Natasha Trajkovski was 21 when she was first prescribed opioids.
After having a C-section, she was diagnosed with stage 2 endometriosis, and said she was living in constant pain.
Ms Trajkovski said her doctor prescribed her low, daily opioid medication to help her manage, but her tolerance to the medication was rising
“I was laying on the couch, doing my best with a heat pack … but my life revolved around my next tablet,”
she said.
At first, the prescription helped her get back to her life.
“That’s why I took the tablets — to be able to be a mum again and not have to be in pain,” Ms Trajkovski said.
Natasha Trajkovski says when she first began withdrawing from opioids, she did not know what was happening. (ABC News: Jonathon Kendall )
But within a year, Ms Trajkovski said the medication she was being prescribed was no longer enough to curb her pain, so she switched to a doctor prepared to give her more.
She said her new doctor also referred her to Simon Gordon, who performed a laparoscopy and hysteroscopy before diagnosing her with stage 4 endometriosis.
Earlier this year, a Four Corners investigation revealed Dr Gordon’s patients were repeatedly operated on for what they were told was severe endometriosis despite that diagnosis not being seen in pathology results.
At the time, Dr Gordon told Four Corners that he “never performed surgery to treat endometriosis or any other condition unless I was absolutely convinced it was in the patient’s best interest and to improve their overall quality of life”.
Ms Trajkovski said the surgery did not resolve her pain, and she continued to turn to opioids prescribed by her GP for relief.
With her tolerance rising, she said she was taking over 800 milligrams of pharmaceutical opioids a day at the peak of her addiction, which was leaving her underweight, shaking and unable to drive between rounds of her prescription.
She said she was also occasionally getting additional pharmaceutical opioids from a friend who was also being prescribed them for chronic pain.
In early 2024, about two years on from her first prescription of opioids, Ms Trajkovski had a second operation with Dr Simon Gordon, which she said left her in “way worse” pain than before.
Soon after, Ms Trajkovski decided to take steps towards abstinence.
She made an appointment with a new GP, Jim Dell’Oro, and was checked into a private rehabilitation facility in Geelong the following day.
“I will forever owe my life to that man,” she said.
Ms Trajkovski has been abstinent for two and a half years, and has been off opioid replacements for over six months.
But she is one of thousands of Australians who have had to grapple with or are still grappling with opioid addiction.
What are opioids?
Opioids block pain signals from the body to the brain.
There are pharmaceutical opioids, like oxycodone, codeine, morphine and methadone, and illegal opioids like heroin.
Opioid-based medications are commonly prescribed for patients in severe pain, such as after surgery or during a terminal illness.
According to the latest data from the Australian Institute of Health and Welfare, in 2024 there were around 12.6 million Pharmaceutical Benefit Scheme-subsidised opioid prescriptions dispensed to around 2.9 million patients in the country.
That same year, there were 635 pharmaceutical opioid-related deaths, and 501 heroin-related deaths.
‘Well-meaning doctors’ and over-prescribing
Adam Straub is an addiction medicine physician — the only one of his kind in regional Victoria.
In the first six months of this year, his clinic has received about 170 referrals.
“There was one day early last week that I had eight referrals in the one day,”
Dr Straub said.
Adam Straub is an advocate for opioid agonist therapy and harm minimisation education. (Supplied: Dr Adam Staub)
The clinic is under the pump and shifting schedules to try to keep the wait time for new patients to under a month.
When the clinic first opened four years ago, it serviced the Grampians and Loddon Mallee region of Victoria.
But as demand grew, and with a lack of services elsewhere in the regions, they expanded their reach to include the Barwon South-West and Gippsland regions.
The clinic now treats 347 patients.
Dr Straub said over half of the people he treats are chronic pain patients — a problem he said was born in the ’90s from “overzealous prescribing” by “well-meaning doctors”.
“There was quite a lot of push from pharmaceutical companies of ‘here’s these new opioids that we’ve created and they’re fantastic, and you don’t have to worry about anything,'” he said.
Dr Straub said there often was not enough monitoring, re-evaluation and discussion around the amount of opioids someone was prescribed.
Patients can be given too much for too long as withdrawal symptoms can mimic the pain the medication was originally prescribed for, he said.
“Over extended periods of opioid use, the brain chemistry changes a little bit, and it starts to need the opioids just to feel normal,” Dr Straub said.
“Then everything shifts gears — it’s no longer treating the painful condition, it’s treating the brain’s irritation when the opioids are not there.
“And that’s when the elements of dependence start to kick in.“
Dr Straub said the solution was far from simply taking patients off opioids.
“[By doing that] you run the risk of removing the thing that has been helping to a point for a patient, and leaving them with nothing except a debilitating pain condition,” he said.
He said one patient’s doctor had cut his opioid prescriptions in half, with drastic health outcomes.
“That patient went from being able to mow the lawns and cook and clean the house themselves, to now being laid up in bed, getting meals on wheels,”
Dr Straub said.
He said in cases of prolonged opioid use, the need for opioids should be reassessed, and dosages should be reduced at small increments, between 10 and 25 per cent, and continually re-evaluated.
“What you need to do is to say, ‘OK, let’s see whether this change has worked or not’, rather than doing huge broad strokes … and then going, ‘good luck with it,'” Dr Staub said.
He said it was important to explain the risks of continued high-use, and the process of “opioid tapering” to patients.
“They’ve lived with pain. They may have missed doses and felt terrible,” he said.
“One of the big things that I’ve learned … is this concept of ‘nothing about me without me’ — so making sure that we involve the person who has to live through our decisions in the decision-making process.“
He said the “profound stigma” around chronic opioid use could leave some patients feeling exposed, wondering whether their pharmacists or doctors will continue to provide them with their medication.
“Because opioids are perceived as this bad, dirty drug, patients are left really vulnerable,” he said.
The dangers of opioid use are becoming more widely discussed. (ABC News: Hugh Sando)
The push for de-prescribing
The push for de-prescribing and the dangers of opioid use are increasingly discussed.
This month, Monash University launched a nation-wide program called Support-Meds, aimed at giving general practitioners, nurses and pharmacists the knowledge and tools to safely “de-prescribe” potentially harmful or unnecessary medications, including opioids for persistent non-cancer-related pain.
Free accredited education can be delivered as online self-paced learning or face-to-face.
Project lead and associate professor Emily Reeve said recent research was changing the way we think about opioids.
“There has been a lot of research into the scale of the problem [and] we are seeing that increasing use of poly-pharmacy with our increasing older adult population [and] high use of these high-risk medications like opioids,” Dr Reeve said.
“Our program really focuses on translating all of that [research] into education and resources that are really helpful for those frontline clinicians.”
‘Addiction does not discriminate’
Ms Trajkovski is now 25 and said that when she was first prescribed opioids, she never thought she was at risk of developing an addiction.
Ms Trajkovski supports measures to prevent people from becoming addicted to prescribed opioids. (ABC News: Jonathon Kendall )
“I didn’t know what I was doing — addiction does not discriminate at all,” she said.
She said she wished there had been more safeguards to prevent her from developing an addiction in the first place, and hoped that by sharing her story, she could prevent people from falling into the same trap.
“The reason I am studying to be a nurse is to be a drug and alcohol nurse,” she said.
“I don’t want this experience for anyone.”
