Heroin-related deaths in New South Wales, Australia, 1992–1996
Introduction
The rate of fatal opioid overdoses in Australia rose from 10.7 per million in 1979 to 67.0 per million in 1995, with 70 fatal overdoses in 1979 and 550 in 1995 (Hall and Darke, 1998). Similar increases have been reported in the United States (United States Department of Health and Human Services, 1997) and Europe (Risser and Schneider, 1994, Steentoft et al., 1996, Davoli et al., 1997, Neeleman and Farrell, 1997).
The state of New South Wales (NSW) contributes approximately a half of the annual total of fatal opioid overdoses that occur in Australia (Lynskey and Hall, 1998a). The purity of heroin in NSW rose steeply in the early 1990s, following the emergence of the Sydney suburb of Cabramatta as a major distribution point for cheap, high purity heroin (Weatherburn and Lind, 1995). A study of street seizures of heroin in the Cabramatta region reported a mean diamorphine content of 59%, ranging up to 80% (Weatherburn and Lind, 1995).
The major study of fatal heroin overdose in NSW, and in the world, conducted to date was that of Zador et al. (1996). The authors analysed the data from coronial files of all 1992 New South Wales heroin-related deaths. This study found that cases of heroin-related deaths were overwhelmingly male, occurred in a dependent non-treatment population of users, and typically occurred in the home. A large proportion of cases had moderate to low blood morphine concentrations (heroin is rapidly metabolised to morphine once ingested). Of major importance, the study also found that nearly half were positive for alcohol at autopsy, and a quarter for benzodiazepines.
More recently, Darke and Ross (1999a) examined trends in all heroin-related fatalities that occurred in south western Sydney, one of the major heroin markets in Australia, over the period 1992–1996. Heroin-related fatalities in the region rose from 20 in 1992 to 54 in 1996. There was a significant increase over the study period in the proportion of fatalities that occurred in public settings. Morphine concentrations doubled over the study period from 0.16 mg/l in 1992 to 0.37 mg/l in 1996. As was the case in the Zador et al. (1996) study, the majority of cases involved heroin in combination with other drugs: alcohol (40%), benzodiazepines (27%) and antidepressants (9%). These data raise the question as to whether these trends in the south west of Sydney are statewide, or specific to a major heroin distribution point.
The aim of the present study was to provide an analysis of all heroin-related deaths in NSW over the five year period 1992–1996. By examining cases over a consecutive and substantial period of time, a period in which the price of heroin declined and purity increased, trends in the demographic characteristics, toxicological findings and circumstances of death could be analysed.
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Procedure
All heroin-related fatalities that occurred during 1992 in the NSW region were identified from the data reported by Zador et al. (1996). These had been identified from Australian Bureau of Statistics records. For later cases, all cases positive for blood morphine that occurred in NSW between 1993 and 1996 inclusive were identified by the Division of Analytical Laboratories (DAL) (NSW Department of Health). The methods used for 1992 data and 1993–1993 data are comparable, as Australian Bureau of
Number of heroin-related fatalities
A total of 953 heroin-related fatalities occurred in NSW during the five year period 1992–1996 (Fig. 1). A fifth of deaths (20%) occurred outside the Sydney metropolitan area.
The number of deaths rose substantially over the period, from 152 in 1992 to 226 in 1996, with a peak of 244 in 1995. The increase in the number of deaths over the period was statistically significant (F1,3=8.9, P<0.05). There were significant increases in the number of heroin-related deaths over the study period in both
Discussion
The major finding of this study was the significant overall increase in the number of heroin-related deaths that occurred in NSW over the study period. Of major importance, the number of deaths increased significantly in both Sydney and the remainder of NSW. The large increase in heroin-related fatalities that occurred across the study period is consistent with the increase in south western Sydney reported by Darke and Ross (1999a) across the same period. Heroin overdose has increased
Acknowledgements
The authors wish to thank the staff at the Coroners Courts, Local Courts and the Division of Analytical Laboratories for their assistance.
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