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A mother who had her family torn apart when she became addicted to opioids has opened up about her ongoing battle with the prescription medicine.

Carmall Casey, 51, was first prescribed opioids 10 years ago after she injured herself jumping off a truck at a dairy farm in Tasmania. 

As  she stuck the first patch on her skin, it felt like heaven.

'I became an addict without knowing,' she says.

The doctor had upped the dosage when the agony from her injury returned but the side effects were hell - depression, anxiety, panic attacks. And her pain got worse.

Desperate, she saw other doctors. They sent her away with more prescriptions for more opioids: fentanyl, codeine, oxycodone, tramadol, buprenorphine, tapentadol, Targin.

Over the past decade she has tried to quit the painkillers. She would return them to the pharmacy and dump them down the sink. 

She suffered through the nightmares and shakes of withdrawal. But eventually, the pain would grow unbearable, so she'd take the drugs again.

Carmall Casey, 51, (pictured) was first prescribed opioids 10 years ago after she injured herself jumping off a truck at a dairy farm in Tasmania

Carmall Casey (right) is comforted by friend, Jake Marshall, while visiting her at home in Black River, Tasmania, Australia

Carmall Casey reads a heartbreaking note she ready while grappling with her opioid addiction

Casey eventually lost her farm. 

But even worse than that, she says, she lost her daughter.

She made bad choices on the drugs, she admits now and was living with a volatile man who began to bully her daughter, who was then 14, so she sent her to live with her father. 

It's a decision that tore them apart, and still tears Casey apart today.

She's not alone in her battle. Australia has failed to heed the lessons of the United States, and is now facing skyrocketing rates of opioid prescriptions and related deaths.

Coroners nationwide have long urged officials to address Australia's ballooning opioid addiction, and to create a tracking system to stop people from collecting multiple prescriptions from multiple doctors. 

Yet even as thousands died, the coroners' pleas were met largely with silence. 

'For what it is worth, I add my voice to the chorus pleading for urgency,' Western Australia coroner Barry King wrote in his report, delivered in May.

Drug companies facing scrutiny for their aggressive marketing of opioids in America have turned their focus abroad, working around marketing regulations to push the painkillers in other countries. 

And as with the U.S., Australia's government has also been slow to respond to years of warnings from worried health experts.

In dozens of interviews, doctors, researchers and Australians whose lives have been upended by opioids described a plight that now stretches from coast to coast. 

Australia's death rate from opioids has more than doubled in just over a decade. 

And health experts worry that without urgent action, Australia is on track for an even steeper spike in deaths like those seen in America, where the epidemic has left 400,000 dead. 

Carmall Casey finds an old pack of tapentadol while going through her box of medicine in her kitchen in Black River, Tasmania

Carmall Casey is embraced by Maxine Piper, a longtime friend and a source of support through Casey's addiction to opioids and battle with chronic pain, at her home in Black River, Tasmania

On an island off the coast of Tasmania, Dr. Bastian Seidel and his colleagues are immersed in what he calls a 'nightmare scenario.'

Two years ago, when he was president of the Royal Australian College of General Practitioners, Seidel dubbed Australia's opioid problem a 'national emergency.'

Today, he wonders if anyone was listening.

'It's depressing at times to see how we, as practitioners, literally messed up our communities,' he says. 

'It's our signature on the scripts. But the pressure being put on by the drug companies, by certain health sectors — that's the situation that we are facing now.'

Australia knows the extent of the problem, he says. The country knows addiction is devastating its communities. And yet, he says, nobody is doing anything.

'Unfortunately, in Australia, we've followed the bad example of the U.S.,' he says. 'And now we have the same problem.'

AUSTRALIA'S OPIOID ADDICTION

Opioids were once reserved for treating pain that was short-term, terminal or related to cancer. But in the 1990s, pharmaceutical companies began aggressively marketing them for chronic pain.

Starting in 2000, Australia began approving and subsidising certain opioids for use in chronic, non-cancer pain. Those approvals coincided with a spike in opioid consumption, which nearly quadrupled between 1990 and 2014, says Sydney University researcher Emily Karanges.

Dr. Jennifer Stevens, a pain specialist, saw the surge with startling clarity while working at St. Vincent's Hospital in Sydney.

A few years ago, a pharmacist at the hospital told her they needed to hire an extra person just to handle all the prescriptions they were handing out for Endone, a brand of oxycodone. 

Stevens discovered that the hospital's Endone prescriptions had increased 500 per cent in eight years, with no decrease in other opioids dispensed. 

Casey tried to quit the painkillers. She returned them to the pharmacy and dumped them down the sink

Further study revealed that 10 per cent of patients were still taking opioids three months after surgery, even though the drugs are generally only recommended for short-term use.

'We were just pumping this stuff out into our local community, thinking that that had no consequences,' says Stevens, a vocal advocate for changing opioid prescribing practices.

'And now, of course, we realise that it does have huge consequences.'

Just like in the U.S., as opioid prescriptions rose, so did fatal overdoses. Opioid-related deaths jumped from 439 in 2006 to 1,119 in 2016 — a rise of 2.2 to 4.7 deaths per 100,000 people, according to the Australian Institute of Health and Welfare.

