Ambulance Victoria may stop using the powerful painkiller Fentanyl, amid an independent audit into its drug-handling procedures and concerns about growing community misuse of the drug.
Two paramedics have been accused of stealing the opioid analgesic from ambulance stations and substituting it with water.
At the same time it has been revealed there have been at least 15 Fentanyl-related deaths over the last year, and drug support agencies say it is in-demand on the black market.
Ambulance Victoria chief executive Greg Sassella told 7:30 Victoria there is no evidence to link the deaths to the alleged thefts by paramedics, but the use of the drug is being reconsidered.
"We've got to decide, we have very good reason for using Fentanyl," he said.
"It's a very effective drug for our patients and for the sake of one or two individuals who are misappropriating the drug or replacing it, is that sufficient to then deny all of our hundreds of thousands of patients that medication?
"Of course, that is something we're going to have to think about."
Health organisations say there is a growing national addiction to the painkiller, often used to treat patients with severe pain.
John Ryan is the chief executive of Anex, a not-for-profit group which tries to prevent drug-related harm, which has released a report showing a 500 per cent spike in prescriptions of Fentanyl in the five years leading up to 2009.
"It can be 100 times stronger than morphine and the problem with Fentanyl is, if it's not being used as prescribed and carefully monitored, the risk of overdose is extreme and obviously that can lead to death," Mr Ryan said.
"It's not really clear why it's been so dramatically increased in its use in the last five years but we do know that doctors are much more proactive in treating pain which is a good thing because people shouldn't be in pain if there's a solution to it.
"On the other hand, we know that some small minority of doctors are actually not very careful in the way that they prescribe and that's where some of the leakage into abusing drugs actually happens."
Feeding the demand
Victoria's Coroners Court has confirmed that since December last year 15 people in Albury-Wodonga have died from an overdose of the drug.
However, Mr Ryan says Fentanyl abuse is not just restricted to regional Victoria.
"Particularly it seems to be an issue in regional and rural areas but we're hearing about the issue in Queensland, western New South Wales, northern Victoria, western Victoria," he said.
The Anex report cites a significant black market for the drug; one example, a pensioner selling his prescription to support a gambling problem.
Doctor shopping and theft also contribute to feeding the demand.
"I would imagine that's an isolated case but we do know that people in high-pressured jobs such as ambulance actually deal with a lot of trauma," he said.
"One of the consequences of trauma is often abuse of drugs."
Mr Ryan says frontline health workers in regional Victoria have been raising concerns for at least two years and Anex is calling for urgent education for health workers.
"I think there's a lot of people in the medical profession that don't understand the risks," he said.
"We've even heard reports of people, of doctors, believing that you can't actually divert Fentanyl and then inject it.
"So, I think we've actually got to get the frontline services educated so that they can educate those people who are using these drugs illicitly."
Popularity
Australian Medical Association federal president Steve Hambleton agrees that over the past decade there have been well-known increases in the misuse of other opioid analgesics, like oxycodone.
And Dr Hambleton said he believes Fentanyl is on its way to becoming as popular as other pharmaceutical drugs, like oxycodone.
"I certainly do and as I say Fentanyl in the patch form and Fentanyl in the lozenge form is really considered one of the safest of the narcotics even when medically used, and that's what's driving its medical use and, I guess, the amount of the product in the community," he said.
"And paralleling that sadly is this misuse of the product, often mixed with heroin, sometimes taken alone."
Anex has handed its report to state governments.
Victorian Premier Ted Baillieu says he is disturbed by the evidence.
"It's important the matter be examined, the coroner is doing that but he is not in a position, according to the Coroner, to reach any conclusion about that at this stage," Mr Baillieu said.
New South Wales Health would not comment.
