Heroin Addiction

Finding a Way Forward With Heroin Use

If heroin use has become hard to stop, or you are worried about someone who uses it, treatment can help and overdose prevention matters now. Heroin is an opioid made from morphine. Drugs sold as heroin may also contain fentanyl without the person knowing it.^[1][6][8]

When Heroin Exposure Needs Emergency Help

If someone cannot be awakened or has slow, shallow, or difficult breathing, give naloxone if available, call 911, place the person on their side, and stay until help arrives.^[5]

Heroin Overdose Signs and Emergency Response

An opioid overdose is an emergency in which opioid effects dangerously suppress consciousness or breathing. It may be difficult to know which opioid or combination caused it. If a person cannot be awakened or is breathing abnormally, act rather than waiting to identify the substance.^[5]

What Are the Signs of an Opioid Overdose?

The CDC identifies several signs that require immediate attention:

• Unconsciousness or inability to awaken.
• Slow, shallow, or difficult breathing.
• Choking, gurgling, or snoring sounds from someone who cannot be awakened.
• Discolored skin, especially around the lips or nails.
• Very small “pinpoint” pupils that do not respond to light.^[5]

Not every sign must be present. If it is unclear whether someone is intoxicated or overdosing, the CDC advises responding as though it is an overdose.^[5]

What Should You Do for a Suspected Heroin Overdose?

Give naloxone if available and call 911.^[5][6] Try to keep the person awake and breathing, place them on their side, and stay until help arrives. Use the approved product according to its directions, including another dose when directed if the person does not respond or symptoms return.^[5][6]

Naloxone reverses opioid overdose temporarily and is available over the counter. Anyone can carry and administer it. Most states have laws that may protect the caller or the person overdosing from some criminal penalties, although protections differ by state. Giving naloxone does not replace emergency care.^[5]

Research reviews of overdose education and naloxone distribution found better overdose knowledge and reduced opioid-related mortality. Most of that evidence involved people who used heroin. The practical step is to obtain naloxone, learn its directions, and keep it where you can reach it.^[7]

Risks of Combining Heroin With Other Drugs

Using more than one drug can increase the chance of serious harm or death, whether the combination is intentional or caused by contamination. Fentanyl may be mixed with heroin, cocaine, methamphetamine, or xylazine, a tranquilizer used in animals, and may be present in counterfeit prescription pills. A person may therefore take a combination without knowing it.^[6]

Combining heroin with a stimulant such as methamphetamine is also risky; the danger is not limited to combining two opioids. The National Institute on Drug Abuse warns that taking multiple drugs increases serious health risks, especially for people not accustomed to powerful opioids such as fentanyl. Do not assume a drug combination is safe.^[6]

Appearance and a product’s label cannot establish whether it contains fentanyl. If opioid exposure is possible, carrying naloxone is a practical safeguard. Fentanyl test strips check for fentanyl and may reduce the risk of unknowingly taking it; testing is a risk-reduction step, not a guarantee of safety.^[3][6][5]

How Does Heroin Differ From Other Opioids?

Opioids are a class of drugs that includes heroin, prescription medicines such as morphine, and synthetic drugs such as fentanyl. “Synthetic” means made in a laboratory rather than obtained from a plant. Although these drugs differ in potency, meaning strength, as well as medical uses and legal status, they can produce opioid effects and contribute to overdose.^[6][2]

Heroin is produced from morphine. Morphine itself comes from substances found in opium poppies. Fentanyl is different: it is made entirely in laboratories. Pharmaceutical fentanyl is approved for certain kinds of severe pain, while most fentanyl contributing to the current U.S. overdose crisis is illegally manufactured.^[1][6]

These distinctions matter because the name used for a product may not accurately describe what it contains. A product sold as heroin may contain fentanyl, and counterfeit tablets made to resemble prescription medicines may also contain it. Physical appearance, taste, or obtaining a product from a familiar source cannot reliably establish its contents.^[3][6]

