Illicit opioids, including heroin

Key findings

  • The risk of overdose in heroin users is high and there have been increases in heroin-related overdoses in recent years.
  • Of the 1,740 drug-induced deaths in Australia in 2018, 438 or 25% were due to heroin.
  • The Australian heroin market is highly stable in terms of drug availability, pricing and purity.
  • Heroin use among the Australian general population is low, with only 0.2% reporting consumption in the last 12 months in 2016.
  • Heroin is used more frequently than other drugs, with 49% of users using as often as weekly in 2016.
  •  In 2019, heroin (45%) was one of the top two most commonly nominated drugs of choice among people who inject drugs, along with methamphetamine (33%).

More information is available in the PDF DownloadIllicit opioids including heroin factsheet.

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 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.


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).


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).
  • The National Wastewater Drug Monitoring Program also shows that 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).
  • 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 (45%) was one of the top two most commonly nominated drugs of choice among people who inject drugs, along with methamphetamine (33%) (Peacock et al. 2018).


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

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.


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).


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 (Man et al. 2019). Of the 1,740 drug-induced deaths in Australia in 2018, 438 or 25% were due to heroin (Man et al. 2019).

Almost 40% (430 deaths) of opioid-induced deaths were attributed to heroin in 2018 (Man et al. 2019).

Overall, the rate of death attributed to heroin in Australia has increased from 0.84 per 100,000 people in 2008 to 1.75 per 100,000 in 2018 (Man et al. 2019).

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 heroin-induced deaths, this is the highest number of heroin-induced deaths since 2000 (ABS 2019). The rate of opioid-induced deaths involving heroin have increased in the past five years (ABS 2019).

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), whereas heroin-induced deaths were more likely to occur in a capital city (ABS 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).


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:
    • In treatment episodes where heroin was the principal drug of concern, 67% (7,453 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 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 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).

Further information on pharmacotherapy in Australia.

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 from 6% in 2017 (Patterson et al. 2019) to 5% in 2018 (Voce & Sullivan 2019). The proportion of prison entrants who had used heroin in the last 12 months was slightly higher (7%) (AIHW 2019c).


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