Opioids are prescribed in Australia to treat acute pain. Fentanyl is generally restricted to palliative care or cases of severe, longstanding pain.

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“Pharmaceutical opioid deaths in Australia now exceed heroin deaths by a significant margin – two to 2.5 times – the reverse of what was seen in the 1990s,” Ms Dwyer said.

“Pharmaceutical opioid deaths particularly dominate in the over-30 age group.”

Between 2011 and 2015 there were 2145 deaths associated with oxycodone, morphine, codeine, fentanyl, tramadol and pethadine, compared with 985 due to heroin.

Information from NSW police shows that between March 2016 and February 2018, 26 per cent of all drug-related deaths were due to opiates or opiate derivatives, and 32.29 per cent of that figure was directly attributed to fentanyl.

Fentanyl, 100 stronger than morphine, was detected in three of the people who are the subject of the inquest in post-mortem examinations.

One of them, a 44-year-old mother, was prescribed fentanyl by a doctor – a fact to come under scrutiny during the inquest.

The US has seen a significant spike in fentanyl deaths, including singer Prince, who died after taking a counterfeit painkiller laced with the drug. In Australia, customs officials have made small seizures of fentanyl and its analogues, but most deaths have been linked to prescription fentanyl.

Another issue to be examined in the inquest is the availability of Naloxone, a drug that saves lives by reversing the opioid-induced depression in overdoses.

Ms Dwyer said Naloxone was available via injection but there were several training, educational and legal issues limiting its deployment to risk groups.

The drug is available outside Australia as a nasal spray.

Brian Muller, medical affairs director at global pharmaceutical network Mundipharma, will give evidence later this week that his company is applying to have the drug approved for use in Australia this year.

“In at least two of the cases Your Honour is inquiring into, Naloxone may have been of assistance,” Ms Dwyer said.

Going over about five days, the inquest will also look into the benefit of a real-time prescription monitoring system that would help doctors restrict patients “shopping” for strong painkillers.

Harm minimisation expert Dr Alex Wodak, who helped establish the first supervised injecting room in Australia and is the current president of the Australian Drug Law Reform Foundation, is expected to speak about his concerns of the significant increase of drug-induced deaths in recent years.