Heroin Found in Cocaine, Ice, Snorting Can Kill
Authorities in New South Wales and Victoria have been warning the public about worrying cases of heroin overdoses after people thought they had taken cocaine or methamphetamine .
We know the issue is also relevant to other parts of Australia . And it’s particularly concerning because heroin can cause life-threatening opioid overdoses, particularly in people inexperienced with heroin who snort it.
Our new research sheds more light on what happens to people who accidentally took heroin thinking it was something else.
We are part of a NSW Health program that helps to find and quickly respond to concerning illicit and recreational drug poisonings and trends. The program is a collaboration between many government health services, including hospitals, the NSW Poisons Information Centre and labs .
We searched our database and found 34 cases of opioid overdoses after using what people thought to be a stimulant drug between January 2022 and June 2024. A total of 19 people thought they were taking cocaine and 15 methamphetamine.
Most of these 34 people had a severe opioid overdose requiring treatment by paramedics and in hospital. Sadly, two people died.
Heroin was the opioid in all cases where we specifically tested for it, and we suspect all the cases.
Cases occurred across NSW but most cases (68%) were in Sydney. In the last eight months of our study we identified multiple cases each month which may indicate these cases are becoming more common.
In the United States, drugs like cocaine and methamphetamine are sometimes mixed with the potent opioid drug fentanyl . This unintentional use of opioids is causing many deaths in the US . But we didn’t find any evidence that fentanyl was the cause of the overdoses we examined.
Cocaine and methamphetamine are stimulant drugs. These are drugs that make a person feel more energetic and confident, and their pupils become larger.
They have the opposite effect to heroin, which is an opioid and sedative. Heroin and other opioids make a person feel relaxed and often drowsy, with smaller pupils.
When overdosing, opioids cause loss of consciousness and a person’s breathing slows or even stops, which is life-threatening. Severe opioid overdose without prompt treatment is lethal.
If you expect to be taking cocaine or methamphetamine, but it is actually heroin, or has some heroin in it, you will very likely overdose. This is particularly true if you don’t usually take opioids, or if you use it for the first time. People can overdose from as little as snorting a line.
Sometimes people get a different drug than they wanted. This can happen because the drug is mixed with something else or swapped.
This can happen for many reasons , including during manufacturing and distribution. It can happen intentionally or unintentionally by the dealer or people using the drug.
One major reason is that you sometimes can’t tell heroin apart from cocaine or methamphetamine just by looking at them. So if drugs are mixed or swapped, you can’t always tell until you take them.
Opioid deaths are preventable. Government and community groups are working together to respond to the problem, either via issuing drug alerts or by educating their members.
But people who take illicit or recreational drugs can reduce their risk by avoiding using drugs alone, and by making sure one person in their group is able to get help if needed.
Unexpected sleepiness is a reason to seek help, not to simply rest. Start CPR if someone is not responsive and call 000.
Definitely, if someone is experiencing an opioid overdose, give them naloxone as soon as possible.
Naloxone is a life-saving medicine that can temporarily reverse an opioid overdose. It comes in an easy-to-use nasal spray, and as a pre-filled injection.
It’s available for free and without a prescription via the national Take Home Naloxone program . You can also order it online and get it by post .
Naloxone is for anyone who may experience, or witness, an opioid overdose or adverse reaction.
NSW authorities recommend it for people who use any illicit drugs including opioids, stimulants (like cocaine, methamphetamine and MDMA), ketamine and counterfeit pharmaceuticals, due to the risk of drugs being mixed with something else or swapped. Call 000 even if you have given naloxone.
You can report unexpected overdoses to the Poisons Information Centre from anywhere in Australia on 131 126. In an emergency in Australia, call 000.
Darren Roberts is the Medical Director of the NSW Poisons Information Centre and a clinical toxicologist and addiction medicine specialist at Royal Prince Alfred Hospital
Jared Brown is affiliated with NSW Ministry of Health and NSW Poisons Information Centre.
Peter Chisholm is a is a public health registrar in Drug and Alcohol Services at The Langton Centre and Prince of Wales Hospital.