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
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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.
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 2 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 2019a).
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 2 decades. Of the 1,740 drug-induced deaths in Australia in 2018, 438 or 25% were due to heroin—the highest number of deaths attributed to heroin since 1999 (Figure HEROIN2; ABS 2019).
Overall, the rate of death attributed to heroin in Australia has increased from 1.0 per 100,000 people in 2009 to 1.8 per 100,000 in 2018 (Table S1.1). The rate of opioid-induced deaths involving heroin have increased in the past 5 years (ABS 2019).
In 2018, deaths with heroin identified had a lower median age at death compared with pharmaceutical opioids (41.2 years for deaths with heroin identified, compared with 46.6 years for pharmaceutical opioids) (ABS 2019).
Data from the ABS reported a higher rate of opioid-induced deaths for people living outside capital cities compared with those living in capital cities, whereas deaths where heroin was identified were more likely to occur in a capital city (ABS 2019). This is consistent with AIHW analysis which showed that the rate of drug-induced deaths where heroin was identified was higher in Major cities than in Regional and remote areas in 2018 (2.1 deaths per 100,000 population compared with 1.1 deaths per 100,000 population) (Table S2.71).
Although deaths involving heroin 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).