How Heroin Acts on Opioid Receptors

Heroin acts on mu-opioid receptors, molecules on nerve cells that also respond to fentanyl and methadone. Receptors are attachment sites involved in a drug’s effects. Methadone activates these receptors more slowly and remains in the body longer, helping explain why supervised treatment can ease withdrawal and craving with less intense pleasurable effects.^[8]

How Prescription Opioid Misuse Relates to Heroin Use

Prescription opioid misuse is a risk factor for starting heroin use, but only a small fraction of people who misuse opioid pain relievers switch to heroin. A history of pain treatment therefore does not establish an inevitable path to heroin.^[2]

Why Heroin Form and Route of Use Matter

Heroin may be sold as powder or as black tar heroin. Appearance, taste, or getting a product from a familiar source cannot reliably show whether it contains illicitly manufactured fentanyl. Prior experience with something that looks similar therefore does not establish whether a new product contains fentanyl.^[1][3]

Route means how a drug enters the body. Injecting opioids adds risks beyond intoxication, the effects present while a drug is acting. These include transmission of blood-borne viruses (viruses spread through blood) such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Sharing injection equipment increases infectious-disease risk.^[9][2]

Injection can also contribute to skin and soft-tissue infections. Syringe services programs aim to reduce these harms by providing sterile equipment, safe disposal, health information, and connections to testing, treatment, and social services. Availability and the exact services offered differ by community.^[10]

These injection risks do not establish that another route is safe. Fentanyl’s strength and combinations of drugs also matter, especially when someone’s body is not accustomed to opioid effects. Tolerance means the body responds less to the same amount of a drug; it is different from physical dependence, which can cause withdrawal when use stops.^[6]

How Fentanyl Changes Heroin Overdose Risk

Fentanyl is substantially more potent than morphine or heroin, meaning a smaller amount can produce powerful effects. The National Institute on Drug Abuse warns that even a small amount can cause a fatal overdose. Drug combinations are particularly dangerous for people whose bodies are not accustomed to powerful opioids such as fentanyl.^[6]

Illicitly manufactured fentanyl may be sold as heroin or placed in counterfeit pills. Some people knowingly use fentanyl, while others are exposed without knowing it. Because neither appearance nor taste is reliable, uncertainty about product contents is itself an important overdose risk.^[3][6]

Fentanyl test strips can be used to test drugs for fentanyl and may reduce the risk of unknowingly using a fentanyl-containing product. A test result does not establish that a product is safe to use.^[6]

How Do Heroin Use, Dependence, and Opioid Use Disorder Differ?

These terms describe different situations. Using them separately helps identify the kind of support someone may need.

In NSDUH reporting, prescription-drug misuse includes using someone else’s medication or taking one’s own differently from the prescribed directions. That is a data definition; it should not be used to assume that every person in the category has a disorder. Opioid use disorder requires a separate assessment of diagnostic criteria.^[3][4]

Intoxication refers to effects present while a drug is acting. Severe opioid intoxication can progress to overdose, in which a person cannot be awakened or cannot breathe adequately. Because it may be difficult to distinguish an overdose from being “high,” the Centers for Disease Control and Prevention advises treating uncertainty as a possible overdose.^[5]

Physical dependence means the body has adapted to repeated opioid exposure. Abruptly stopping or substantially changing opioid exposure may then cause withdrawal. Dependence can occur with heroin, fentanyl, or opioid medications, including medications appropriately used to treat opioid use disorder.^[6][8]

Dependence alone does not establish addiction or opioid use disorder. The CDC notes that tolerance and withdrawal do not count toward the diagnosis when they occur solely during appropriate medical treatment.^[4]

How Is Opioid Use Disorder Diagnosed?

Opioid use disorder is a clinical diagnosis based on a problematic pattern of opioid use. Under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria summarized by the CDC, at least two of 11 features must occur within a 12-month period.^[4]

Two or three criteria indicate mild disorder. Four or five indicate moderate disorder. Six or more indicate severe disorder.^[4]

The criteria concern patterns and consequences rather than the mere presence of an opioid in the body.

