Heroin addiction: what dependence looks like and how treatment works in the UK

Heroin is made from morphine, which comes from the opium poppy. FRANK describes it as a powerful opiate, usually sold as a white or brown powder. It slows the heart rate and breathing and produces feelings that people describe as happy, relaxed, euphoric and sleepy.

Addiction, or dependence, develops when the brain and body adapt to regular use. FRANK says the effects of heroin on the brain can cause cravings and a strong drive to keep on using, and that tolerance builds so that more is needed for the same effect. Stopping can then produce withdrawal symptoms, which makes it hard to stop without help.

Dependence on heroin is treated as a health condition in the UK, not only a criminal justice issue. Heroin is a Class A drug, so possession is illegal, but the NHS is clear that people seeking treatment are entitled to confidential care and that you do not have to be ready to stop completely to ask for help.

FRANK says heroin kills more people in the UK than any other illegal drug through overdose. If someone overdoses they may become very sleepy, their breathing slows and they can fall into a coma. If breathing slows too much a person can die.

Tolerance matters here. FRANK explains that if someone who has used regularly stops for even a few days, tolerance drops rapidly, and taking the same dose as before risks an overdose. The NHS makes the same point about detox: it lowers your tolerance, so the risk of overdosing is higher if you use heroin or other drugs such as benzodiazepines afterwards.

• Overdose is more likely when heroin is combined with other sedating drugs, including alcohol, benzodiazepine tranquillisers and methadone.

• Heroin sedates and suppresses coughing, so there is a risk of death from inhaling vomit.

• Injecting is described by FRANK as very dangerous: it makes overdose easier and risks damaged veins, infections and blood clots.

• Sharing needles and syringes risks spreading viruses such as HIV, hepatitis B and hepatitis C.

• Street heroin can be cut with other substances, including highly potent opioids such as fentanyls, which FRANK says are even more dangerous than heroin itself.

FRANK says that if you or someone else needs urgent help after taking drugs or drinking, you should call 999 for an ambulance and tell the crew everything you know. FRANK describes the signs of overdose as becoming very sleepy, with breathing that slows and can progress to coma. More detail on this situation is on the opioid overdose page.

The NHS says you can see a GP or contact your local drug treatment service. The NHS also points people to the FRANK website to find drug and alcohol support nearby. Charities and the NHS provide most drug treatment, and there are also private services, which you would pay for.

At the first appointment the doctor or drugs worker will ask how much heroin you take, whether you use other drugs or alcohol, about your physical and mental health, your personal circumstances such as where you live, and whether you have had treatment before. You will be asked for a urine sample, which is tested to confirm heroin use. You are given a key worker who helps you put together a personalised treatment plan and meets you regularly.

The NHS says your key worker will help you decide between two approaches. Both aim to help you withdraw from heroin gradually and to ease withdrawal symptoms.

You can switch from maintenance therapy to detox at any time, according to the NHS, and some people start with maintenance and later go on to detox. If there are no issues you usually live at home while switching to maintenance or going through detox. Detoxing from heroin while living at home can take up to 12 weeks. Your daily dose of methadone or buprenorphine is supervised by a drugs worker or pharmacist for at least the first 3 months.

Methadone is an opioid medicine that the NHS says is one of the medicines used to help you stop taking heroin. It works by reducing withdrawal symptoms such as feeling restless or anxious, a runny nose, sweating, feeling or being sick, diarrhoea, shaking and muscle cramps, and it helps stop cravings. For heroin dependence it is available on prescription only, usually as a green liquid you swallow, from a local drug treatment service or your GP.

The NHS lists the most common side effects, if you are not used to opioids, as constipation, feeling or being sick, and feeling cold and sweaty. It advises avoiding alcohol while taking methadone because it can cause very serious side effects. Methadone is itself addictive, so the dose is reduced slowly if you want to stop, after talking to your GP or prescriber. You may have regular urine or saliva tests to check for heroin, methadone and other drugs.

The NHS says detox as a hospital inpatient or in residential rehab is usually offered only if you need medical help for other physical or mental health problems, need to detox from alcohol or another drug such as benzodiazepines as well as heroin, or if detoxing at home has not worked before.

Other help that may be offered includes talking therapies such as CBT if you have anxiety or depression, local self-help groups such as Narcotics Anonymous or SMART Recovery, support for family and carers, tests for infections such as HIV and hepatitis, and incentives such as vouchers or take-home doses of methadone for sticking with treatment. After detox the key worker also helps with issues such as housing or getting back into work or education.

FRANK says doctors have developed a number of effective ways to treat addiction to street heroin, and that medicines such as methadone and buprenorphine are intended to supplement the counselling and social support normally needed to become drug-free and recover. The NHS describes at least 6 months of follow-up support after detox.

If you are not ready to stop, the NHS says you can still get help with staying safe and healthy, including advice on reducing harm and testing and treatment for infections.

The NHS and charities provide most drug treatment in the UK. Private drug and alcohol treatment organisations also exist and must be paid for. The medicines and assessment steps described above are the same kind of care in either setting, but the choice and availability of residential services varies by area, so ask any service what ongoing support it provides after detox.