Australian Institute of Health and Welfare 2021. Alcohol, tobacco & other drugs in Australia. Cat. no. PHE 221. Canberra: AIHW. Viewed 31 July 2021, https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare. (2021). Alcohol, tobacco & other drugs in Australia. Retrieved from https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Alcohol, tobacco & other drugs in Australia. Australian Institute of Health and Welfare, 22 July 2021, https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2021 [cited 2021 Jul. 31]. Available from: https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare (AIHW) 2021, Alcohol, tobacco & other drugs in Australia, viewed 31 July 2021, https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
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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 2020).
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 number and weight of heroin seizures at the Australian border have increased over the past 10 years
Prior to COVID-19 in 2020, the Australian heroin market was highly stable in terms of drug availability, pricing and purity
Heroin use among the Australian general population is low, with less than 0.1% reporting consumption in the last 12 months in 2019
The risk of overdose for people who use heroin is high and there have been increases in deaths involving heroin in recent years
Of the 1,865 drug-induced deaths in Australia in 2019, 474 or 25% were due to heroin
Heroin was the principal drug of concern in 5.1% of closed treatment episodes in 2019–20 provided for clients' own drug use
View the Illicit opioid (heroin) in Australia fact sheet >
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 with 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 illicit drugs (Peacock et al. 2019). This suggests that the Australian heroin market was highly stable (Table S2.11). In 2020, the price of heroin remained relatively stable compared to other years. However, there were some changes in the perceived purity and availability of heroin. More specifically, in 2020:
Notably, IDRS interviews were conducted from June–September 2020, after COVID-19 restrictions were introduced in Australia (Peacock et al. 2021). This should be taken into account when comparing these data with previous years.
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 26% over the last decade, from 250 in 2009–10 to 184 in 2018–19. However, the weight of heroin detected has increased 141% over the same period, from 117.5 kilograms in 2009–10 to 283.4 kilograms in 2018–19. There has also been an increase in both the number and weight of national heroin seizures over the past decade. Between 2009–10 and 2018–19 the number of national heroin seizures increased 32% from 1,582 up to 2,080, while the weight of heroin seized increased 165% from 74.7 kilograms to 197.7 kilograms (ACIC 2020).
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).
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.
The National Wastewater Drug Monitoring Program (NWDMP) indicates that heroin consumption in Australia is relatively low, but has increased over time. The estimated weight of heroin consumed has steadily increased from 750 kilograms in 2017–18 to 1,021 kilograms in 2019–20 (ACIC 2021; Figure HEROIN2). In 2020, the estimated population-weighted average consumption of heroin reached its highest level since the program commenced, both in regional areas (April 2020) and capital city sites (August 2020) (ACIC 2021).
Data from the most recent NWDMP report show that nationally:
For state and territory data, see the National Wastewater Drug Monitoring Program reports.
(a) “Average consumption” refers to estimated population-weighted average consumption.
1. Data are from 56 wastewater treatment sites, covering approximately 56% of the Australian population in 2020.
2. Heroin data for August 2016 are not available.
Source: AIHW. Adapted from NWDMP Report 12.
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).
Source: Adapted from ACIC 2019a; Nielsen & Gisev 2017; NSW Ministry of Health 2017.
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).
Data on alcohol and other drug-related ambulance attendances are sourced from the National Surveillance System for Alcohol and Other Drug Misuse and Overdose report. Data for heroin-related attendances for 2019 are available for New South Wales, Victoria and the Australian Capital Territory. Data are not presented for Tasmania due to low numbers of attendances. Data are presented for 4 snapshot months per year, specifically March, June, September and December. Please see the data quality statement for further information.
The rate of heroin-related attendances ranged from 8.4 per 100,000 population in New South Wales to 18.0 in the Australian Capital Territory and 18.1 in Victoria.
Across the 3 reporting jurisdictions, the majority of heroin-related attendances were for males. The median age of attendances were similar across jurisdictions—39 years in the Australian Capital Territory and 40 years in both New South Wales and Victoria.
Higher rates for heroin-related ambulance attendances were reported in metropolitan areas for New South Wales (10.1 per 100,000 population compared with 4.8 for regional areas) and Victoria (21.3 per 100,000 population compared with 8.1 for regional areas).