They include:

• Taking opioids in larger amounts or for longer than intended.
• Wanting or trying unsuccessfully to reduce or control use.
• Spending substantial time obtaining, using, or recovering from opioids.
• Experiencing craving or a strong urge to use.
• Being unable to meet important responsibilities at work, home, or school.
• Continuing despite persistent social or relationship problems.
• Giving up or reducing important activities.
• Repeatedly using in physically hazardous situations.
• Continuing despite awareness of persistent physical or psychological problems.
• Developing tolerance outside appropriate medical supervision.
• Experiencing or avoiding withdrawal outside appropriate medical supervision.^[4]

When Should Someone Seek an Opioid Use Assessment?

An assessment is reasonable when opioid use feels difficult to control, interferes with responsibilities or relationships, continues despite harm, occurs in hazardous situations, or takes increasing time and attention. Craving, repeated unsuccessful efforts to cut down, overdose, and withdrawal are also reasons to discuss opioid use with a qualified clinician.^[4]

No single behavior proves the diagnosis. A clinician considers the whole pattern over time, the person’s medical treatment, other substances, physical and mental health, and immediate safety. The CDC recommends discussing concerns nonjudgmentally and collaborating with the patient on safety and treatment.^[4]

An overdose should prompt urgent medical care rather than waiting for a routine assessment. After the emergency has been addressed, an emergency department or another healthcare setting may also help connect the person with evidence-based opioid use disorder treatment.^[5][8]

What Are the Short-Term Effects of Heroin and Other Opioids?

Opioid effects can include relaxation, euphoria (a strong feeling of pleasure), drowsiness, confusion, nausea, constipation, and slowed breathing. The National Institute on Drug Abuse describes these effects in its prescription-opioid guidance and notes that prescription opioids have effects similar to heroin. These are opioid-class effects, not a way to identify what an illegal product contains.^[2][3]

The important safety distinction is between drug effects and signs of a possible overdose. Someone who cannot be awakened, breathes slowly or shallowly, or makes choking or gurgling sounds needs an emergency response. Do not assume severe sleepiness is harmless or wait for every overdose sign to appear; if unsure, treat the situation as an overdose.^[5]

How Can Heroin Use Affect Physical and Mental Health?

The health consequences associated with heroin use arise from several overlapping sources: opioid intoxication and overdose, physical dependence, injection, an unpredictable supply, co-occurring substance use, and the social or medical circumstances in which use occurs.

This complexity matters when interpreting research. A finding among people who inject multiple drugs cannot automatically be attributed to heroin alone. A cross-sectional study, which measures participants at one period rather than following causes over time, can identify associations but generally cannot prove what caused them.

Heroin Overdose and Brain Injury Risk

A major immediate danger is overdose, particularly when fentanyl is present or a person has limited tolerance to opioid effects. Fentanyl’s high potency means a small amount may produce severe or fatal effects, and a person may not know it is present.^[3][6]

Slowed or stopped breathing can cause hypoxia, meaning too little oxygen reaches the brain. This can lead to coma, permanent brain damage, or death. These are possible consequences of inadequate oxygen during opioid overdose, not proof that every episode of opioid use causes lasting brain injury. Research continues into other long-term brain effects of opioid addiction and whether they can be reversed.^[2]

People with opioid use disorder have higher healthcare use, illness, and mortality than people without opioid use disorder. This broad comparison concerns opioid use disorder as a whole rather than heroin alone and does not identify one mechanism for every outcome.^[9]

Infection Risks From Injecting Heroin and Other Opioids

Injecting opioids carries additional risk of blood-borne virus transmission, including HIV and HCV. Sharing injection equipment increases the risk of infectious diseases. These injection-associated risks are distinct from the drug’s direct effects on alertness and breathing.^[9][2]

Syringe services programs aim to reduce infectious-disease transmission and skin and soft-tissue infections, involving skin and the tissue beneath it. They can provide sterile syringes, disposal, and connections to health and social services. Ask a local program or healthcare service about HIV and hepatitis C testing and where to obtain care for injection-related wounds; do not assume every program offers each service onsite.^[10]