Most of those deaths were related to prescription opioids, rather than illegal opioids such as heroin.

More than 3 million Australians — an eighth of the country's population — are getting at least one opioid prescription a year, according to the latest data.

The numbers and the warnings may have been glossed over partly because of Australia's piecemeal system of data collection and reporting, says Dr. Christian Rowan, an addiction specialist in the state of Queensland. 

Data is reported by various states, coroners and agencies, and often includes only prescriptions filled through the government-subsidised drug system and not private prescriptions.

Carmall Casey walks past photos of her kids that hang next to a clock in the shape of Tasmania, in her home. While struggling with her addiction, Casey lost her farm. Even worse, she says, she lost her daughter. She made bad choices on the drugs, she admits now. She was living with a volatile man who began to bully Sarah, so she sent her daughter, then 14, to live with her father

Carmall Casey, left, is visited by Jake Marshall, a friend who has recovered from an opioid addiction himself, at her home in Black River, Tasmania

'Because it's fragmented, people haven't had a line of sight as to what's happening,' he says.

Australia's government insists it is now taking the problem seriously.

The opioid codeine, which used to be available over the counter, was restricted to prescription-only in 2018. 

And last month, the country's drug regulator, the Therapeutic Goods Administration, announced tougher opioid regulations, including restricting the use of fentanyl patches to patients with cancer, in palliative care, or under 'exceptional circumstances.'

'I can't speak for the past,' says Greg Hunt, who became the federal Health Minister in 2017. 

'I can speak for my watch and my time where this has been one of my absolute priorities, which is why we've taken such strong steps. My focus has been to make sure that we don't have an American-style crisis.'

But for Sue Fisher, whose 21-year-old son Matthew died in 2010 of an overdose, it's too little, too late. The crisis is here, along with what she calls a 'crisis of ignorance.'

'We're living in a country that is oblivious to what's going on,' she says. 'Why aren't we learning from America's mistakes? Why don't we learn?'

HOW THE GOVERNMENT FELL SHORT

Former Australian soldier Matthew Tonkin was suffering from Post-Traumatic Stress Disorder when he became addicted to the prescription medicine. 

He overdosed at least four times before his death in 2014.

His father David Tonkin blames his son's death on the system that allowed him to see 24 doctors and get 23 different medications from 16 pharmacies — all in the space of six months.

Between January and July 2014 alone, Matthew Tonkin got 27 prescriptions just for oxycodone. The addiction that ultimately ended Matthew's life began in 2012, after he was injured while serving with the Australian Army in Afghanistan.

When the 22-year- old arrived on leave at his father's home in the Western Australian city of Perth, he held up a stack of OxyContin pill strips. The drugs had been prescribed to him by American doctors in Afghanistan for his injured hip and ankle.

'Look, Dad,' he said. 'The Yanks really know how to look after you.'

Matthew was 14 kilograms (30 pounds) lighter than the last time his father had seen him. 

David Tonkin holds a photo of his late son, Matthew, in his room at their home in Perth, Australia, Sunday, July 21, 2019. The addiction that ultimately ended Matthew's life began in 2012, after he was injured during a training session while serving with the Australian army in Afghanistan. The pills had been prescribed to him by American doctors in Afghanistan

David Tonkin looks over the coroner report on his son, Matthew, as Matthew's friend, Ivo Kinshela, looks on in Perth, Australia, Sunday, July 21, 2019. Kinshela considers David a father figure. He has long been close to the Tonkin family having lived with David and Matthew for three years when he was younger

He was suffering from post-traumatic stress disorder from the horrors of Afghanistan, including the death of his best friend, a fellow soldier. He was also suffering from a growing addiction to opioids. 

The addiction escalated after the army sent him to recover in Queensland, where doctors put him on an opioid called tramadol.

Matthew soon discovered how easy it was to get whatever prescriptions he wanted. He forged his doctor's signature. He told one doctor he'd knocked a bottle of pills into the toilet and needed more.

In August 2013, another doctor prescribed him more oxycodone after Matthew said he was suffering from PTSD and hip pain.

A few weeks later, Matthew had his first oxycodone overdose. A few months after that, he was discharged from the army.

One doctor called a hotline for medical professionals to report Matthew's apparent misuse of prescription drugs. 

But when Matthew moved back to Perth to live with David, doctors there had no way of knowing his drug use had been flagged in Queensland.

He hopped around clinics collecting prescriptions for opioids. 

The doctors were largely oblivious to what he was doing because Australia has no national, real- time prescription tracking system.

Bracelets remembering Matthew Tonkin, left, and his friend and fellow soldier, Robert Poate, sit on a table at the Tonkin home in Perth, Australia, Sunday, July 21, 2019. Matthew was suffering from post-traumatic stress disorder, a result of the horrors he experienced in Afghanistan, including the death of his best friend, Poate. He was also suffering from a growing addiction to opioids

David Tonkin walks past a mural decorated with the map of Australia and the word "Hope," in his neighborhood in Perth, Australia, Sunday, July 21, 2019. His son, Matthew, who died from a drug overdose, hopped from clinic to clinic, collecting prescriptions for opioids and benzodiazepines, used to treat anxiety. The doctors were largely oblivious to what he was doing because Australia has no national, real-time prescription tracking system

David begged Matthew's doctors and pharmacists to stop giving him OxyContin. Matthew just went to other doctors.

