Chronic liver disease may be to blame for the increased number of older, more experienced heroin users dying from overdose in Australia, a new study has found.

More than 350 heroin users die in Australia each year – typically older, unemployed men killed by an overdose. Puzzled as to why the most experienced are the most likely to die, researchers at the National Drug and Alcohol Research Centre (NDARC) carried out Australia’s first study analysing the autopsy results of hundreds of deceased addicts.

Increased purity of the drug has commonly been blamed for the deaths but these new results put forward systemic disease as a more likely cause.

Pathology results of 841 people who died in NSW between 1998 and 2002 found “appalling levels” of disease, particularly among older users, study author and NDARC professor Shane Darke said.

More than 70 per cent were hepatitis C positive, and almost half had evidence of current hepatitis.  One in 10 aged 35-44 years had chronic liver disease – a figure that jumped to 25 per cent in the over 44 age group.

This was most prominent disease recorded, “strongly suggesting” it was a factor in their deaths.

“We’ve long been puzzled as to why these experienced users die after decades of doing what they’ve always done, and often there’s not even much morphine found in their blood,” said Prof Darke, from the University of NSW.  “Now we know liver disease is a strong candidate for an explanation for why they drop down dead.

“Their liver decays, the ability to metabolise the drugs and alcohol decreases and that’s it.”

Older users also had high levels of lung disease and heart disease, particularly serious coronary artery disease.
Almost half of those aged over 44 had multiple organ disease, Prof Darke said.

“They pretty much all smoked, drank and took other drugs so they’d been living hard since their teens,” he said. “This shows just how sick these people really are, I mean crikey, it’s amazing they could even walk around.”  He said the results showed the importance of getting younger addicts into treatment programs to break this cycle.

“And given what we know now, we need to monitor things like their liver and heart disease within that treatment setting because this is what could kill them,” Prof Darke said.

Statistics show half of heroin users are dead by the age of 50, mostly from overdose – more than 14 times the rate of other people.