Australia has a drug problem. But this time it’s not ice, or MDMA, or even heroin. Instead, the biggest issue is—and has been for a long time—the abuse of legal prescription drugs.

According to the Coroners Court of Victoria, pharmaceutical drugs were involved in 82 percent of all Victorian fatal overdoses in 2014. Illegal drugs only played a part in around 42 percent of the 384 overdose deaths in the state that year.

The majority of these deaths resulted from taking benzodiazepines, aka benzos, which are prescribed to treat everything from anxiety and insomnia, to seizures and muscle spasms. Diazepam (broadly known as Valium) was the most lethal, playing a role in 168 overdoses.

Opioids are the other big concern, with prescriptions rising 228 percent since 1991, according to the 2011 National Drug Strategy. As the report notes, since the late 1990s, “it is clear that the cause of poisoning has shifted from heroin to pharmaceutical opioids.”

In spite of all this evidence, prescription drug abuse is a health crisis that’s almost completely ignored in Australia, without a national health body or task force “cracking down” on the epidemic.

To try and get an idea of how serious Australia’s pharmaceutical abuse is, VICE spoke to four different people, each with a different stake in pharmaceuticals to figure out the causes and solutions for this health crisis.

Winston, 26
After a serious car accident, Winston is suffering from an iatrogenic addiction

VICE: Hey Winston, could you tell me about your story with pharmaceutical drugs?
Winston: After I was out of hospital, the doctors gave me a prescription for 100mg of endone for the pain. That was supposed to last over a month, but I ran out in a week. Eventually, I’d just keep going back to my doctor every time I ran out saying I was in pain, and they’d just give it to me. I racked up a $10,000 debt from endone over three months. I was fully addicted.

Did the doctors warn you about how addictive these painkillers were?
No, but the pharmacist told me. I feel pharmacists are more cautious than doctors but if you have a script, they can’t say no—no pharmacist ever said no to me. Doctors are just so busy and overworked, they don’t have time to think about every person.

How easy was it for you to get a prescription?
I never doctor shopped but I know a lot of people who do. My friend has a list of doctors around Sydney who give you whatever you want. People think these drugs are okay to party with because they’re legal but really, what is a “good drug addiction?”

Are you still taking endone?
Nah but I just got prescribed tramadol recently. I’m not addicted but once I finish this pack, I will be. I’m meant to take 200mg a day but I take the maximum I can a day, which is 400mg.

Is there an end date for you with these drugs?
I reckon if I go to my doctor and ask for more drugs, she’ll keep giving me drugs. There’s no end date.

Dr Nick Carr
Melbourne GP who has spoken out about the dangers of prescription medication for 25 years

Hey Nick, if certain pharmaceuticals are known to be so addictive and dangerous, why are GPs prescribing them?
A lot of GPs don’t actually think these drugs are dangerous or they’re prescribing these drugs on an initial consultation with patients saying “my usual doctor is interstate” or “I have insomnia so I need valium.” GPs prescribe them because we perceive risk, in a personal sense, that something bad might happen if they don’t oblige. But it’s nonsense. For drugs like Valium you’ll have bad withdrawals but you won’t die.

So are doctors the problem here?
It’s not that simple. Doctors get little practical advice from the health department and the Drugs and Poisons Unit for consultations and preventing doctor shopping. It’s easier to write a script than it is to argue with patients. It’s depressing really. As doctors we’re not doing our duty as we’re allowing this to continue.

Is there any punishment for a doctor who incorrectly prescribes these drugs?
They’re meant to lose their license but there’s still a huge amount of doctors who are recklessly prescribing drugs like Valium or oxycodone. The pharmacists and medical board all know who these doctors are, but we need harsher penalties because the authorities aren’t clamping down on it.

So are harsher penalties the solution?
We need to have a multi-faceted approach with greater education for doctors, a real time prescription monitoring system, and we need to reduce pack sizes. People do need these drugs, but there’s no reason anyone needs 50 packs of valium. If you reduce the standard pack size, we’d see a massive decrease in the abuse of this drug. But we already know this. That’s basic addiction medicine.

Jane, 54
Has been addicted to prescription benzodiazepines for 30 years after a back injury

Hey Jane, can you tell me what happened when you first sought professional help for your prescription addiction?
I was in and out of a lot of health centres and hospitals, but all the doctors there were only used to people with illicit addictions. They’d just treat everyone the same, regardless of their situations, and put you in these horrible ancient rooms with one window to look out of. There weren’t any doctors that were able to help me.

Do you think the doctors took your addiction seriously?
It took 30 years before a doctor told me, “This is what we’re going to do,” instead of just giving me benzos. It’s because no one is talking about [prescription drug addiction]. People don’t want to identify as an addict, because of the stigma, and doctors don’t understand what they are prescribing.

Can you describe the stigma for me?
People are too embarrassed or terrified to admit they’re a victim of prescription addiction because of this idea that it means they’re weak or because, simply, it came from a doctor who we as a society trust entirely, so they just keep feeding it.

What do you see as the solution to Australia’s prescription drug problem?
We need more services for people with prescription drug addiction and victims of iatrogenesis [addiction caused by medical treatment]. We need to begin conversations, we need to change our vocabulary. Our language and our treatment is so damaging to victims of this. People are dying because [these drugs] are so addictive and so dangerous. It took my soul from me.

BEE ISMALI
CEO OF SCRIPTWISE, an organisation raising awareness about the dangers of pharmaceutical drugs

Hey Bee, your organisation advocates for a stronger response to pharmaceuticals abuse. Why do you think Australia needs this?
Because we know that at least 44 Australians are dying every day from pharmaceutical related overdoses and nothing is being done to stop it.

That’s scary. Why do you think people are overdosing on prescribed drugs?
It’s a lack of education when it comes to these drugs. People do need these substances but they aren’t being told how addictive they are or that mixing them with other substances can be fatal. You can have up to five year dependencies on some of these substances if you take them for longer than three to four weeks. There’s just a lack of recognition or understanding of how dangerous these drugs are in comparison to ice, just because they’re legal.

Does your organisation get any support from the government?
We get no government funding and neither does any advocacy group like us in Australia so we’re all really limited in what we can do. There are a lot of government-funded organisations we’ve tried to work collaboratively with but they ignore us or say they’ve only been funded to talk about illicit drugs.

That’s messed up. How do you think Australia solves its prescription drug problem?
We’ve been lobbying for the past eight years for a prescription monitoring system so GPs and pharmacists can monitor and view a patient’s medical history. Tasmania have one and Victoria has pledged one for 2018 but we really need one on a national level.

Follow Sam on Twitter.