The case study also described expanded syringe services, HIV testing and counseling, health screening, linkage to care, food assistance, and housing-related support. These observations show how harm-reduction programs may serve as entry points to broader care, although local program models and resources differ.^[10]

Mental Health and Other Substance Use Alongside Heroin

Mental illness and opioid-related problems can occur in the same person. A systematic review of psychosocial treatments added to opioid medication included some trials specifically involving people with psychiatric disorders or prominent mental-health symptoms. Other trials focused on people with additional substance-use conditions, including cocaine use, moderate to heavy alcohol use, or dependence on sedating drugs.^[9]

These selected treatment populations do not establish how often mental illness occurs among everyone who uses heroin. Nor do they show that heroin caused participants’ mental-health conditions. Less than 10% of the review’s evidence base specifically recruited people with co-occurring mental-health conditions, limiting conclusions about their treatment needs.^[9]

Co-occurring use of stimulants, alcohol, sedatives, or other substances further complicates both health and research findings. Since overdose deaths often involve multiple drugs, a reported heroin- or fentanyl-involved event may not have been caused by only one substance.^[6][11]

A useful assessment looks beyond one drug. Consider bringing questions about other substance use, mental health symptoms, pain, pregnancy, infection risk, housing, or barriers to care when relevant. Treatment research includes some of these circumstances, but several groups, including pregnant people and people with co-occurring mental health conditions, remain underrepresented. Ask how the evidence and available services apply to your situation.^[9][10][8]

What Happens During Heroin Dependence and Withdrawal?

Physical dependence develops when the body adapts to repeated opioid exposure. Heroin withdrawal is part of the broader opioid withdrawal response: the collection of symptoms that may occur when opioid exposure stops or falls substantially in a physically dependent person. Tolerance means the same amount produces less effect, or more is needed to obtain the previous effect.^[6]

Dependence and tolerance can occur without opioid use disorder, including during appropriate medical treatment. Conversely, a person may meet other opioid use disorder criteria without tolerance or withdrawal. That is why diagnosis considers the complete 12-month pattern rather than using withdrawal as a shortcut.^[4]

In a physically dependent person, stopping opioids can cause very uncomfortable withdrawal. Symptoms can include muscle and bone pain, sleep problems, diarrhea, vomiting, cold flashes with goose bumps, involuntary leg movements, and strong cravings. National Institute on Drug Abuse guidance on prescription opioids notes that symptoms may begin within hours of the last use; this is not a precise timetable for every opioid or person.^[2]

Fentanyl poses particular overdose danger for people whose bodies are not accustomed to opioid effects. Products sold as heroin may contain fentanyl without the person’s knowledge, so overdose prevention, including naloxone access, should remain part of discussions about ongoing care.^[3][6][5]

How Heroin Withdrawal Care Differs From Ongoing Treatment

Medical detox and withdrawal care address symptoms when opioid use stops or changes. For example, lofexidine is a non-opioid medicine approved to reduce opioid withdrawal symptoms. Relieving those symptoms is a different task from treating opioid use disorder over time. In its treatment measures, NSDUH distinguishes medications for opioid use disorder from medicines used only for withdrawal or overdose reversal.^[2][3]

These services can have complementary purposes: emergency care addresses overdose, medications such as methadone and buprenorphine reduce withdrawal and craving during ongoing treatment, and peer services may help with engagement and treatment navigation. Evidence for peer support is mixed, so it should not be treated as a substitute for medication or emergency care.^[5][8][12]

Ask a clinician what symptom relief and continuing treatment would involve, rather than creating a personal withdrawal schedule. Starting naltrexone presents different challenges from starting methadone or buprenorphine. Methadone and buprenorphine can themselves cause physical dependence, and abruptly stopping them may cause withdrawal; discuss changes with the treating clinician.^[8]

What Treatments Help With Heroin-Related Opioid Use Disorder?

