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To compare the blood toxicology of heroin overdose cases and morphine positive homicide victims.Analysis of coronial cases.Sydney, Australia.A total of 705 cases of death due to opioid toxicity and 28 morphine positive homicide cases (1 January 1998–31 December 2002).There was no significant difference between the median morphine concentrations of the overdose and homicide groups (0.50 versus 0.45 mg/l). The overdose group was more likely to have blood alcohol (OR 3.21) present, but less likely to have methadone (OR 0.26) and cannabis (OR 0.04). There was a significant negative correlation between blood morphine and alcohol concentrations among the overdose group (rho = −0.32), but not among the homicide group (rho = −0.03). Independent predictors of a higher blood morphine concentration were a lower alcohol concentration and a higher methadone concentration.Morphine concentrations per se are not diagnostic of overdose. The study confirms the salience of concomitant alcohol consumption in such events.