Deaths related to drug ‘misuse’ remain at an all-time high in the United Kingdom (UK). Older heroin consumers are particularly at risk, with the highest rates of deaths among people aged 40–49 and the steepest rises in the over-fifty age bracket. Accordingly, a popular theory for the UK’s increase in drug-related deaths, made by the government, and propelled in the media, is that there is an ageing cohort of heroin users with age-related health complications predisposing them to an overdose. However, drawing on in-depth interviews with those people deemed to be most at risk, this article works to complicate this theory, with participants citing a shift in (a) experience and responsibility, (b) route of administration, (c) desired effects, (d) acceptance of their drug use and ‘user’ status and (e) valuing health. Disrupting age as a given risk factor, this article turns attention away from the individual and these ‘natural’ processes to what participants describe as a singular, punitive, and inflexible treatment system and its intersecting structures. Approaching life and death as a matter of sociomaterial ‘mattering’, this article rethinks a reductionist, causal link between age and drug-related death with a treatment despondency and fatalism that could prove fatal.