People with opioid use disorder who are treated with methadone or buprenorphine are less likely to die or to have an overdose than those who do not receive treatment.^[8]

Treatment can reduce withdrawal and craving, help people remain in care, and support reduced opioid use. In the United States, three medications are approved for opioid use disorder: methadone, buprenorphine, and naltrexone. Their actions, starting requirements, and access pathways differ.^[8]

Medication treatment provides ongoing care for opioid use disorder, rather than simply reversing an overdose or managing withdrawal. The medicines work at opioid receptors: molecules on nerve cells that opioids attach to. Methadone and buprenorphine activate these receptors to different degrees; naltrexone blocks them. These differences help explain their benefits and starting requirements.^[3][8]

Comparing Opioid Use Disorder Medications

The comparison below summarizes how each medication works. The medication sections that follow explain access and starting requirements. Extended-release formulations are longer-acting forms designed to release medication over time.^[8]

How Methadone Treats Opioid Use Disorder

Methadone activates the same type of opioid receptor as heroin and fentanyl, but it acts more slowly and remains in the body longer. For people with opioid use disorder, it can reduce withdrawal and craving without producing the same intense, rapid effects associated with heroin.^[8]

In the United States, methadone for opioid use disorder is dispensed through approved opioid treatment programs. People may initially attend daily or nearly daily. Current rules allow many established patients to receive take-home doses, sometimes up to 28, depending on program and individual circumstances.^[8]

Transportation and geographic access can be barriers, especially when no opioid treatment program is nearby. A person considering methadone can ask a program what attendance, counseling, testing, take-home policies, and payment arrangements would mean in daily life.^[8]

How Buprenorphine Treats Opioid Use Disorder

Buprenorphine activates opioid receptors less fully than methadone and can block other opioids from attaching to them. It can reduce withdrawal and craving without producing intense intoxication in people with opioid use disorder when taken as prescribed.^[8]

Approved formulations include tablets or films placed under the tongue, cheek film, extended-release injections, and implants. Some products combine buprenorphine with naloxone. Regulatory approval is different from current U.S. marketing or availability: an approval listing should not be read as confirmation that an implant can currently be obtained.^[8]

For practical treatment planning, ask about under-the-tongue tablets or films and extended-release injections, and confirm which products can actually be obtained through the prescriber and pharmacy or treatment service. Ask what receiving each would involve. Buprenorphine can be prescribed in physician offices, but some people encounter pharmacies that do not carry or dispense it.^[8][13]

Many physicians, nurse practitioners, and physician assistants can prescribe buprenorphine outside a specialized opioid treatment program. Telehealth may also be available. Buprenorphine can sometimes be started in an emergency department after an overdose to reduce withdrawal and craving and support entry into continuing treatment.^[8]

How Naltrexone Treats Opioid Use Disorder

Naltrexone blocks opioid receptors rather than activating them. The National Institute on Drug Abuse describes it as not addictive, and it is available as a long-acting monthly injection for opioid use disorder. It is also approved for alcohol use disorder.^[8]

For a person who is physically dependent on opioids, starting naltrexone before opioids have cleared can precipitate withdrawal, meaning it can trigger withdrawal suddenly. Guidance commonly describes stopping opioids for 7 to 10 days before standard naltrexone initiation, but the correct interval and process require clinical assessment.^[8]

Once successfully started and continued, naltrexone can be as effective as buprenorphine at helping people avoid a return to opioid use. However, studies have found it harder to start because of the required opioid-free period. This is an initiation limitation, not evidence that the medications are universally interchangeable.^[8]

Are Methadone and Buprenorphine Just Substituting One Drug for Another?

