Young rural women are increasingly seeking help for ice addiction, but frontline workers say access to rehab has not improved since a landmark report on the use of the drug.
Health workers had told state Labor MP Trish Doyle the use of ice was "out of control" in western NSW, she told an inquiry into rural health on Tuesday.
Methamphetamine, known as ice, was the primary drug for 64 per cent of young women who went through a rehab program in Orange in the past year, an increase of eight per cent from the year before.
Julie Dignan, a director at the rehab's operator Lives Lived Well, said alcohol was the second most common drug of concern at 16 per cent.
Men over 40 going through withdrawal and residential rehab were more likely to be addicted to alcohol, followed by ice.
Drug and alcohol services were stretched in cities and the regions, but the challenges were more pronounced in country areas, Ms Dignan said.
"Regional and rural may struggle a bit more with the barriers in terms of distance and access to service and workforce retention and recruitment," she told the inquiry sitting in Orange.
A parliamentary committee is investigating progress on recommendations of the damning 2021-22 NSW health inquiry, which found country people have worse health outcomes than their city peers.
Committee chair Joe McGirr asked whether there were any improvements in drug and alcohol treatment since the 2020 special commission into the drug ice.
That commission found drug policies failed to deal with the "profound harms" of ice use, particularly in rural areas.
The NSW government's formal response came almost three years later, featuring funding to improve early intervention strategies.
But little of that funding had reached the frontline, Mission Australia's western NSW program manger Jess Silva said.
The drug and alcohol hub in Bathurst, for example, has a waiting list of 40 days due to lack of staff.
Ms Silva said drug addiction was increasingly seen in young teens, but rehabilitation programs were capped at 18.
"That's certainly a barrier ... because unless you're 18, not much can happen," she said.
The committee was also told a shortage of pilots was putting rural patients at risk.
Only half the daily air ambulance shifts were covered, potentially leaving critically ill patients stranded at rural hospitals, said Randall Greenberg, from the University of Sydney's School of Rural Health.
"It is worse than I have ever seen," Associate Professor Greenberg said.
The inquiry will hold hearings in Sydney from Friday.
