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 2022; Figure HEROIN2).
Data from Report 15 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 reached its highest recorded levels in capital cities in August 2020, before declining in August 2021.
Between April 2021and August 2021, heroin consumption increased in both regional areas and capital cities (ACIC 2022).
For state and territory data, see the National Wastewater Drug Monitoring Program reports.

(a) “Average consumption” refers to estimated population-weighted average consumption.
Notes:
1. Data in Report 15 are from 58 wastewater treatment sites, covering approximately 57% of the Australian population in 2021.
2. Heroin data for August 2016 are not available.
Source: AIHW. Adapted from NWDMP Report 15.
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) (Table S2.68).
Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System for Alcohol and Other Drug Misuse and Overdose. Data for 2020 are currently available for New South Wales, Victoria, Queensland and the Australian Capital Territory. Data are presented for 4 snapshot months per year, specifically March, June, September and December. Please see the data quality statement for further information.
In 2020, multiple drugs were consumed in at least 3 in 10 heroin-related ambulance attendances, ranging from 30% in Victoria to 40% in Queensland (Table S2.81).
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
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Long-term effects
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- 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
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- 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
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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 S2.69).
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).
Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System for Alcohol and Other Drug Misuse and Overdose.
In 2020, for heroin-related ambulance attendances:
- The rate of attendances ranged from 3.6 per 100,000 population in Queensland to 16.5 per 100,000 population in the Australian Capital Territory.
- The majority of attendances were for males, ranging from 62% of attendances in the Australian Capital Territory to 73% of attendances in Victoria.
- The median age of patients was similar across jurisdictions—39 years in New South Wales and the Australian Capital Territory and 40 years in Victoria and Queensland.
- Heroin-related attendances where multiple drugs (excluding alcohol) were present ranged from 30% of attendances in Victoria to 40% of attendances in Queensland (Table S2.81).
The characteristics of heroin-related ambulance attendances varied by region in 2020:
- Higher rates of attendances were reported in metropolitan areas than in regional areas in New South Wales (7.8 per 100,000 population and 3.3, respectively), Victoria (15.4 per 100,000 population and 5.3, respectively) and Queensland (5.7 per 100,000 population and 1.7, respectively).
- A higher proportion of attendances were transported to hospital in metropolitan areas than in regional areas for New South Wales (70% and 59% respectively).
- Higher proportions of attendances were transported to hospital in regional areas in Victoria (66% regional and 56% metropolitan) and Queensland (84% regional and 79% metropolitan).
- In the Australian Capital Territory (metropolitan only), 44% of attendances were transported to hospital (Table S2.81).
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).
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 S1.1a). 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 S1.1a).
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).