Heroin-related deaths in Sydney, Australia. How common are they?

The objetive of this article was to determine the number of recent deaths c aused by, accidental illicit drug overdoses seen at the NSW Institute of Fo rensic Medicine, Globe (Sydney). All Forensic cases (3559) were reviewed du ring the period July 1995-Februay 1997. Any that were classified as acciden tal illicit drug overdose were followed up, and demographic and toxicologic al data were collected for analysis. Our results found that one hundred and forty three accidental illicit drug overdoses were identified from 3359 au topsies during the 20 month data collection period (4%) Male to female rati o was 5:1, but females predominated in the methadone toxicity group. Most o f the cases were under 40 years of age. Toxicological results showed that 8 0% of the deaths were associated with morphine (heroin) levels in toxic ran ge, although 91% had morphine present at some level. Only 35% of cases had significant levels of bile morphine, suggesting 'chronic" usage. In many ca ses, multiple illicit substances and/or alcohol were thought to be importan t contributing factors. Cocaine was found in 13% of cases, and all of these had morphine (heroin) in their blood. Methadone was found in 13% of cases, and 13/19had toxic levels-9/19 also had morphine in their blood. Only two cases had amphetamines or methamphetamines in their blood. The authors conclude that Heroin overdose is by far the most common cause o f accidental illicit drug overdose. Those at greater risk are naive users a nd those who are not tolerant. There is an urgent need for increased awaren ess and further education concerning the dangers of heroin use, particularl y of multiple drug use (including alcohol). Only about one-third of these c ases appear to be "chronic" users.