Methadone and buprenorphine are opioids and can produce physical dependence. However, when prescribed for opioid use disorder, their slower, steadier effects reduce withdrawal and craving without the intense effects produced by rapidly acting illegal opioids. This can create stability needed for health care and recovery.^[8]

Physical dependence on a treatment medication is not the same as uncontrolled use. Abrupt discontinuation may cause withdrawal, so changes should be planned with the treating clinician rather than made suddenly.^[8]

Methadone and buprenorphine can both reduce opioid use and help people stay in treatment. Methadone may help some people remain in treatment longer. The practical choice can be affected by access, the ability to start treatment, and the ability to continue it.^[8]

Pregnancy and Heroin Use

Do not abruptly stop opioids during pregnancy on your own. Contact a prenatal clinician or an opioid-treatment provider for a treatment plan. Methadone and buprenorphine are recommended first-line medications for opioid use disorder during pregnancy; care should coordinate addiction treatment and prenatal services.^[17]

A baby can develop withdrawal after exposure to opioids, including treatment medication. That possibility alone is not a reason to withhold treatment. The pediatric team can monitor and treat the baby. Ask who will coordinate care during pregnancy, after delivery, and through the postpartum period.^[17]

How Counseling and Peer Support Fit Into Heroin Treatment

Medication and psychosocial care play different roles. Psychosocial interventions include counseling and structured approaches that address behavior, coping, relationships, or practical goals. Research on adding these services to opioid agonist treatment (medication such as methadone or buprenorphine that activates opioid receptors) helps clarify which additions may improve outcomes. It does not establish that these medications require a particular counseling approach to work.^[9]

What Does Counseling Add to Opioid Medication Treatment?

Contingency management, which offers defined rewards for meeting treatment goals, improved retention when added to opioid medication in a systematic review. Most studies did not establish that adding psychosocial treatment improved opioid-use outcomes over medication alone. That does not show counseling has no value; approaches, participants, and outcomes differed.^[9]

Medication is a central treatment, not merely a support for counseling. Counseling, contingency management, and other services can be added according to your goals and needs. Ask what each part of the plan is intended to help you do and how progress will be reviewed.^[9]

How Can Peer Support Help With Opioid Recovery?

Peer recovery support is provided by someone whose lived experience informs encouragement, navigation, or practical help. A peer specialist is not necessarily a clinician and should have a clearly defined role.

A systematic review found potential benefits across some substance-use and mental-health settings, including treatment engagement and adherence. However, results varied, many studies found no advantage over usual care, and more research is needed to determine where peer services are most effective.^[12]

One nonrandomized emergency-department study involved 151 people after opioid overdose.^[12] It compared peer support and treatment navigation plus naloxone and usual care with naloxone plus usual care and with usual care alone. Usual care included medical stabilization and a printed list of treatment programs. Assignment depended on provider and patient discretion, limiting causal interpretation.^[12]

At 12 months, medical-record review did not demonstrate differences between groups in medication initiation, repeat overdose visits to the same emergency department, deaths, or time to death.^[12] This lack of demonstrated benefit does not establish that the approaches were equivalent.^[12]

Another pilot outreach effort identified 88 people actively using opioids.^[12] Of 72 who were eligible, 70 attended a treatment-linkage meeting.^[12] This suggests peers may help reach and engage interested people, but the small pilot did not by itself establish long-term effectiveness.^[12]

Peer support can still be meaningful for companionship, hope, navigation, and practical problem-solving. If you are exploring mutual-help groups, our Heroin Anonymous guide describes one option. Peer support can complement clinical treatment and harm-reduction services. It does not replace overdose care, infection treatment, or medication for opioid use disorder.^[12][8]

Heroin Harm Reduction and Recovery Support

A person does not have to be ready for abstinence before taking steps that protect life and health. Families can support safety without demanding an immediate commitment to one recovery path.

