domingues-Zaupa, 22, another escort he allegedly supplied cocaine to at his flat in November 2009.

Since mid-2004, Nair's drug addiction has led to a string of conditions - including urine testing three times a week - being placed on his medical registration.

Testimonials spoke "compellingly" of Nair's devotion to his work and his good reputation in his chosen area of expertise, Justice Latham noted.

He was first changed with an offence, supplying cocaine to Ms Domingues-Zaupa, on November 25 and his registration as a medical practitioner was suspended the next day.

He was granted bail, a condition of which was not to engage the services of an escort or prostitute and not to consume any illicit drug.

"On 9 January 2010, the applicant was arrested at his home in the company of two naked escorts," Justice Latham noted.

"There was 5.14g of cocaine in the premises, some of which had been prepared for ingestion on a dinner plate."

The judge said Nair later told his psychiatrist that the "force of his addiction was such that if he could get away with it he was prepared to risk the loss of his bail".

Nair was charged with drug offences relating to the January episode, refused bail, and later charged with manslaughter and murder.

"The crown case on the charge of murder cannot, in my view, be characterised as strong," the judge said.

She noted the evidence appeared to fall short of "coercion or force" on the part of Nair in the ingestion of the cocaine by Ms Domingues-Zaupa.

Further, his state of mind "was undoubtedly affected by his consumption of a large quantity of cocaine and some alcohol".

Referring to the many conditions placed on Nair's working as a neurosurgeon, the judge said it was "abundantly clear" he had been afflicted by a long-standing addiction to drugs.

Further, "he is prone to excessive consumption of alcohol and there are other features of his mental health that have required the services of a treating psychiatrist.

"In spite of this history, (he) seems to enjoy the confidence and support of his peers in neurosurgery.

"I can only conclude that (he) is a gifted practitioner whose skills were so much in demand that suspension was a remedy of last resort."

According to Nair's psychiatrist, his experience in prison had led to his no longer being in denial about his addiction.

But the judge concluded the "strength" of that addiction made it likely he would commit further serious offences if granted bail.