Illicit opioids, including heroin

Opioids refer to a class of drugs that are naturally or synthetically derived from the opium poppy plant (ACIC 2019; NSW Ministry of Health 2017). Diacetylmorphine, commonly known as heroin, is a derivative of morphine, an alkaloid contained in raw opium (ACIC 2021a).

This section focuses on the harms, availability and consumption of illicit opioids including heroin, as distinct from pharmaceutical opioids such as morphine, methadone and oxycodone. See the section on pharmaceuticals for recent trends and data in relation to the use and harms for pharmaceutical opioids.

Key findings

View the Illicit opioid (heroin) in Australia fact sheet >

Availability

The availability of heroin in Australia has fluctuated over time. In the early 2000s, there was a rapid and considerable reduction in the availability of heroin in Australia (commonly referred to as the heroin shortage or drought) and this was associated dramatic reductions in heroin-related overdoses (Degenhardt et al. 2004). Since then, the availability of heroin has steadily increased.

Prior to COVID-19 in 2020, the Illicit Drug Reporting System (IDRS) showed no significant changes in the perceived availability, pricing and purity of heroin in Australia, as reported by people who inject drugs (Peacock et al. 2019). This suggests that the Australian heroin market was highly stable (Sutherland et al. 2021, Figure 9). In 2021, the price of heroin decreased compared to 2020. There were also changes in the perceived purity and availability of heroin. More specifically, in 2021:

Data collection for 2021 took place from June to July. Due to COVID-19 restrictions being imposed in various jurisdictions during data collection periods, interviews in 2020 and 2021 were delivered face-to-face as well as via telephone. This change in methodology should be considered when comparing data from the 2020 and 2021 samples relative to previous years (Sutherland et al. 2021).

The Australian Criminal Intelligence Commission (ACIC) collects national illicit drug seizure data annually from federal, state and territory police services, including the number and weight of seizures to inform the Illicit Drug Data Report (IDDR). The number of heroin detections at the Australian border has fluctuated over the past decade, with the long-term trend remaining relatively stable. The number of heroin detections at the Australian border has decreased 24% over the last decade, from 232 in 2010–11 to 177 in 2019–20. The weight of heroin detected has decreased 72% over the same period, from 400 kilograms in 2010–11 to 110 kilograms in 2019–20.

Between 2010–11 and 2019–20 the number of national heroin seizures increased 31% from 1,700 up to 2,230, while the weight of heroin seized decreased 44% from 375 kilograms to 210 kilograms (ACIC 2021a).

Consumption

The National Drug Strategy Household Survey (NDSHS) shows that heroin use among the general population has remained low in Australia between 2001 (0.2%) and 2019 (less than 0.1%) (Figure HEROIN1). However, between 2016 and 2019, more people reported heroin to be the drug of most concern to the community (7.5% compared with 8.5%) and thought it caused the most deaths (10.6% compared with 11.9%) (AIHW 2020, tables 9.5 and 9.3).

Figure HEROIN1: Lifetimeᵃ and recentᵇ use of heroin, people aged 14 and over, 2001 to 2019 (per cent)

This figure shows the proportion of lifetime and recent use of heroin for people aged 14 and over between 2001 and 2019. In 2019, only 0.1% of people aged 14 and over reported using heroin in the last 12 months and this has remained stable since 2001. Lifetime use of heroin has been decreasing since 2007, from 1.6% to 1.2% of people aged 14 and over.

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Geographic trends

The National Wastewater Drug Monitoring Program (NWDMP) indicates that heroin consumption in Australia is relatively low, but has fluctuated over time. The estimated weight of heroin consumed steadily increased from 750 kilograms in 2017–18 to 1,021 kilograms in 2019–20 before declining to 984 kilograms in 2020–21 (ACIC 2022a; Figure HEROIN2). 

Data from Report 16 of the NWDMP show that nationally:

  • Consumption of heroin is around 3 times lower in regional areas than capital cities.
  • The estimated population-weighted average consumption of heroin decreased in both capital city and regional sites between August and December 2021, before increasing in capital cities between December 2021 and February 2022 (regional data not yet available) (ACIC 2022b).

For state and territory data, see the National Wastewater Drug Monitoring Program reports.

Figure HEROIN2: Estimated consumption of heroin in Australia based on detections in wastewater, 2020 to 2021

This infographic shows that Australians consumed an estimated 984 kilograms of heroin in 2020–21. Heroin consumption is typically higher in capital cities than regional areas. Between August and December 2021, average consumption of heroin decreased in capital cities and regional areas.

(a) “Average consumption” refers to estimated population-weighted average consumption.

Notes: Report 15 covers 57% of the Australian population (58 wastewater treatment sites), Report 16 covers 56% of the Australian population (56 wastewater treatment sites).

Source: AIHW, adapted from ACIC 2022a and ACIC 2022b.

