Fatal heroin overdoses resulting from non-injecting routes of administration, NSW, Australia, 1992-1996

Aims. To document cases of fatal heroin overdose in New South Wales by non- injecting routes of administration, and to compare the characteristics and toxicology of these cases with injecting fatalities. Design. Examination of coronial files. Setting. New South Wales, Australia. Participants. All fat al heroin overdose cases in NSW between 1992 and 1996 Findings. There were 10 cases of death resulting from non-injecting routes of heroin administrat ion between 1992 and 1996, representing 1 % of cases. In three cases the ro ute of administration was by inhalation, in five cases by nasal administrat ion and in two cases by swallowing The mean age of cases was 29.6 years, an d nine of the cases were male. The median blood morphine concentration of n on-injectors was 0.31 mg/l (range 0.06-0.99 mg/l). Drugs other than morphin e were also detected in seven cases. Conclusions. Heroin overdose deaths ar e not restricted to the injection of heroin. While injection may constitute a greater overdose risk-factor, there is no safe, overdose-free way to use heroin.