Alcohol, tobacco & other drugs in Australia

Opioids refer to a class of drugs that are naturally or synthetically derived from the opium poppy plant (ACIC 2019a; NSW Ministry of Health 2017). Diacetylmorphine, commonly known as heroin, is derived from the sap extracted from the seedpod of the opium poppy (ACIC 2019a).

This section focuses on the harms, availability and consumption of illicit opioids (heroin), namely heroin, as distinct from pharmaceutical opioids such as morphine, methadone and oxycodone. See the section on the non-medical use of pharmaceutical drugs for recent trends and data in relation to the use and harms for pharmaceutical opioids.

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. The Illicit Drug Reporting System (IDRS) has shown no significant changes in the perceived availability, pricing and purity of heroin in Australia in recent years, as reported by people who inject drugs (Peacock et al. 2019). This suggests that the Australian heroin market is now highly stable (Table S2.11).

The number of heroin detections at the Australian border has increased 6% over the past decade, from 250 in 2008–09 to 265 in 2017–18. However, the weight of heroin detected has increased 26% over the same period, from 150.6 kilograms in 2008–09 to 190 kilograms in 2017–18. There has also been an increase in both the number and weight of national heroin seizures over the past decade. Between 2008–09 and 2017–18 the number of national seizures increased 17% from 1,691 up to 1,977, while the total weight of heroin seized increased 57% from 145.6 kilograms to 229 kilograms (ACIC 2019a; ACC 2010).

Consumption

The National Drug Strategy Household Survey (NDSHS) shows that heroin use among the general population is low in Australia.

• In 2016, only 0.2% of Australians aged 14 and over reported using heroin in the last 12 months and this has remained stable since 2001 (Figure HEROIN1).
• Although use of heroin is low, frequency of use is much higher than other drugs, with 49% of users using heroin as often as weekly.
• Compared with other drugs, people using heroin had the highest proportion saying they tried to stop or cut down but could not (44%) (AIHW 2017) (Table S2.35).
• This is consistent with findings from the National Wastewater Drug Monitoring Program that shows heroin consumption in Australia is relatively low, with the captial city average consumption higher than the regional average (ACIC 2019b). The average capital city consumption captured in April 2019 was the highest on record compared to December 2018 (ACIC 2019b).
• This is also consistent with findings from the ABS Causes of Death data, in 2018, heroin-induced deaths were more likely to occur in a capital city (ABS 2019).
• The use of opioids such as heroin or morphine is very uncommon (less than 1%) among secondary school students aged 12–17 in Australia. Of the very small proportion that reported using heroin, the majority did so only once or twice (Guerin & White 2018) (Table S2.53).
• In 2018, heroin was one of the top two most commonly nominated drugs of choice among people who inject drugs, along with methamphetamine (Peacock et al. 2018).

Data from the ABS, reported a higher rate of opioid-induced deaths for people living outside capital citites (5.0 deaths per 100,000 population) compared to those living in capital cities (4.3 deaths per 100,000 population) (ABS 2019).

Harms

Heroin is a central nervous system depressant. Like other opioids, it attaches receptors to 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

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

Hospitalisations

Opioid poisoning can result in significant harm, including respiratory failure, aspiration, hypothermia and death. In
2016–17, hospitalisations with a principal diagnosis of opioid poisoning were more likely to involve pharmaceutical opioids than heroin or opium (AIHW 2018).

The number of hospitalisations for opioid poisoning continues to increase over time. Between 2007–08 and 2016–17 there was a 25% increase in the number of hospitalisations with a principal diagnosis of opioid poisoning (from 14.1 to 17.6 per 100,000 population, after adjusting for age) (AIHW 2018).

Burden of disease and injury

Opioid use was responsible for 1.0% of the total burden of disease and injuries in Australia in 2015 and 37% of the total burden due to illicit drug use (Table S2.69). 