Poly drug use

Heroin

Poly drug use is defined as the use of more than 1 illicit drug or licit drug in the previous 12 months. The 2019 NDSHS showed that cannabis (86%) was the most common substance used concurrently with heroin. Other drugs commonly used were tobacco (79%), pharmaceuticals (66%) and alcohol (65% exceeded the single occasion risk guideline at least monthly) (AIHW 2020, Table 1.3).

Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System (NASS). Monthly data for 2021are currently available for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory It should be noted that some data for Tasmania and the Australian Capital Territory have been suppressed due to low numbers. Please see the data quality statement for further information.

In 2021, multiple drugs (excluding alcohol) were involved in at least 3 in 10 heroin-related ambulance attendances, ranging from 33% in the Australian Capital Territory to 43% in Queensland (Table S1.10).

For related content on Multiple drug involvement see Impacts: Ambulance attendances.

Figure HEROIN3: Ambulance attendances for heroin, by age, sex and selected states and territories, 2021

Harms

For related content on illicit opioid (including heroin) impacts and harms, see also:

Heroin is a central nervous system depressant. Like other opioids, it binds to receptors in the brain, sending signals to block pain and slow breathing.

Heroin may be snorted, swallowed or smoked, but is most commonly melted from a powder or rock form and injected. Injection comes with a range of additional harms associated with the unsanitary sharing of injecting equipment, such as the transmission of blood borne viruses like Hepatitis C and HIV (Table HEROIN1).

Table HEROIN1: Short and long-term effects of heroin use

Short-term effects

Long-term effects

  • Analgesia
  • Cough suppressant
  • Euphoria
  • Dry mouth
  • Heavy feeling in hands and feet
  • Nausea and vomiting
  • Severe itch
  • Drowsiness
  • Respiratory depression resulting in fatal and non-fatal overdose, especially when used in conjunction with other sedative substances including benzodiazepines and alcohol
  • Severe constipation
  • Tooth decay (from lack of saliva)
  • Irregular menstrual periods in females
  • Impotence in males
  • Loss of appetite and weight
  • Neurochemical changes in the brain
  • Memory impairment
  • Mental health issues including depression
  • Physical dependence and associated withdrawal, which manifest as flu-like symptoms

Source: Adapted from ACIC 2019a; Nielsen & Gisev 2017; NSW Ministry of Health 2017.

Burden of disease and injury

The Australian Burden of Disease Study 2018  found that opioid use was responsible for 0.9% of the total burden of disease and injuries in Australia in 2018 and 32% of the total burden due to illicit drug use (Table S2.5). 

Most of the burden due to opioid use was due to 2 linked diseases: poisoning and drug use disorders (excluding alcohol). Poisoning contributed to 42%, and drug use disorders (excluding alcohol) to 28%, of the total burden due to opioid use. A further 2.9% of the burden due to opioid use was attributable to suicide and self-inflicted injuries (AIHW 2021b).

Ambulance attendances

Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System (NASS). Monthly data are presented for 2021 for people aged 15 years and over for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory. Attendance numbers for Tasmania and the Australian Capital Territory are reported at the total state level due to small numbers in other categories.

In 2021, for heroin-related ambulance attendances in these jurisdictions:

  • Rates of attendances ranged from 2.5 per 100,000 population in Tasmania to 45.8 per 100,000 population in the Australian Capital Territory.

In 2021, for heroin-related ambulance attendances in New South Wales Victoria and Queensland:

  • 7 in 10 (69%) of attendances were for males.
  • Rates of attendance are typically higher in the older age groups. The highest rates of attendances were in people aged 35–44, in:
    • Victoria (808 attendances, 86.5 per 100,000 population).
    • New South Wales (394 attendances, 35.3 per 100,000 population).
    • Queensland (132 attendances, 19.1 per 100,000 population) (Table S1.9).

Figure HEROIN3: Ambulance attendances for heroin, by age, sex and selected states and territories, 2021

This figure shows heroin-related ambulance attendances in NSW. The highest number of attendances were for males aged 35-44. There is a filter to select state/territory, drug and measure (number of attendances or rate per 100,000 population).

Hospitalisations

Opioid poisoning can result in significant harm, including respiratory failure, aspiration, hypothermia and death.

In 2018–19, drug-related hospitalisations with a principal diagnosis of opioid poisoning were more likely to involve pharmaceutical opioids than heroin.

  • Nearly half (46%) were due to natural and semi-synthetic opioids, 16% to synthetic opioids and methadone accounted for 7%.
  • Heroin accounted for 1 in 4 (25%) (Man et al. 2021).

The age-standardised rate of hospitalisations due to heroin poisoning increased from 3.2 per 100,000 in 2017–18 to 4.1 in 2018–19. Over the same period, the rate of hospitalisations due to natural and semi-synthetic opioids decreased from 8.1 to 7 per 100,000 population (Man et al. 2021).

