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 fatal heroin overdose cases in NSW between 1992 and 1996 Findings. There were 10 cases of death resulting from non-injecting routes of heroin administration between 1992 and 1996, representing 1 % of cases. In three cases the route of administration was by inhalation, in five cases by nasal administration and in two cases by swallowing The mean age of cases was 29.6 years, and nine of the cases were male. The median blood morphine concentration of non-injectors was 0.31 mg/l (range 0.06-0.99 mg/l). Drugs other than morphine were also detected in seven cases. Conclusions. Heroin overdose deaths are 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.