About a year ago, David Farnsworth, from a town somewhere in the southern end of our region, had been prescribed oxycodone after a shoulder operation in the hospital. 

"The pain wasn't really that bad but when I took the 'oxies' within about ten minutes I had just this feeling of contentment I hadn't had in such a long time. The pain in my shoulder meant I had been working, and I hadn't felt very good about myself." 

"I just felt so relaxed and content, the pills wore off, I took some more, they ran out, and I eventually got onto the dark web. But when I did, I ordered something stronger - fentanyl, and I never felt such a blissful sense of satisfaction. It gave me this almost childhood-like sense of happiness.". 

Soon enough, he was struggling with regular use - and the joblessness and the long days in bed he had tried to escape with his shoulder injury became his life once again.

"Fentanyl is a synthetic opioid that can be up to 100 times stronger than morphine, or around 50 times more potent than heroin," Alcohol and Drug Foundation's Chief Executive Officer, Dr Erin Lalor AM, told the Western Plains App. 

"Fentanyl is commonly used in medical settings for pain management, for chronic pain, severe cancer pain, nerve damage, back injury, major trauma, and surgery. 

"It can be 'diverted,' meaning that when a medical professional prescribes the medication, it's not used as directed, or is given or sold to a third party." 

The use of opioids oxycodone and fentanyl remains much higher in regional areas than in capital cities, according to the Australian Criminal Intelligence Commission's (ACIC) National Wastewater Drug Monitoring Program released this month.  

Nearly 60 wastewater treatment plants covering a population of 13.9 million Australians were monitored by the ACIC in December 2022 and again in February 2023 at capital city sites for the latest report. 

"The highest consumption of fentanyl was found at some sites in regional NSW and South Australia, while a site in Tasmania had the highest capital city levels," the report said. 

Regional NSW ranked first nationally in the consumption of cocaine and fentanyl, and second in the consumption of heroin and MDMA. 

Susi Tegan. Image: National Rural Health Alliance. 

Susi Tegan, Chief Executive of the National Rural Health Alliance, explained to the Western Plains App that the drug is usually only prescribed for renal failure.   

"Alcohol and drug use is higher in rural areas, often due to boredom and a feeling of hopelessness. But generally, there is a very good communication system between doctors and pharmacists. Doctors are generally good at sharing information. My feeling is that the way this drug is being spread is not through the medical system, particularly in smaller towns where networks being doctors and pharmacists is so strong." 

"I think the big problem is the black market in fentanyl. It's a very sophisticated system of people who sell these products, and they are the ones that have to be stopped. At the same time, you need people on the ground to provide the right healing process to help them get off the drugs. It's the same reason people sniff petrol or become alcoholics," she told the Western Plains App. 

David says his use of fentanyl has cut down, and he never really developed a full daily habit where his body was completely addicted to it. Still, he now tends to turn to it when there are two conflicting events - to celebrate and to deal with difficult issues. 

Image: Australian Government. 

"If you are just taking these to get high, you are taking these to get over emotional pain," Dr. Tegen said. 

"It's so hard to get off it; the body is wired to routine, and trying to change that takes months and months and months, and then faced with an issue and you do not know how to deal with it, and so it really is a multi-pronged approach the second one is really dealing with the issues of people selling these drugs, the other is providing education and treatment. It ends up affecting not just that person but the family and whole communities. 

She said using it is very risky as it is extremely hard to judge a dose size. 

"If the dose of fentanyl is too high, a person may experience an overdose. If you or someone is experiencing chest pain, slowed breathing, bluish lips and complexion, seizure, passing out, coma, or death, call an ambulance straight away by dialing triple zero (000). 

Dr. Tegan says she thinks the problem hasn't yet peaked, and fentanyl may well become a more widespread problem in Australia, with rural and regional Australia disproportionately impacted. 

She says there might not be a solution, but that our capacity to mitigate what might become a more widespread problem comes back to a familiar problem - the need for better health services in the bush. 

"I think it has yet to peak because we still have people not accessing proper care in rural and regional Australia. We know there needs to be more services. If you don't have people who can help you get to the root of the problem in your community, then it's hard to get over." 

[Editor's note: *some names have been changed to protect people's identities.]