Hypoxic brain injury is an under-recognised consequence of heroin overdose. This article documents the disability experienced by 10 people with hypoxic brain injuries following heroin overdose who presented in the 2-year period July 1997 to June 1999 at the Royal Talbot Rehabilitation Centre, a brain injury rehabilitation facility in Melbourne, Australia. Medical histories of these clients were reviewed and follow-up interviews were conducted between 2 and 4 years postinjury. Measures included the Functional Independence Measure (FIM) and the Community Integration Questionnaire (CIQ). The results showed that there were significant and enduring consequences for most of the 10 participants. At follow-up two participants had died from subsequent overdose, three required support to live in the community and one lived in an aged care facility. Only one participant was able to return to work. Cognitive problems were present in most of the group and problem solving and social interaction difficulties were the most commonly recorded problems. Three cases are described in detail to highlight some of the significant issues identified in this sample. Implications for the rehabilitation of people with brain injury following heroin overdose are discussed.