Most of the burden due to opioid use was due to two linked diseases: poisoning and drug use disorders (excluding alcohol). Poisoning contributed to 20%, and drug use disorders (excluding alcohol) to 31%, 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 2019e).

Deaths

The risk of overdose in heroin users is high, especially when used in conjunction with other drugs like benzodiazepines (e.g. alprazolam, diazepam) and alcohol.

Opioids, including both licit and illicit substances, have been the leading class of drug present in drug-induced deaths in Australia for the last 20 years (ABS 2017). Of the 1,795 drug-induced deaths in Australia in 2017, 392 or 22% were due to heroin (Table S2.71) (AIHW 2019d).

In 2016, of all drug types (licit and illicit) heroin had the second lowest median age at death at 41.2 and death was most commonly due to accidental overdose (95% in 2016) (ABS 2017). In 2018, there were 438 herion-induced deaths, this is the highest number of herion-induced deaths since 2000 (ABS 2019). The rate of opioid-induced deaths involving heroin have increased in the past five years (ABS 2019). 

The National Drug and Alcohol Research Centre (NDARC)  reported that the proportion of opioid-induced deaths among Australians aged 15–64 years that were attributed to heroin only increased from 19% in 2007 to 36% (389 deaths) in 2017 (Chrzanowska et al. 2019).

Overall, the rate of death attributed to heroin among Australians aged 15–64 years has increased from 0.9 per 100,000 people in 2007 to 2.41 per 100,000  in 2017 (Chrzanowska et al. 2019).

Although heroin-induced deaths are not as high as they were in the late 1990s when heroin consumption was at its peak in Australia (Degenhardt, Day & Hall 2004), overdose deaths involving heroin have significantly increased in recent years (ABS 2017). However, there are some challenges in interpreting the numbers of heroin deaths, as heroin can be difficult to identify at toxicology because it is rapidly metabolised by the body and resultant morphine metabolites cannot be distinguished from other morphine sources.

The increase in deaths due to heroin in Australia is consistent with international trends. These increases have been attributed to increases in heroin purity and availability, and also because the ageing cohort of heroin users have a range of medical conditions resulting from long-term drug use, making them particularly vulnerable (UNODC 2019).

Treatment

Data collected as part of the AIHW’s 2017–18 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) showed that: 

• Heroin was a principal drug of concern in 5.5% of closed treatment episodes (Table S2.76).
• Injecting was the most common method of use in most episodes where the principal drug of concern was heroin (81%) (AIHW 2019a).
• Client demographics:
  • Where heroin was the principal drug of concern, 67% of clients were male and 12.3% (1,366 clients) were Indigenous (Table S2.79).
• Source of referral:
  • The most common source of referral for treatment episodes with heroin as the principal drug of concern was self/family (49%), followed by a health service (24%), and corrections (12.3%) (Table S2.80).
• Type of treatment:
  • The most common main treatment types were counselling (27%), followed by support and case management only (17.2%), assessment only (15.6%) and withdrawal management (14.9%) (Figure HEROIN3, Table S2.81).

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 natured of service delivery in this sector, these data are captured in the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection.

NOPSAD data showed that nationally in 2018, 37% of clients reported heroin as their opioid drug of dependence. However, this data should be used with caution due to the high proportion of clients with ‘not reported’ as their drug of dependence in New South Wales (65%), Victoria (32%) and the Australian Capital Territory (31%) (AIHW 2019b).

At-risk groups

Aboriginal and Torres Strait Islander people

Indigenous Australians are overrepresented in treatment services for heroin as the principal drug of concern (AIHW 2019a).

People who inject drugs

Heroin is commonly injected and so its use is overrepresented among people who inject drugs. In 2019, 55% of the IDRS sample reported using heroin in the preceding six months (Table S2.54), and 36% of recent consumers reported using heroin daily (Peacock et al. 2019).

