The context, management and prevention of heroin overdose in Victoria, Australia: The promise of a diverse approach

Heroin overdose is a common experience amongst heroin users in Victoria, Australia and presents an increasingly serious public health problem for the Victorian community. The number of heroin-related fatalities has increased from 49 in 1991 to 268 in 1998 while the numbers of non-fatal heroin overdoses attended by ambulances in the capital city, Melbourne, increased from 157 per month in June 1998 to a peak of 382 per month in March 1999. These large increases in heroin related mortality and morbidity derive from a variety of factors including recent changes in the heroin market as well as particular risk behaviours heroin users engage in. Widespread recognition of the urgency of the problem of heroin overdose has resulted in a diversity of effort aimed at minimising this key heroin-related harm in Victoria. A Victorian Heroin Overdose Working Group has been established with representation from a variety of government and nongovernment sectors. Prevention and education focused initiatives have been undertaken ranging from peer education about overdose prevention and training in resuscitation techniques to a new service provides individuals who have recently experienced a nonfatal overdose with counselling and referral. A number of new initiatives are either currently being trialed or under consideration including a service targeting those who have recently experienced non-fatal heroin overdose, the provision of supervised injecting facilities, and the establishment of a recovery space for young people who are either intoxicated or have experienced a heroin overdose. While evidence as to the effectiveness of these initiatives has yet to be collected, the diverse nature of the approach taken in Victoria is an appropriate response to what is a complex problem.