Reducing Risks When Heroin Use Continues

Focus first on preventable dangers. Keep naloxone accessible, ensure people nearby know where it is, and know the overdose signs. Treat unusual unresponsiveness or abnormal breathing as an emergency, give naloxone if available, call 911, position the person on their side, and stay with them.^[5]

Do not rely on an illegal product’s appearance or label to judge whether it contains fentanyl. Fentanyl test strips can check for fentanyl and may reduce the risk of unknowingly taking it. Testing addresses fentanyl exposure and is a risk-reduction step, not a guarantee of safety.^[3][6]

Avoiding multiple substances reduces one source of uncertainty because intentional or unintentional drug combinations increase the risk of serious health effects. This is particularly important when products may already contain undisclosed fentanyl.^[6]

If injection occurs, seek sterile syringes and avoid sharing injection equipment. Syringe services programs aim to reduce infectious-disease and other drug-related harms through syringe access, disposal, and connections to health and social services. Ask a local program about available supplies, infection testing, and care referrals rather than assuming every service is offered onsite.^[2][10]

Finding Treatment for Heroin Use

A manageable first step is to ask for an opioid use disorder assessment rather than choosing the entire recovery plan in advance. Our treatment center directory can help you identify services to contact.^[4]

Many physicians, nurse practitioners, and physician assistants can prescribe buprenorphine; approved opioid treatment programs provide methadone for opioid use disorder. Buprenorphine can also be started in an emergency department after an overdose. Ask a service what it offers and how to begin.^[4][8]

Ask whether the service offers or arranges all three approved medications. Also ask about appointment frequency, telehealth, counseling requirements, cost, transportation, privacy, mental-health care, pregnancy-related care, pain treatment, infection testing, and what happens if an appointment is missed.

In the United States, the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-HELP (4357) provides treatment referrals.^[6] FindTreatment.gov can also be used to search for qualified providers. When contacting a provider, ask about openings, payment options, and whether its services match your needs.^[6]

Supporting Ongoing Recovery From Heroin Use

Recovery may include medication, counseling, peer support, mutual-help groups in which members support one another, medical care, housing assistance, or employment support. NSDUH counts several of these as separate service categories. Research on peer services also describes programs combining treatment, housing, and vocational support; their results do not establish which individual component produced a benefit.^[3][12]

Keep overdose prevention part of the plan: products sold as heroin may contain fentanyl without the person’s knowledge. Maintain access to naloxone, and discuss medication changes with the treating clinician. Abruptly stopping methadone or buprenorphine can cause withdrawal.^[3][5][8]

If a return to use occurs, it does not erase prior progress. It is a reason to reassess safety, naloxone access, treatment fit, medication continuity, co-occurring conditions, and practical barriers.

How Families and Friends Can Support Someone Using Heroin

Use direct, nonjudgmental language. Describe what you have observed, ask what the person wants help with, and offer a specific step such as obtaining naloxone, making a call, arranging transportation, or sitting with them during an appointment search.

Learn overdose response even if the person is not seeking treatment. Anyone can give naloxone, and overdose education programs have improved knowledge and reduced opioid-related mortality in the reviewed evidence.^[7][5]

Set boundaries around what you can safely provide without treating punishment as healthcare. A family member can support care while involving clinicians in diagnosis and withdrawal planning. For a suspected overdose, give naloxone if available and call emergency services.^[4][8][5]

Heroin Use and Overdose Statistics in the United States

Different data systems answer different questions. A household survey can estimate reported use and symptoms in a defined population. Emergency-department surveillance tracks suspected overdoses that reach participating hospitals. Neither automatically captures every person who uses heroin, every overdose, or every death.

How Many People Report Heroin Use in the United States?

The National Survey on Drug Use and Health, or NSDUH, interviews people age 12 or older in the U.S. civilian, noninstitutionalized population.^[14] This excludes people who are institutionalized and does not make the survey a complete count of everyone in the country. Its detailed tables cover reported substance use, substance use disorder, mental health, and treatment.^[14]

In the 2025 survey, an estimated 581,000 people reported past-year heroin use, and 3,972,000 met criteria for past-year opioid use disorder.^[15][16] The denominator for both percentages below is the surveyed U.S. population age 12 or older, not only adults or people who use opioids.^[15][16] The broader opioid use disorder estimate is not a heroin-only figure.^[15][16]

