Heroin: client demographics and treatment

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In 2021–22, heroin was reported as a drug of concern (either principal or additional) in 5.7% of all treatment episodes (12,043 episodes) (Table Drg.4).

Heroin was the fourth most common principal drug of concern:

  • in 4.5% of all treatment episodes (9,400 episodes) (Table Drg.4).
  • This has remained consistent across the 10 years to 2021–22, although the proportion of heroin-related episodes has declined from a peak of 8.3% (12,800 episodes) in 2012–13 (Table Drg.5).

In 2021–22, over 1 in 3 heroin-related treatment episodes listed at least 1 additional drug of concern (36% or 3,400 episodes) (Table Drg.2). The most common additional drugs of concern were amphetamines 33% or 1,900 episodes), cannabis (19% or 1,100 episodes) and nicotine (15% or 850 episodes) (Table Drg.3). These drugs may not have been the subject of any treatment within the episode.

Treatment for heroin use in the AODTS NMDS collection

People who seek treatment for heroin use have several options for treatment, including withdrawal programs (called detoxification) and abstinence-based treatment (for example, residential rehabilitation in a therapeutic community) (O’Brien 2004).

In Australia, one of the most common treatments for heroin use is opioid pharmacotherapy treatment (also known as opioid agonist therapy). Opioid pharmacotherapy involves replacing opioid drugs, including heroin, with a longer-lasting, medically prescribed opioid.

Agencies whose sole function is to prescribe or provide dosing services for opioid pharmacotherapy are excluded from the AODTS NMDS. Data from these agencies are captured in the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection (AIHW 2023). For more information, please see the 2022 NOPSAD report.

For information on heroin use and harms, please see:

Client demographics

In 2021–22, 5,242 clients received treatment for heroin as the principal drug of concern. Of these clients:

  • Over 2 in 3 were male (68% of clients) (Table SC.9).
  • Over 2 in 3 were aged either 30–39 (35% of clients) or 40–49 (33%) (Table SC.10). This was consistent for both males and females (Figure HEROIN 1).
  • Over 1 in 5 were Indigenous Australians (21% or 1,100 clients) (Table SC.11). This represents a crude rate of 187 Indigenous clients per 100,000 population (Table SCR.26).

Figure HEROIN 1: Clients with heroin as the principal drug of concern, by sex and age group, 2021–22

The butterfly bar chart shows that in 2021-22, male clients receiving treatment for heroin as the principal drug of concern were most likely to be aged 40-49 (34.5%) followed by 30-39 (33.4%). Female clients were most likely to be aged 30-39 (37.1%) followed by 40-49 (28.7%).

Treatment

In 2021–22, 9,396 treatment episodes were provided to clients for heroin as the principal drug of concern (Table Drg.4).

Among heroin-related treatment episodes in 2021–22:

  • The most common source of referral was self/family (43% of episodes), followed by health services (28%) (Figure HEROIN 2, Table Drg.55).
  • The most common main treatment type was counselling (21% of episodes), followed by assessment only (21%) and pharmacotherapy (19%) (Figure HEROIN 2, Table Drg.54).
  •  In the 10 years to 2021–22, main treatment types for heroin have fluctuated:
    • Treatment episodes for withdrawal management decreased from 22% to 6.8% (or from around 2,800 to 640 episodes).
    • Conversely, pharmacotherapy episodes increased from 7.8% to 19% (or from around 1,000 to 1,800 episodes). Fluctuations in pharmacotherapy treatment episodes over time can be attributed to changes to jurisdictional coding practices and systems, resulting in under-reporting of pharmacotherapy at the national level.
  • Over 7 in 10 treatment episodes took place in a non-residential treatment facility (72% of episodes) (Table Drg.56).
  • The median duration of treatment episodes was around 1 month (30 days) (Table Drg.58).
  • 3 in 5 treatment episodes ended with a planned completion (60% of episodes), while just under 1 in 5 (19%) ended unexpectedly (Figure HEROIN 2; Table Drg.56).

Figure HEROIN 2: Treatment episodes with heroin as the principal drug of concern, by main treatment type, reason for cessation or source of referral, 2012–13 to 2021–22

The line graph shows that counselling has been the most common main treatment type among treatment episodes for cannabis for most of the 10 years to 2021–22. The number of counselling episodes has fallen from 4,209 in 2012–13 to 1,949 in 2021–22. Other treatment types fluctuated across time, with assessment only becoming the most common treatment type in 2021–22 (1,983 episodes). Filters allow the user to view data as the number or per cent of episodes for main treatment type, reason for cessation or source of referral.

In 2021–22, injecting remained the most common method of use in heroin-related treatment episodes (71% of episodes) (Table Drg.6). Clients reported injecting drugs in the past 3 months in nearly 1 in 2 treatment episodes (46% of episodes). In a further 11% of episodes, clients reported that they last injected 3–12 months ago (Table Drg.52).

Between 2012–13 and 2021–22 the proportion of treatment episodes where clients reported that they had never injected drugs increased 4-fold, rising from 5.4% (696 episodes) to 20% (1,900 episodes) (Table Drg.52).

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