Executive Summary

The coronial files of all 1995 heroin-related deaths in the South Western Sydney (SWS) region were inspected for toxicological results, demographic characteristics and circumstances of death. These data were compared with SWS heroin-related deaths from 1992. There were 44 deaths attributed to heroin overdose in the region during 1995, an increase of 120% compared with the 20 cases that occurred in 1992. The mean age of cases was 31.7 years, and 96% were male. Cases were significantly older than in 1992, and more likely to be male. The route of heroin administration was by injection in all cases in both years.

Over a half (59%) of fatalities occurred in the suburb of Cabramatta, compared to 15% of cases in 1992. Seventy one percent of fatalities occurred in a public place, including 92% of cases who died in Cabramatta. The proportion of fatalities that occurred in public settings has increased markedly since 1992, when 35% of fatalities occurred in public places. The proportion of cases in which no interventions occurred prior to rose from 60% in 1992 to 80% in 1995.

The median blood morphine concentration among fatalities in 1995 was 0.35 mg/L (range 0.08-3.20 mg/L), more than twice the corresponding figure of 0.16 mg/L in 1992. The majority of deaths (69%) involved drugs in addition to heroin, a similar pattern to 1992 fatalities (79%). Alcohol was the most frequently detected drug other than morphine, present in 52% of cases at a median concentration of 0.10 g/100ml (range 0.01-0.33 g/100ml). The median blood morphine concentration in cases positive for alcohol was significantly lower than in cases without alcohol (0.26 v 0.55mg/L). There was also a significant negative correlation between blood alcohol and blood morphine concentrations (r_s= - 0.41).

A large increase has occurred since 1992 in the number of heroin-related deaths in SWS, and higher concentrations of morphine are being detected. Cabramatta has clearly emerged as a focal point of these fatalities. The patterns of these fatalities also appears to be changing, with more deaths occurring in public settings, and fewer interventions occurring prior to death. Heroin-related fatalities in SWS represent a growing, and changing problem. Interventions designed to prevent heroin-related fatalities in SWS must take into account of the changing patterns of heroin related fatalities in SWS.