These are survey estimates, not exact counts; percentages are rounded. The disorder measures use criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, a framework for diagnosing mental health and substance use conditions. The 2025 past-year heroin-use estimate of 0.2% means about two in every 1,000 people age 12 or older reported heroin use during that timeframe.^[15][16][4]

Heroin use and opioid use disorder answer different questions. Use describes taking the drug; opioid use disorder concerns a pattern of symptoms and consequences over a year and can involve opioids other than heroin. A use estimate therefore should not be treated as a disorder estimate, or a broad opioid estimate as a heroin-only figure.^[4][2]

Prescription-drug misuse is another distinct measure. NSDUH defines it as use in any way not directed by a doctor, including use without one’s own prescription or use in greater amounts, more often, or longer than directed. This definition describes how a medication was used; it does not by itself establish opioid use disorder.^[3][4]

Treatment also matters when interpreting disorder estimates. The 2024 report notes that some respondents receiving medication may have met disorder criteria more than 12 months earlier but not during the past year.^[3][11] A past-year disorder estimate therefore is not a count of everyone with a treatment history. Emergency-visit counts measure a different outcome again.^[3][11]

How Are Heroin and Fentanyl Overdose Visits Changing?

A U.S. study examined suspected nonfatal overdoses treated in emergency departments from October 2020 through April 2025.^[11] After data-quality filters, its surveillance data covered 3,095 facilities in 46 states, the District of Columbia, and Guam.^[11] These were emergency visits, not population prevalence estimates.^[11]

Across the study period, monthly suspected heroin-involved overdose counts declined by an average of 3.1%, while fentanyl-involved counts increased by an average of 2.0%.^[11] Fentanyl-involved counts surpassed heroin-involved counts in February 2023 and remained higher through April 2025.^[11]

In October 2020, the system recorded 5,571 suspected heroin-involved overdoses and 913 fentanyl-involved overdoses.^[11] In February 2023, it recorded 2,341 heroin-involved and 2,464 fentanyl-involved overdoses.^[11] These counts reflect visits captured by participating, consistently reporting facilities, not all U.S. overdoses.^[11]

The categories could overlap because an overdose might involve more than one drug. The system used chief-complaint text (the recorded reason for the emergency visit) and discharge diagnosis codes, standardized labels for diagnoses recorded after evaluation. These identified suspected overdoses before confirmatory evidence was necessarily available. Coding and data quality therefore matter when interpreting the trends.^[11]

For readers, the practical message is not that heroin has become harmless because heroin-coded visits declined. It is that the illegal opioid supply has changed, fentanyl has become increasingly important, and prevention should address opioid overdose regardless of the label attached to a product.

Next Steps for Heroin Help and Recovery

For a substance-use or mental-health crisis, suicidal thoughts, or severe emotional distress in the United States, call or text 988 to reach the 988 Suicide & Crisis Lifeline.^[6][5] A suspected overdose requires naloxone if available and a 911 call rather than relying on 988 alone.^[6][5]

If there may be an overdose now, give naloxone if available, call 911, place the person on their side, and stay with them.^[5] Do not wait to identify the drug.^[5]

If use is continuing, make one safety step manageable: obtain naloxone and learn the overdose-response steps, ask about fentanyl test strips, or contact a syringe services program about sterile supplies and connections to care. Ask a healthcare service about HIV and hepatitis C testing when injection is relevant.^{[5][6][10][9]}

If treatment is being considered, request an opioid use disorder assessment and ask specifically about methadone, buprenorphine, and naltrexone. Compare not only the medications but also what attendance, starting treatment, transportation, telehealth, and follow-up would involve in everyday life.^[8]

If treatment is already underway, discuss cravings, withdrawal, side effects, return to use, pain, mental health, and access barriers openly. Do not abruptly stop methadone or buprenorphine or try to create a personal taper without clinical guidance.^[8]

If you are supporting someone else, learn to use naloxone and be ready to call 911 and stay with them during a suspected overdose.^[5][6] Offer one concrete form of help, such as finding a treatment contact together. You can help with overdose preparedness before the person has chosen a treatment plan.^[5][6]