At a solemn gathering to honour military personnel on April 25, 2014, two of Matthew's friends had to hold him upright.

Back at home after the service, David told Matthew to hand over his pills. 

Matthew shoved David across the kitchen into the cupboard. Then he pinned his father to the floor and began to choke him.

David thought he was going to die.

Matthew eventually let go and both men went to the hospital for treatment. Two days later, Matthew called his father. 

'Do you still love me, Dad?' he asked. And of course, he did. So David kept trying to save him, right up until July 3, 2014, when he returned home from a walk and realised Matthew hadn't come out of his room all morning.

The night before, Matthew had been sick. 

David had cleaned the vomit off his son's bedroom floor and changed his sheets. Matthew took a shower, thanked his father and climbed into bed.

David walked into his son's room.

Ivo Kinshela wipes a tear while talking about his childhood friend, Matthew Tonkin, at the Tonkin's home in Perth, Australia, Sunday, July 21, 2019. 'Matt left Perth and Australia to Afghanistan a very healthy, fit young man, and he came back broken,' said Kinshela. "And he came back broken and addicted to opioids'

David Tonkin pets Ned, his son Matthew's cat, that now sleeps on David's bed on the sleeping bag Matthew used in Afghanistan, in Perth, Australia, Sunday, July 21, 2019. After Matthew died, and for years to come, David would suddenly awaken at 10 p.m. _ the same time that Matthew used to call from Afghanistan. Now, instead of Matthew's voice, there is only silence. Just like the silence from the officials he believes did little to prevent the death of his son

'Time to get up, mate.' There was no answer.

David placed a hand on Matthew. His body was warm. But he had no pulse. David called for an ambulance and started CPR. As he pumped his son's chest, the dispatcher counted out the beats.

One. Two. Three. Four.

Nothing. Nothing. Nothing. Nothing.

Five. Six. Seven. Eight.

Nothing.

WARNINGS IGNORED

The conclusion from King, the coroner, was blunt: Had a prescription tracking system been in place, Matthew would not have been given the oxycodone that killed him.

King's findings on Matthew's death were delivered at least a dozen years after the first coroners' reports began warning of a growing opioid problem. 

As early as 2007, a coroner had suggested that someone look into why the opioid prescription rate on the island of Tasmania was so high.

Two states — Tasmania and Victoria — developed their own prescription tracking systems, but they only monitor opioid prescriptions within their respective states, and neither is currently mandatory.

The development of a national system has been mired in bureaucratic delays. 

In 2017, the government committed 16 million Australian dollars (US$11 million) to creating one, and Hunt, the health minister, later said it would be ready by the end of 2018. It has yet to be rolled out.

In an interview, Hunt blamed the delay on the states. The national framework is ready, he said, but the states must connect to it.

In March 2019, New South Wales coroner Harriet Grahame warned that Australia's opioid deaths could reach many thousands over the next five years. 

'We appear to have few co-ordinated strategies to address this problem,' Grahame wrote in a report.

'Lowering the rate of opioid overdose is clearly achievable but it will require a government willing to listen to health experts and to act decisively on their advice.'

After Matthew died, and for years to come, David would suddenly awaken at 10pm — the same time that Matthew used to call from Afghanistan. Now, instead of his son's voice, there is only silence.

THE POOR PAY THE PRICE

From her home in rural northwest Tasmania, 51-year-old Carmall Casey seethes over a system she says pushed her and so many others into addiction. It is a system that has made opioids the cheap and easy alternative for Australians, particularly the poor.

Here in Tasmania, there are echoes of American Appalachia — in the rural towns, the poverty and the cascade of lives torn apart by pills that promised to take away the pain but in the end created more.

This is Australia's poorest state, and like Appalachia, it is the country's epicentre for opioids. 

Tasmania has the nation's highest rate of opioid packs sold per person — 2.7 each. One region has the highest number of government- subsidised opioid prescriptions in Australia: more than 110,000 for every 100,000 people.

Casey still has the tattered envelope she scrawled her anguish on as she battled her addiction. 

'Imagine having a toothache for weeks, months, one year, two years, three, four, and it's still aching now ... the pain eats away at you, the drugs send you crazy,' she wrote.

In June, she told herself: Enough. She returned the remaining pills to her pharmacist.

She found a surgeon who took her seriously. And she got an appointment with a physiotherapist who is teaching her exercises to manage her pain.

On a recent afternoon, while rifling through a box of medicine in her kitchen. Suddenly, she freezes. Tucked inside is an old pack of tapentadol that she thought she'd thrown away. She washes the pills down the kitchen sink.

She doesn't know what she'll do when the pain returns. But she says she will never return to opioids.

'I'm not going back,' she says and begins to weep. 'I'm not.'

The AP's reporting on the global opioid crisis is supported by a grant from the Pulitzer Center on Crisis Reporting. The Global Opioids project can be seen here.