The authors explored an age-specific back-calculation approach to estimating long-term trends in the incidence and prevalence of opiate use/injecting drug use (IDU) in England for 1968-2000. The incidence of opiate use/IDU was estimated by combining information on the observed opiate overdose deaths of persons aged 15-44 years with knowledge on the distribution of the time between starting opiate use/IDU and death by overdose (incubation time distribution). The resulting incidence, together with the incubation time distribution, other drug-related mortality, and the general age-specific mortality rate, was then used to estimate the prevalence of current and former users. Provisional estimates suggested two major increases in incidence in the late 1970s and early 1990s, with models including information on age at death suggesting a recent decline since 1997 and that prevalence of opiate use/IDU increased substantially in the 1990s. Results were crucially dependent on assumptions about key parameters of the back-calculation framework. In theory, the approach is a valuable addition to the portfolio of indirect methods for estimating incidence and prevalence of dependent opiate use/IDU. In practice, its full potential will be realized only once better information on the process of stopping opiate use/IDU becomes available and more precise estimates of current and historical overdose mortality are obtained.