Heroin: client demographics and treatment

In 2020–21, heroin was reported as a drug of concern (either principal or additional) in 6.1% of all treatment episodes (13,600 episodes) (Table Drg.4).

Heroin was the fourth most common principal drug of concern, recorded in 4.6% of treatment episodes (10,300 episodes) (Table Drg.4). This has remained consistent across the 10 years to 2020–21, although the proportion of heroin-related episodes has declined from a peak of 8.8% (12,900 episodes) in 2011–12 across that period (Table Drg.5).

In 2020–21, around 2 in 5 heroin-related treatment episodes listed at least 1 additional drug of concern (39% or 4,000 episodes) (Table Drg.2). The most common additional drugs of concern were amphetamines (30% or 2,100 episodes), cannabis (20% or 1,400 episodes) and nicotine (17% or 1,200 episodes) (Figure DRUGS1; Table Drg.3). These drugs may not have been the subject of any treatment within the episode.

Treatment for heroin use in the AODTS NMDS collection

People who seek treatment for heroin use have several options for treatment, including withdrawal programs (called detoxification) and abstinence-based treatment (for example, residential rehabilitation in a therapeutic community) (O’Brien 2004).

In Australia, one of the most common treatments for heroin use is opioid pharmacotherapy treatment (also known as opioid agonist therapy). Opioid pharmacotherapy involves replacing opioid drugs, including heroin, with a longer-lasting, medically prescribed opioid.

Agencies whose sole function is to prescribe or provide dosing services for opioid pharmacotherapy are excluded from the AODTS NMDS. Data from these agencies are captured in the National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collection (AIHW 2022). For more information, please see the 2021 NOPSAD report.

For information on heroin use and harms, please see:

Client demographics

In 2020–21, 5,400 clients received treatment for heroin as the principal drug of concern. Of these clients:

  • Over 2 in 3 were male (69% of clients) (Table SC.9).
  • Over 2 in 3 were aged either 30–39 (35% of clients) or 40–49 (34%) (Table SC.10). This was consistent for both males and females (Figure HEROIN1).
  • Nearly 1 in 5 were Indigenous Australians (19% or 1,000 clients) (Table SC.11). This represents a crude rate of 185 Indigenous clients per 100,000 population (Table SCR.26).

Figure HEROIN1: Clients with heroin as the principal drug of concern, by sex and age group, 2020–21 (per cent)

The butterfly bar chart shows that male clients receiving treatment for heroin as the principal drug of concern were most likely to be aged 30–39 (33.8% of clients) or 40–49 (35.4%) in 2020–21. This was similar for female clients (37.0% aged 30–39 and 30.3% aged 40–49).

Treatment

In 2020–21, 10,300 treatment episodes were provided to clients for heroin as the principal drug of concern (Table Drg.4). The median duration of these treatment episodes was just under 4 weeks (27 days) (Table Drg.58).

Among heroin-related treatment episodes in 2020–21:

  • The most common source of referral was self/family (42% of episodes), followed by health services (33%) (Figure HEROIN2; Table Drg.55).
  • The most common main treatment type was counselling (23% of episodes), followed by support and case management (20%) and pharmacotherapy (17%) (Figure HEROIN2; Table Drg.54). In the 10 years to 2020–21, main treatment types for heroin have fluctuated:
    • Treatment episodes with withdrawal management as the treatment type decreased from 26% to 7.6% (or from 3,300 to 790 episodes).
    • Conversely, pharmacotherapy episodes increased from 3% to 17% (or from 410 to 1,800 episodes). Fluctuations in pharmacotherapy treatment episodes over time can be attributed to changes to jurisdictional coding practices and systems, resulting in under-reporting of pharmacotherapy at the national level.
  • Over 7 in 10 treatment episodes took place in a non-residential treatment facility (71% of episodes) (Table Drg.56).
  • Nearly 3 in 5 treatment episodes ended with a planned completion (58% of episodes), while 20% ended unexpectedly (Figure HEROIN2; Table Drg.56).

Figure HEROIN2: Treatment episodes with heroin as the principal drug of concern, by main treatment type, reason for cessation or source of referral, 2011–12 to 2020–21 (number or per cent)

The line graph shows that counselling was the most common main treatment type among treatment episodes for cannabis across the 10 years to 2020–21, although the number of counselling episodes fell from 4,377 in 2011–12 to 2,385 in 2020–21. Other treatment types fluctuated across time, with assessment only being the second most common main treatment type in 2020–21 (2,056 episodes). Filters allow the user to view data as the number or per cent of episodes for main treatment type, reason for cessation or source of referral.

In 2020–21, injecting remained the most common method of use in heroin-related treatment episodes (74% of episodes) (Table Drg.6). Clients reported injecting drugs in the past 3 months in nearly 1 in 2 treatment episodes (49% of episodes). In a further 12% of episodes, clients reported that they last injected 3–12 months ago (Table Drg.52).

However, the proportion of treatment episodes where clients reported that they had never injected drugs increased 4-fold between 2011–12 and 2020–21, rising from 4.9% (630 episodes) to 18% (1,800 episodes) (Table Drg.52).