Help for heroin addiction

The European drug supply has shifted, and it has become more dangerous. A joint statement from UK people services published by Change Grow Live describes the arrival of nitazenes in the UK in the last two years. 

Nitazenes are a new class of synthetic opioids. Some analogues are far more potent than heroin. They have been found mixed into the heroin supply, and have been linked to accidental overdoses and deaths in several parts of the UK.

The picture across wider Europe tells the same story. The European Union Drugs Agency (EUDA) reported more than 7,500 overdose deaths across the EU in 2023, with opioids involved in over two-thirds. In Estonia, for example, drug-induced deaths rose from 82 in 2022 to 119 in 2023, and nitazenes were implicated in over half of them.

A family history of addiction raises personal risk. This works through genetics and through the environment. Growing up around heavy substance use shapes how someone learns to handle stress or difficulty later on.

Serious trauma, especially in childhood, raises someone’s risk of opioid addiction. Heroin offers immediate relief and dampens distress. For someone whose nervous system has been carrying too much for too long, that effect can be what makes use stick.

Depression, anxiety and PTSD are common alongside heroin addiction. Heroin gives short-term relief from symptoms that are hard to bear. Over time, that relief becomes the reason use carries on.

Some people who develop heroin addiction in the UK and Ireland started with prescribed painkillers, usually for chronic pain or recovery after surgery. When those prescriptions ended or became harder to access, heroin filled the gap. This route is more common than the cultural image suggests.

Heavy stress with little support, or already using alcohol or other drugs, can both raise the risk. Neither makes addiction certain, and neither means recovery is out of reach.

• Constricted, very small pupils
• Drowsiness or appearing to drift in and out of consciousness
• Slow or shallow breathing
• Sudden weight loss
• Nausea and being sick
• Skin infections or wounds at injection sites

The pattern of addiction takes shape over weeks and months, and tends to look like:

• Heroin taking up more time and mental energy than it used to
• Use continuing despite mounting harm to relationships and finances
• Trying to stop and finding that the body will not let you
• Increasing secrecy, or withdrawing from people you used to be close to

• Strong cravings that feel impossible to ignore
• A constant low-level fear of withdrawal
• Shame about use that makes reaching for help feel harder
• A growing sense that life without heroin feels impossible

Heroin in film and news coverage tends to be shown in one narrow form: visibly unwell, visibly unable to function. The reality is broader. Many people using heroin hold jobs, raise children, and present as well as anyone around them. If your life doesn’t look like the cultural image, it can be easy to tell yourself the problem isn’t really a problem.

Denial is not the same as lying. It’s the mind’s way of protecting someone from a truth that, if accepted, would feel unmanageable. Many people in recovery describe knowing and not knowing at the same time. That isn’t weakness; it’s a recognised feature of how addiction works.

Not everyone reaches a point where treatment feels possible, and recovery has to be something a person can move toward of their own accord. Readiness takes time to arrive. For some it comes quickly; for others it takes years, and for some it doesn’t come at all.

• Restlessness, agitation and trouble sleeping
• Muscle and bone pain
• Stomach cramps and diarrhoea
• Sweating and chills, often with goosebumps (the original “cold turkey”)
• Strong cravings

Withdrawal is unpleasant. For someone using heroin heavily, going through withdrawal alone is risky, especially if other substances or health conditions are involved. Medical detox exists for this reason. Our heroin detox and withdrawal page sets out what medically supervised withdrawal involves and how it is managed.

If you are ready to take a first step, there are several routes:

• Speak to your GP. Your GP can refer you to NHS community drug and alcohol services, which provide opioid substitution, harm reduction and structured treatment. Wait times vary by area.
• Contact a community drug service directly. In most UK regions you can self-refer to a local service without a GP referral. Change Grow Live, We Are With You and Turning Point all run free services across multiple regions. In Ireland, the HSE Drug and Alcohol Helpline (1800 459 459) is the starting point.
• Consider private inpatient treatment. Private rehab is a faster route to medically supervised detox and structured therapy in a residential setting. At Castle Health we can admit patients to our inpatient treatment centres within 48 hours.

If you’d like to talk through what help for heroin addiction could look like in your situation, our team is available for a confidential conversation whenever you’re ready.

You can’t make someone ready for treatment, and accepting that is one of the hardest parts. There’s no perfect script for the conversation either. What helps is choosing a moment when they aren’t under the influence and aren’t in withdrawal, and focusing on what you’ve noticed and how it’s felt to you.

‘I’ statements tend to land better than accusations. Avoid arguing about whether or not they have an addiction; that argument rarely goes anywhere. If they seem open, offer something concrete, like looking into options together, or going with them to a first appointment.

Enabling is what care can become when it takes practical forms that make it easier for the addiction to continue. Covering for someone at work, or paying off debts caused by use, are examples, even when the intent is to protect.

Living alongside someone’s heroin addiction is exhausting. You don’t have to carry it on your own. Nar-Anon and Families Anonymous run free meetings, in person and online, for family and friends of people with substance addictions. Many find them a source of practical guidance and relief from isolation.

At Castle Health, family and couples therapy is part of how we work, because heroin addiction affects the whole family and the whole family deserves support.

If you’re worried about overdose, naloxone is an emergency medicine that can reverse an opioid overdose if given in time. It’s available to family and friends across much of the UK and Europe, through community pharmacies, drug services or your Doctor. Because some current heroin is mixed with nitazenes, more than one dose of naloxone may be needed. Call emergency services first, give naloxone, and put the person in the recovery position while you wait for the ambulance.

The most recent UK Government data for 2023–24 records around 138,000 adults in treatment for opiate addiction in England. The single largest age group is 40 to 44 years old, with more males than females impacted.

You don’t develop physical dependence after a single use, but the brain’s reward learning begins straight away. Heroin’s effect on the reward system means the brain quickly learns to want the experience again.

The mechanism is the same. Both act on mu-opioid receptors in the brain, and both can produce tolerance and physical dependence. The differences are in dose, purity and route. People who became addicted to prescribed painkillers often arrive at heroin later, when those prescriptions end or get harder to access. Treatment for both follows similar principles.

Yes. Naloxone is an emergency medication that reverses an opioid overdose, and it’s available to family and friends of people who use heroin. Access varies by country, but in much of the UK you can get it free from a pharmacy, drug service or GP. Worth keeping accessible if heroin is part of someone’s life.

The medical foundations are similar across Europe: medically supervised withdrawal, structured therapy and long-term aftercare. What varies is access and the visibility of harm reduction. Castle Health operates clinics in Scotland and Ireland and works with people from across Europe.

Yes. Length of use isn’t a barrier to starting treatment, though it can affect what the treatment plan needs to address. Many of the people we work with have been using heroin for a decade or more. Treatment is adapted to the person rather than the timeline.

Yes. Therapy is a core part of heroin addiction treatment, alongside medically supervised withdrawal and long-term aftercare. Cognitive behavioural therapy (CBT) addresses the patterns of thinking that drive use. Trauma-informed therapy works with the earlier experiences that often sit underneath addiction. The evidence for therapy combined with medical treatment is stronger than the evidence for either on its own.

Speak to a doctor or to a community drug and alcohol service as soon as you can. Do not try to stop suddenly without medical advice, because abrupt withdrawal during pregnancy can be risky for the baby. Specialist support is available through the NHS in the UK and the HSE in Ireland, and most community drug services have pathways for pregnant women.