In New South Wales, a higher proportion of heroin-related attendances were transported to hospital in metropolitan areas than in regional areas (67% and 60%, respectively). In Victoria, 50% of heroin-related attendances in metropolitan areas were transported to hospital compared with 62% in regional areas. In the Australian Capital Territory, 38% of attendances were transported to hospital (Table S2.81) (Moayeri et al. 2020).
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:
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).
Drug-induced deaths are defined as those that can be directly attributable to drug use, as determined by toxicology and pathology reports (ABS 2017).
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 1,865 drug-induced deaths in Australia in 2019, 474 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 2010 to 1.9 in 2019. Between 2017 and 2019, the rate has remained steady at 1.9 per 100,000 population (Figure HEROIN3; Table S1.1a).
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 1,373 in 2017 to 1,129 in 2019, while the number of deaths due to heroin has increased from 444 to 474 in the same period.
View data tables >
The increase in deaths due to heroin in Australia is consistent with international trends. This has been attributed to increases in heroin purity and availability, and also because the ageing cohort of people who use heroin have a range of medical conditions resulting from long-term drug use, making them particularly vulnerable (UNODC 2019). In 2018, deaths with heroin identified had a median age at death of 41.2 years, lower than for pharmaceutical opioids (median 46.6 years) (ABS 2019).
The rate of drug-induced deaths where heroin was identified was 1.8 times higher in Major cities than in Regional and remote areas in 2019 (2.1 deaths per 100,000 population compared with 1.2 deaths per 100,000 population) (Table 8).
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:
Source: AIHW. Supplementary tables S2.76, S2.78 and S2.80.
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 2020, 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 stated/not reported’ as their drug of dependence in New South Wales (64%), Victoria (33%) and Tasmania (19%) (AIHW 2021b).
Further information on pharmacotherapy in Australia >
For related content on at-risk groups, see:
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, 2018. 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) 2019. Illicit Drug Data Report 2017–18. Canberra: ACIC. Viewed 7 August 2019.
ACIC (Australian Criminal Intelligence Commission) 2020. Illicit Drug Data Report 2018–19. Canberra: ACIC. Viewed 21 October 2020.
ACIC 2021. National Wastewater Drug Monitoring Program Report 12. Canberra: ACIC. Viewed 1 March 2021.
AIHW (Australian Institute of Health and Welfare) 2018. Opioid harm in Australia and comparisons between Australia and Canada. Cat. no. HSE 210. Canberra: AIHW. Viewed 9 November 2018.
AIHW 2019a. 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.
AIHW 2019b. The health of Australia’s prisoners 2018. Cat. no. PHE 246. Canberra: AIHW. Viewed 30 May 2018.
AIHW 2020. National Drug Strategy Household Survey 2019. Drug statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW. Viewed 16 July 2020.
AIHW 2021a. Alcohol and other drug treatment services in Australia annual report. Cat. no. HSE 250. Canberra: AIHW. Viewed 16 July 2021.
AIHW 2021b. National Opioid Pharmacotherapy Statistics Annual Data collection. Cat. no. PHE 266. Canberra: AIHW. Viewed 31 March 2020.
Chrzanowska A, Man A, Sutherland R, Degenhardt L & Peacock A 2021. Trends in drug-induced deaths in Australia, 1997–2019. Drug Trends Bulletin Series. Sydney: National Drug and Alcohol Research Centre, UNSW. Viewed 23 April 2021.
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. (2020). ASSAD 2017 Statistics & Trends: Australian Secondary Students’ Use of Tobacco, Alcohol, Over-the-counter Drugs, and Illicit Substances. Second Edition. Cancer Council Victoria. Viewed 21 July 2020.
Moayeri F, Ogeil R, Faulkner A, Wilson J, Matthews S, Lubman D, Scott D. National Surveillance System for Alcohol and Other Drug Misuse and Overdose. Melbourne: Turning Point, Melbourne.
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.
NSW Ministry of Health 2017. A quick guide to drugs and alcohol, 3rd edn. Sydney: National Drug and Alcohol Research Centre.
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.
Peacock A, Uporova J, Karlsson A, Price O, Gibbs D, Swanton R et al. 2021. Australian Drug Trends 2020: Key findings from the National Illicit Drug Reporting System (IDRS) interviews. Sydney: National Drug and Alcohol Research Centre, UNSW.
UNODC (United Nations Office on Drugs and Crime) 2019. World Drug Report 2018. Vienna: UNODC. Viewed 19 February 2019.
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