Clinical characteristics of heroin overdose deaths among older adults in Australia, 2000-2025

To determine: (1) the circumstances of death and case characteristics of heroin-related toxicity deaths aged ≥ 65 years in Australia, 2000-2025 and (2) the toxicological profile and major autopsy findings.

Retrospective study of fatal heroin overdose cases aged ≥65 years, 2000-2025.

Australia-wide.

59 cases were identified (65-69 years: 37, ≥70 years: 22), 51 (86.4%) male.

Circumstances of death, toxicology, major autopsy findings.

No case occurred in the period 2000-2010, two between 2011 and 2015 and 57 between 2016 and 2025. All had documented histories of both substance use problems and injecting drug use. Cause of death was drug toxicity (n = 36, 61.0%) or combined drug toxicity and disease (n = 23, 39.0%), the majority being unintentional (n = 49, 83.1%). The final route of administration was by injection in 58 cases. Amongst cases in which toxicology was available for inspection (n = 52), the median free morphine concentration was 0.2 mg/l (0.0-3.7 mg/l), and 6-acetylmorphine was present in 34 (65.4%). Psychoactive drugs other than heroin were present in 45 (86.5%) cases. Of autopsied cases, 18 (56.3%) had severe coronary artery disease, 14 (43.8%) cardiomegaly and 11 (34.4%) replacement fibrosis, indicating a past infarct. Five cases (15.6%) were diagnosed with acute bronchopneumonia, and chronic obstructive pulmonary disease was detected in 12 (37.5%).

A new senior demographic of people who use heroin has emerged in Australia and is being reflected in overdose deaths. Systemic disease contributed to a large proportion of deaths between 2000 and 2025, and the toxicology is consistent with shorter survival times compared with younger cases.