Opioid dependence in Australia

Opioid dependence: 
A chronic and relapsing disease1

Opioids are among the top 4 illicit drugs used in Australia.2

Opioids include heroin, nitazenes, opium, and prescription opioids such as codeine, morphine, buprenorphine, methadone, oxycodone, fentanyl, and tramadol.3

Opioids alter how the brain works, hijacking the motivation and rewards processes – increasing the risk of dependence and making it extremely hard to quit.4

One in 4 people who use heroin will become dependent.5

Harms associated with opioid use

Almost 1 in 5 people detained by police in Australia (18%) tested positive for opioids.6

In Australia, people accessing Specialist Homelessness Services and Alcohol and Other Drug Services (AODS) are 2x more likely to report heroin as the primary drug of concern (vs AODS-only clients).7

There are >150 daily opioid-related hospitalisations.8

Opioids are the most common drug type associated with unintentional drug-induced deaths (2022-2023), contributing to 49.3% of such deaths.9

Long-term use of opioids have significant health consequences, including:10,11

Constipation Opioid-induced constipation can be severe and debilitating.
Tooth decay From lack of saliva.
Weight loss From loss of appetite.
Brain function Neurochemical changes in the brain. Memory impairment.
Depression Some people may experience depression as a consequence of opioid use.
Hyperalgesia Chronic use of opioids can increase pain sensitivity.
Falls Opioid use can increase the risk of falls due to central nervous system effects including sedation.
Hormonal effects Hormonal effects from opioids are well recognized and include hypogonadism, erectile dysfunction, infertility, infrequent menstrual periods, and osteoporosis.
Tolerance, physical dependence and withdrawal Patients require higher doses to achieve the same pain relief (tolerance). Abrupt cessation is likely to cause withdrawal symptoms (physical dependence).

Help stop the stigma

Stigma is a barrier to treatment.12

The experience of stigma is associated with delays in seeking treatment, increased rates of treatment withdrawal, withholding information in an effort to avoid sub-standard care, as well as increased engagement in risky behaviour such as needle sharing.

Fear of being stigmatised is also a key barrier for carrying naloxone, and can lead to injecting drug users distancing themselves from harm reduction services such as syringe exchanges.

Tips for reducing stigma in everyday conversations:13

  • Use person-centred language that focuses on the person, not their substance use
  • Correct others who may have misconceptions about alcohol and other drug use or people who use alcohol and other drugs (AOD)
  • Show support by treating people with dignity and respect
  • Use non-stigmatising language that encourages people to seek help
  • Don’t use stigmatising words like ‘addict’ that can hurt, damaging self- image and stand in the way of recovery. Instead talk about a person with dependence
  • Focus on hope. When you empathise, you begin to see how words like ‘abuse’, ‘relapse’, ‘non-compliant’, and ‘dependent’ may come across like a prison sentence: hurtful, demeaning, pessimistic and hopeless
  • Be aware of negative stereotyping – many people who use AOD feel threatened by the prejudice that results from misconceptions about AOD use
  • Be an active listener. Acknowledge what the person is saying – don’t brush it off
  • Use body language that shows you are there for them, let them know they are not alone, and their issue is important.

Treatment goals: minimising harm14

Treatment for opioid dependence in Australia is based on the principles of harm minimisation.

Goals of treatment include reducing demand and by extension the harms associated with use and improving quality of life.

Treating the person1

No one option works for everyone, and people with opioid dependence often go through a cycle of treatment, lapses and relapses into use. All available treatments should be considered in consultation with the person, taking into account their individual circumstances and preferences.

Options include1

  • Counseling and psychosocial support
  • Detoxification (facilitated withdrawal)
  • ‘Rehab’ programs
  • Substitution treatment: daily, weekly, or monthly

There are different options for medication assisted treatments. It is important to review available options to find what’s best suited to the individual.1

Psychosocial support1

Psychosocial support is critical regardless of the form of treatment a person chooses. A person who is using drugs, including prescription drugs, may have reduced opportunities to engage in ‘normal’ life, including relationships, employment, or accommodation. Therefore it is important that the treatment plan is holistic and involves key services.

Counselling and psychosocial support, including self-help groups, are important components of relapse prevention. Psychological interventions help people to identify and address the reasons for drug use, the negative consequences of drug use, and the benefits associated with reducing or discontinuing illicit drug use.

For more information about opioid dependence and treatment options, call the 
National Alcohol and Other Drug Hotline 1800 250 015.

References: 1. Gowing L, Ali R, Dunlop A, et al. National Guidelines for Medication-Assisted Treatment of Opioid Dependence [Internet]. Canberra, Australia; 2014 [cited 27 February 2025]. Available from: https://www.health.gov.au/resources/publications/national-guidelines-for-medication-assisted-treatment-of-opioid-dependence. 2. Australian Institute of Health and Welfare. Illicit drug use [Internet]. Canberra: Australian Institute of Health and Welfare, 2024 [cited 2025 Feb. 27]. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/illicit-drug-use. 3. Alcohol and Drug Foundation. Opioids [Internet]. Melbourne, Australia; 2025 [cited 27 February 2025]. Available from: https://adf.org.au/drug-facts/opioids/. 4. Kosten T and George T. The neurobiology of opioid dependence: implications for treatment, Science & Practice Perspectives. 2022;1(1):13–20, doi:https://doi.org/10.1151/spp021113. 5. Darke S. The life of the heroin user: Typical beginnings, trajectories and outcomes, Cambridge: Cambridge University Press, 2011. 6. Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia: People in contact with the criminal justice system [Internet]. Canberra: Australian Institute of Health and Welfare, 2025 [cited 2025 Feb. 27]. Available from: https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/people-in-contact-with-the-criminal-justice-system. 7. Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia: People experiencing homelessness [Internet]. Canberra: Australian Institute of Health and Welfare, 2025 [cited 2025 Feb. 27]. Available from: https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/people-experiencing-homelessness. 8. Australian Institute of Health and Welfare 2018. Opioid harm in Australia and comparisons between Australia and Canada. Cat. no. HSE 210. Canberra: AIHW. Available from: https://www.aihw.gov.au/getmedia/605a6cf8-6e53-488e-ac6e-925e9086df33/aihw-hse-210.pdf?v=20230605175040&inline=true. 9. Penington Institute (2024). Australia’s Annual Overdose Report 2024. Melbourne: Penington Institute. ISSN: 2652-7790 10. Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia: Illicit opioids, including heroin [Internet]. Canberra: Australian Institute of Health and Welfare, 2025 [cited 2025 Feb. 27]. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/drug-types/illicit-opioids-including-heroin. 11. Medicinewise News: High-risk prescription opioid use: 10 things you need to know. Sydney, Australia: National Prescribing Service; 18 November 2021 [cited 27 February 2025]. Available from: https://www.nps.org.au/news/high-risk-opioid-use-10-things-you-need-to-know. 12. Cheetham A, Picco L, Barnett A, Lubman DI, Nielsen S. Subst Abuse Rehabil. 2022;13:1-12. 13. Alcohol and Drug Foundation. Stigma – why words matter [Internet]. Melbourne, Australia; 2025 [cited 27 February 2025]. Available from: https://adf.org.au/insights/stigma-why-words-matter/. 14. Commonwealth of Australia Department of Health. National Drug Strategy 2017-2026 [Internet]. Canberra, Australia; 2017 [cited 27 February 2025]. Available from: https://www.health.gov.au/sites/default/files/national-drug-strategy-2017-2026.pdf