Authorities in and have been warning the public about worrying cases of overdoses after people thought they had taken or .
We know the issue is also relevant to . And it’s particularly concerning because heroin can cause life-threatening opioid overdoses, particularly in people inexperienced with heroin who snort it.
Our sheds more light on what happens to people who accidentally took heroin thinking it was something else.
What we did and what we found
We are part of a 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 and .
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 . This unintentional use of opioids is . But we didn’t find any evidence that fentanyl was the cause of the overdoses we examined.
What happens when you take heroin by accident?
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.
Why is this happening?
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 , 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.
What can we do about it?
Opioid deaths are preventable. Government and community groups are working together to respond to the problem, either via or by 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.
How about naloxone?
Definitely, if someone is experiencing an opioid overdose, give them 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 . You can also order it online and get it .
Naloxone is for anyone who may experience, or witness, an opioid overdose or adverse reaction.
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.
, Conjoint Associate Professor in Clinical Pharmacology and Toxicology, St Vincent’s Healthcare Clinical Campus, ; , Clinical Senior Lecturer, Sydney Pharmacy School, Faculty of Medicine and Health, , and , Conjoint Associate Lecturer, School of Population Health,
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