Heroin: client demographics and treatment

In 2019–20, heroin was reported as a drug of concern in 7% of all closed treatment episodes, either as a principal or additional drug of concern:

  • heroin was the 4th most common principal drug of concern (5% or 11,133 episodes)
  • the most common additional drugs of concern reported with heroin include amphetamines (30%) or cannabis (18%) but these drugs are not the subject of any treatment within the episode (Figure DRUGS1; tables SD.6–8).

Heroin use and harms

Heroin is an opioid drug; opioids are strong pain-killers with addictive properties. Short-term side effects of use include pain relief and feelings of euphoria and wellbeing, while long‑term effects can include lowered sex drive and infertility (for women), along with risk of overdose, coma and death (ADCA 2013).

People who seek treatment for heroin use can take part in a withdrawal program (also called detoxification), an abstinence-based treatment (for example, residential rehabilitation in a therapeutic community) or attend an opioid maintenance substitution program (O’Brien 2004).

Results from the 2019 National Drug Strategy Household Survey showed that:

  • nationally, 1.2% of people aged 14 and over had used heroin in their lifetime and less than 0.1% had used it in the previous 12 months. However, the recent heroin use estimate has a relative standard error of 25–50% and should be interpreted with caution.
  • there was no statistically significant change in the proportion of people using heroin between 2016 and 2019 (AIHW 2020).

Results from the 2020 National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection reported that clients receive pharmacotherapy treatment for a range of opioid drugs. These include illicit opioids (such as heroin) and pharmaceutical opioids available by prescription (such as oxycodone) or through illicit means. From 1 February 2018, all formerly over-the-counter (non-prescription) codeine-containing medicines for pain relief, cough and colds became available by prescription only. Results from NOPSAD include:

  • Data for opioid drug of dependence has a high proportion of clients with ‘Not stated/not reported’ as their opioid drug of dependence (38% of clients in 2020).
  • High rates of ‘Not stated/not reported’ were reported in New South Wales (64%), Victoria (33%) and Tasmania (19%).
  • For the 62% of clients with a reported opioid drug of dependence, heroin was the most commonly reported drug of dependence (37%) followed by oxycodone (6%) and buprenorphine (5%).
  • Heroin was the most common drug of dependence in all states and territories, except Tasmania and the Northern Territory, where morphine was the most common (AIHW 2021).

Client demographics

Where heroin was the principal drug of concern, 70% of clients were male and 18% were Indigenous Australians (tables SC.6, SC.8).

For clients whose principal drug of concern was heroin:

  • almost 2 in 5 clients were aged 30–39 (38%), followed by those aged 40–49 (32%) (Table SC.7)
  • male (70%) and female (69%) clients were most likely to be aged 30–49 (Figure HEROIN1)
  • the rate of Indigenous clients receiving treatment increased from 146 per 100,000 people in 2015–16 to 190 in 2019–20.

Figure HEROIN1: Clients with heroin as a principal drug of concern, by age group (years) and sex, 2019–20 (%)

Figure 4.3


Treatment

In 2019–20, for treatment episodes where heroin was the principal drug of concern:

  • the most common source of referral was self/family (43%), followed by a health service (32%) (Table SD.85)
  • the most common main treatment types for heroin as a principal drug of concern were counselling (24%), followed by support and case management (15%) and pharmacotherapy (13%) (Table SD.90)
  • treatment episodes were most likely to take place in a non-residential treatment facility (68%) (Table SD.92).

Over the 10-year period to 2019–20 the proportion of episodes for heroin as a principal drug of concern with the main treatment type of:

  • withdrawal management treatment decreased from 25% in 2010–11 to 10% in 2019–20 (SD.90)
  • pharmacotherapy increased from 2% in 2010–11 to 17% in 2014–15; the decrease since 2015–16 can be attributed to jurisdictional coding practices/system changes resulting in under-reporting at the national level for pharmacotherapy as a treatment type (Figure HEROIN2; Table SD.90).

Figure HEROIN2: Closed treatment episodes with heroin as a principal drug of concern, by main treatment type, reason for cessation or source of referral, 2010–11 to 2019–20 (%)

Figure 4.3

For treatment episodes where heroin was the principal drug of concern in 2019–20:

  • injecting was the most common method of use (78% of episodes) (Table SD.87)
  • in over half (54%) of episodes, the client reported they had injected drugs in the previous 3 months, while 12% reported they last injected 3–12 months ago (Table SD.88)
  • the median duration of episodes was about 4 weeks (29 days)
  • just over half (53%) of episodes ended with an expected cessation (Table SD.93).

Over the 10-year period to 2019–20:

  • the proportion of episodes where heroin was the principal drug of concern almost halved, falling from 9% (13,354 of episodes) to 5% (11,133 of episodes) (Table SD.2)
  • the median duration of heroin treatment episodes decreased from 36 days in 2010–11 to 29 days in 2019–20 (Table SD.95).

References

See reference list.