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 the non-medical use of pharmaceutical drugs 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 (Table S2.11). 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%) (tables S2.37 and S2.70; AIHW 2020).

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 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.

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 April and August 2021, average consumption of heroin increased in Major cities and Regional areas.

(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

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 S2.69). 

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).

Ambulance attendances

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).

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 S1.1a). 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).

Figure HEROIN3: 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.

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Treatment

The 2020–21 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) Early Insights 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. Detailed information about treatment episodes for heroin will be updated in July 2022.

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 4th most common principal drug of concern in closed treatment episodes provided to clients in 2019–20 (Figure HEROIN4). Heroin was the principal drug of concern in 5.1% of closed treatment episodes provided for clients’ own drug use—a similar proportion to 2018–19 (5.2%) (Table S2.76). In over three-quarters (78%) of these episodes, the method of use was injecting (AIHW 2021a).

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

  • Most (70%) clients were male and around 1 in 6 (18%) were Indigenous Australians (tables S2.77 and S2.78).
  • Over two-thirds of clients were aged 30–39 (38% of clients) or 40–49 (32%) (AIHW 2021a).
  • The most common source of referral was self or family (43% of closed treatment episodes), followed by a health service (32%) (Table S2.79).
  • Counselling was the most common main treatment type (24% of closed treatment episodes), followed by assessment only (19%) and support and case management (15%) (Table S2.80).

Figure HEROIN4: Treatment provided for own use of heroin, 2019–20 (per cent)

This infographic shows that heroin was the principal drug of concern in 5%25 of closed treatment episodes provided for clients’ own drug use in 2019–20. 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 4 episodes).

Source: AIHW. Supplementary tables S2.76, S2.78 and S2.80.

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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.