People engaged with the criminal justice system

In 2017–18 there were 3,029 national arrests relating to heroin and other opioids (a 2% increase from  2016–17). Most of the arrests related to consumers (89.5%) rather than providers of the drug (ACIC 2019a).

The Drug Use Monitoring in Australia (DUMA) program showed the proportion of detainees testing positive to heroin decreased between 2016–17 (7.3%) and  2017–18 (6.4%) (ACIC 2019a). The proportion of prison entrants who had used heroin in the last 12 months was similar (7%) (AIHW 2019c).

References

ABS (Australian Bureau of Statistics) 2017. Causes of death, Australia, 2016. ABS cat. no. 3303.0. Canberra: ABS. Viewed 4 January 2018.

ABS 2019. Causes of death, Australia, 2019. ABS cat. no. 3303.0. Canberra: ABS. Viewed 15 October 2019.

ACC (Australian Crime Commission) 2010. Illicit drug data report 2008–09. Canberra: ACIC. Viewed 7 August 2019.

ACIC (Australian Criminal Intelligence Commission) 2019a. Illicit drug data report 2017–18. Canberra: ACIC. Viewed 7 August 2019.

ACIC 2019b. National wastewater drug monitoring program, report 8 . Canberra: ACIC. Viewed 28 October 2019.

AIHW (Australian Institute of Health and Welfare) 2017. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.

AIHW 2018. Opioid harm in Australia and comparisons between Australia and Canada. Cat. no. HSE 210. Canberra: AIHW. Viewed 9 November 2018.

AIHW 2019a. Alcohol and other drug treatment services in Australia 2017–18: key findings. Web Report. Viewed 17 April 2019.

AIHW 2019b. National opioid pharmacotherapy statistics (NOPSAD) 2018. Web Report. Viewed 3 April 2019.

AIHW 2019c. The health of Australia’s prisoners 2018. Cat. no. PHE 246. Canberra: AIHW. Viewed 30 May 2018.

AIHW 2019d. Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment, 2016–17. Cat. no. HSE 212. Canberra: AIHW. Viewed 15 March 2019.

AIHW 2019e. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Series no.19. BOD 22. Canberra: AIHW. Viewed 13 June 2019.

Chrzanowska A, Dobbins T, Degenhardt L & Peacock A 2019. Trends in Drug-Induced Deaths in Australia, 1997–2017. Drug Trends. Sydney: National Drug and Alcohol Research Centre, UNSW Australia. Viewed 16 July 2019.

Degenhardt L, Day C & Hall W 2004. The causes, course and consequences of the heroin shortage in Australia. Canberra: National Drug Law Enforcement Research Fund.

Degenhardt L, Reuter P, Collins L & Hall W 2004. ‘Chapter 5: Evaluating factors responsible for the heroin shortage’ in The causes, courses and consequences of the heroin shortage in Australia. Degenhardt L, Day C & Hall W (eds). Monograph no. 3. Canberra: National Drug and Law Enforcement Research Fund. Viewed 14 December 2017.

Guerin N & White V 2018. Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2017. Victoria: Centre for Behavioural Research in Cancer. Viewed 11 March 2019.

NSW Ministry of Health 2017. A quick guide to drugs and alcohol, 3^rd edn. Sydney: National Drug and Alcohol Research Centre.

Nielsen S & Gisev N 2017. Drug pharmacology and pharmacotherapy treatments. In: Ritter, King and Lee (eds). Drug use in Australian society. 2nd edn. Oxford University Press.

Peacock A, Uporova J, Karlsson A, Gibbs D, Swanton R, Kelly G, Price O, Bruno R, Dietze P, Lenton S, Salom C, Degenhardt L & Farrell M 2019. Australian Drug Trends 2019: Key findings from the National Illicit Drug Reporting System Interviews. Sydney: National Drug and Alcohol Research Centre, UNSW Australia.

UNODC (United Nations Office on Drugs and Crime) 2019. World Drug Report 2018. Vienna: UNODC. Viewed 19 February 2019.