Deaths

Drug-induced deaths are determined by toxicology and pathology reports and are defined as those deaths that can be directly attributable to drug use. This includes deaths due to acute toxicity (for example, drug overdose) and chronic use (for example, drug-induced cardiac conditions) (ABS 2021).

People who use heroin have a particularly high risk of overdose, especially when heroin is used in conjunction with other drugs like benzodiazepines (for example, alprazolam, diazepam) and alcohol. However, there are some challenges in interpreting the numbers of heroin deaths. Heroin can be difficult to identify at toxicology because it is rapidly metabolised to morphine by the body and these metabolites cannot be distinguished from other morphine sources (for example, codeine).

Opioids, including both licit and illicit substances, have been the leading class of drug present in drug-induced deaths in Australia for the last 2 decades. While illicit opioids include opium as well as heroin, most illicit opioid deaths involve heroin–99.5% of drug-induced deaths involving an illicit opioid in 2019 (Chrzanowska et al. 2021).

Of the 1,842 drug-induced deaths in Australia in 2020, 462 or 25% were due to heroin–the highest number of deaths attributed to heroin since 1997 (Table S1.1). The rate of deaths involving heroin has overall declined since the late 1990s, when heroin consumption was at its peak in Australia (Degenhardt, Day & Hall 2004). However, deaths involving heroin have increased from 1.0 per 100,000 people in 2011 to 1.9 in 2020. Between 2017 and 2020, the rate has remained steady at 1.9 per 100,000 population (Figure HEROIN3; Table S1.1).

In 2018, deaths with heroin identified had a median age at death of 42.1 years, lower than for pharmaceutical opioids (median 46.6 years) (ABS 2019).

Figure HEROIN4: Number or age-standardised rate (per 100,000 population) of drug-induced deathsᵃ for all opioids and heroin only, 1997 to 2020

The figure shows that the number of drug-induced deaths due to all opioids and heroin only steadily increased from 2006 to 2017. The number of deaths due to all opioids has decreased from 1,385 in 2017 to 1,091 in 2020, while the number of deaths due to heroin has increased from 453 to 462 in the same period.

Treatment

The 2020–21 Alcohol and Other Drug Treatment Services in Australia annual report shows that heroin was the principal drug of concern in 4.6% of treatment episodes provided for clients’ own drug use (AIHW 2022a).

This is a similar proportion to 2019–20 (5.1% of closed treatment episodes) (AIHW 2021a).

Data collected for the AODTS NMDS are released twice each year—an Early Insights report in April and a detailed report mid-year.

The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) provides information on treatment provided to clients by publicly funded AOD treatment services, including government and non-government organisations. Data from the AODTS NMDS showed that heroin was the fourth most common principal drug of concern in closed treatment episodes provided to clients in 2020–21 (Figure HEROIN4). Heroin was the principal drug of concern in 4.6% of treatment episodes provided for clients’ own drug use, a similar proportion to 2019–20 (5.1%) (AIHW 2022, Table Drg.5). In almost three-quarters (74%) of these episodes, the method of use was injecting (AIHW 2022a, Table Drg.6).

In 2020–21, where heroin was the principal drug of concern:

  • Most (69%) clients were male and nearly 1 in 5 (19%) were Indigenous Australians (AIHW 2022a, tables SC.9 and SC.11).
  • Over two-thirds of clients were aged 30–39 (35% of clients) or 40–49 (34%) (AIHW 2022a, Table SC.10).
  • The most common source of referral was self or family (42% of treatment episodes), followed by a health service (33%) (AIHW 2022a, Table Drg.55).
  • Counselling was the most common main treatment type (23% of treatment episodes), followed by support and case management (20%) and pharmacotherapy (17%) (AIHW 2022a, Table Drg.54).

Figure HEROIN5: Treatment provided for own use of heroin, 2020–21 (per cent)

This infographic shows that heroin was the principal drug of concern in 4.6%25 of closed treatment episodes provided for clients’ own drug use in 2020–21. Around 1 in 6 clients were Indigenous Australians. The most common main treatment type provided to clients for their own heroin use was counselling (1 in 5 episodes).

Source: AIHW 2022, tables Drg.1, SC.11 and Drg.54.

Treatment agencies whose sole function is prescribing or providing dosing services for opioid pharmacotherapy are excluded from the AODTS NMDS. Due to the multi-faceted nature of service delivery in this sector, these data are captured in the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection.

NOPSAD data showed that, on a snapshot day in 2021, 44% of clients reported heroin as their opioid drug of dependence across Australia (excluding data for Queensland). However, these data should be used with caution due to the high proportion of clients with ‘Not stated/not reported’ as their drug of dependence; this was the case for 35% of clients overall (AIHW 2022b).

Further information on pharmacotherapy in Australia >

At-risk groups

  • Indigenous Australians are overrepresented in treatment services for heroin as the principal drug of concern. 
  • Heroin is commonly injected and so its use is overrepresented among people who inject drugs.