NDARC Technical Report No. 68 (1999)

EXECUTIVE SUMMARY

The coronial files of all heroin-related fatalities that occurred in New South Wales (NSW) over the period 1992-1996 were inspected for details and trends in demographic characteristics, circumstances of death and toxicological findings. There were 953 heroin-related fatalities in NSW over the study period. There was a substantial, statistically significant increase in heroin-related fatalities over the study period, from 152 deaths in 1992 to 226 during 1996. Twenty percent of deaths occurred outside the Sydney metropolitan region, with the Illawarra region contributing the largest number of deaths from outside Sydney. The proportional increase in the number of deaths that occurred outside Sydney was greater than that which occurred within Sydney (130% v 34%). The immediate surrounds of Kings Cross and Cabramatta contributed 35% of all NSW fatalities.

The mean age of cases was 31.0 years, 85% were male, and 85% were classified as dependent on heroin at the time of death. Five percent of cases had recently been released from prison, 2% died in custody, 3% were enrolled in methadone maintenance at the time of death, and 5% were classified as suicides. There were no significant trends in demographic characteristics of cases over the study period.

Fatalities predominantly occurred in home settings (61%). Of those cases in which an estimate could be made, 15% were classified as having died instantly upon heroin administration. No intervention occurred in 79% of cases.

Morphine concentrations rose markedly over the study period, from 0.24 mg/L in 1992 to 0.38 mg/L in 1996, with the major increase having occurred in the period 1993-1994. The majority of cases (76%) involved heroin in combination with other drugs: alcohol (46%), benzodiazepines (27%), antidepressants (7%) and cocaine (7%). In only 24% of cases was morphine the sole drug detected. The median blood alcohol concentration of cases in which alcohol was present was 0.13 g/100 ml. Males were significantly more likely to have alcohol detected at autopsy (49% v 24%), while females were more likely to have benzodiazepines detected (41% v 17%). The median blood morphine concentration among cases in which alcohol was detected was significantly lower than other cases (0.27 mg/L v 0.39 mg/L). In 66% of cases the cause of death was attributed to "acute narcotism" (or "narcotism"). Of the cases in which drugs other than morphine were detected, 57% of deaths were attributed solely to narcotism.

The problem of heroin-related fatalities grew throughout NSW throughout the study period. Innovative responses are necessary if the rise in the number of fatal cases is to be curbed. Possible interventions include educating heroin users on the dangers of the use of other drugs in combination with heroin, the provision of safe injecting rooms to reduce the number of street-based fatalities, expansion of methadone maintenance services, distributing naloxone directly to heroin users, and an improvement of responses to overdoses by witnesses.

Resources

Author(s)

Shane Darke, Joanne Ross, Deborah Zador, Sandra Sunjic
Date Commenced
27 Nov 1998
Resource Type
Technical Reports