Heroin Toxicity Deaths in Australia (2020-2022)

November 2023
Darke, S., Duflou, J., Peacock, A., Farrell, M., & Lappin, J. (2023). A descriptive coronial study of heroin toxicity deaths in Australia, 2020-2022: characteristics, toxicology, and survival times. Addiction.

In recent years, much of the focus of the media has been on drugs such as methamphetamine, cocaine, and MDMA (‘ecstasy’). While these are clearly worthy of serious discussion, little recent attention has been given to heroin. Just because one drug comes to prominence does not mean that another ceases to be a problem. In order to examine the situation regarding fatal heroin overdose in Australia in the early 2020s, we examined all cases over the period 2020 to 2022. The results are presented in our recent article, published in Addiction.

We found that 610 people died from heroin overdose in those few years. Beyond question, heroin is still a significant problem. Who were these people? The average age was 43 years but ranged into the seventies. We are seeing far more older people dying from heroin overdose than when I first studied overdose in the 1990s. Most were men, and few were in a treatment programme for their heroin dependence. As we have seen across decades, almost all cases involved heroin being used with other drugs, most commonly hypnosedatives such as diazepam. Most importantly, using the toxicology results we were able to make an estimate of survival times. We estimated that in over half of cases, there had been a survival time in excess of 20-30 minutes.

What then can be done? Each of these deaths is a tragedy and we must learn from them to reduce the number of such cases. We know that enrolment in a treatment programme substantially reduces the risk of overdose and death. The more people with heroin dependence who we enrol in treatment, the more lives are likely to be saved. Making sure take-home naloxone, the ‘antidote’ to a heroin overdose, is available to heroin users (indeed all users of opioids) is crucial. Nasal preparations are now available to the person administering the antidote does not need to know how to inject a person. In most cases, there is ample time to intervene. Always call an ambulance when a person has overdosed. Finally, we might well consider using wearable technology to detect, and initiate responses to overdose. Widely used with elderly people, it has not been trialled in Australia with people who use heroin. 

Heroin has not gone away, and significant numbers of people continue to die from using it. We must keep this in mind and not be distracted by the attention given to other drugs. 

A copy of the study can be accessed here.