There are approximately 74,000 dependent heroin users in Australia. Opioid overdose was responsible for 737 deaths in Australia in 1998. The death rate from opioid overdose more than doubled from 38.3 to 87.1 per 1,000,000 adults between 1989 and 1998. It is estimated that there are between 12,000 and 21,000 non- fatal overdoses in Australia annually.
Victims of overdose are predominately single, unemployed men aged in their late 20s and early 30s, with a long history of heroin dependence.
Concomitant alcohol or benzodiazepine use, and recently depleted tolerance, are significant risk factors for overdose.
Death from overdose is rarely instantaneous. Overdose most commonly occurs in a private home, with or near other people. Witnesses of overdose are reluctant to seek help.
Overdose fatality is not a simple function of heroin dose or purity. There is no evidence of toxicity from contaminants of street heroin in Australia.
Non-fatal opioid overdose has the potential to cause significant persisting morbidity. Research is required to quantify overdose related morbidity. Health care costs associated with overdose are significant. Ambulance call-outs to overdoses in Australia cost approximately $7.7 million annually. Adverse effects associated with the narcotic antagonist naloxone appear to be rare events.
Opioid overdose fatalities are preventable. Treatment services, such as methadone, protect against fatality from overdose and should be expanded where possible. Alternative pharmacotherapies should be trialled to attract high-risk untreated heroin users into treatment.
Education based interventions for both heroin users and police have the potential to reduce overdose fatality. The distribution of naloxone to heroin users may prevent fatality from overdose.