Opioid addiction (including heroin)

What it is

Opioid use disorder involves loss of control over use of opioids: heroin, or prescription painkillers such as codeine, tramadol, morphine and others. Opioids are powerfully addictive, producing strong physical dependence and a severe, distressing withdrawal (body aches, cramps, vomiting, agitation, intense craving) that drives continued use. It is a medical condition, and a dangerous one, but it is treatable, and treatment dramatically reduces the risk of death.

In parts of East Africa, heroin use, including by injection, carries the added dangers of HIV and hepatitis transmission through shared equipment, making this a public-health priority as well as an individual one.

The overdose danger and how lives are saved

The gravest risk is overdose: opioids can slow and stop breathing, and overdose can be fatal within minutes. This risk is highest after a period of abstinence (after release from custody or a break in use), when tolerance has dropped. Overdose can be reversed if naloxone, a safe antidote, is given quickly, which is why expanding access to it saves lives. Anyone around opioid use should know the signs of overdose and how to seek emergency help immediately.

How common is it

Opioid use disorder is a serious and growing concern in parts of East Africa, particularly along the coast and in Nairobi, where heroin use, including by injection, occurs. Injecting and sharing equipment add the dangers of HIV and hepatitis, which is why this is a public health priority. Prescription opioids such as tramadol and codeine are also misused.

What causes it

Opioids are powerfully addictive, and dependence can develop from heroin or from misused prescription painkillers. Risk is higher with a history of trauma, other mental health conditions, pain treated with opioids, and an environment where opioids are available. With repeated use the body adapts, so stopping brings severe withdrawal and strong craving, which drives continued use. This is a medical condition, not a moral failing.

How it is diagnosed

A clinician makes the diagnosis through an honest conversation about use, control, craving, withdrawal, and the effect on health and life, alongside a medical assessment. For someone who injects, testing for HIV and hepatitis is important. The aim is not to judge but to start effective, life-saving treatment quickly.

How it is treated

The most effective treatment is opioid agonist therapy: long-term medicines such as methadone or buprenorphine, which prevent withdrawal and craving, allow stable functioning, and substantially reduce overdose deaths, crime and disease transmission. Methadone is on the WHO Essential Medicines List, and methadone programmes now operate in several African countries. Medication works best with counselling and social support, plus harm-reduction services (clean equipment, HIV testing and treatment) for those who inject.

Detoxification alone, without ongoing treatment, has high relapse and overdose risk; sustained, medication-supported treatment is what changes outcomes.

Opioid use disorder in the African context

East Africa lies on a major heroin route, and coastal cities and Nairobi have been most affected. The response has grown: methadone treatment programmes now operate in Kenya, alongside harm reduction services such as clean equipment, HIV testing, and treatment. Stigma and fear of the law keep many people away from help, yet treatment saves lives, reduces the spread of disease, and allows people to rebuild. Reaching these services early is what changes the outcome.

Managing it day to day

Alongside medication-supported treatment, these points matter.

• Stay in treatment. Methadone or buprenorphine works only while taken, and stopping suddenly raises the risk of overdose.
• Know that overdose risk is highest after any break in use, when tolerance has dropped.
• If you or those around you use, learn the signs of overdose, and keep naloxone within reach where it is available.
• If you inject, never share equipment, and use harm reduction and HIV services.
• Build routine, support, and reasons to stay engaged, one day at a time.

Helping someone

If someone you love has an opioid problem, your support can be life-saving.

• Learn the signs of overdose, such as being unresponsive, slow or stopped breathing, or blue lips, and how to get emergency help fast.
• Encourage medication-supported treatment such as methadone, the most effective option, rather than detox alone.
• Avoid shaming, which deepens secrecy and risk, and stay connected.
• Help them reach services. Our Get Support page can point the way.
• Look after yourself, and share the burden with others you trust.