Heroin-related deaths in Victoria (Australia): A review of cases for 1997 and 1998

The number of deaths attributed to the intravenous use of heroin has increased dramatically in Victoria in the past five years. Since 1991, the prevalence of deaths attributed to heroin toxicity has risen from 49 to 268 in 1998. This represents a five-fold increase in seven years. The increase has been particularly dramatic over the last 12-months (an increase in over 60%). In 1998 deaths from intravenous use of heroin each year constituted 47% of all drug deaths reported to the coroner (Annual Report, 1997/98, Victorian Institute of Forensic Medicine). The heroin death is typified by a median age of 30 years (both male and female), although the age range extends from children as young as 15 to adults in their fifth decade of life. Over 85% of cases are using other central nervous system depressants, with benzodiazepines (45%) and alcohol (36%) being the most common. Approximately 60% of deaths occur indoors at a private residence, the remaining deaths occur in public places and other locations. A similar number (60%) die alone. Disturbingly, the heroin problem is not restricted to the known 'hot-spots' in Melbourne; rather most suburban areas appear to be affected. The mean (± SD) blood concentration of total morphine was 0.52 ± 0.53 mg/l. Concentrations ranged from 0.01-3.4 mg/l. The median concentration was 0.4 mg/l. A summary of the toxicological findings from 434 heroin-related deaths will be presented.