Someone I know is using heroin. How concerned should I be?

You should be very concerned. Of all people who try illegal drugs only a very small percentage go on to use heroin. Percentage-wise, it is an extreme behavior.

The use of heroin crosses some psychological boundaries. Heroin is widely regarded as one of the most dangerous drugs around. (See What are the dangers of using heroin?) Anyone who takes it knows that they have crossed the line to a new class of drugs, and a new class of hazards. This is no longer a case of pot smoking or a casual beer or two. They know they are taking a big risk and, for whatever reason, have decided to do it. Call it "rebellion", "the kid has mental problems", "simple bad behavior", or whatever you will -- the use of heroin is a big psychological break from what is "normal".

If heroin is injected, it also crosses some physical and medical boundaries. The drug goes directly into the body, bypassing all the defenses that might lessen its impact. Overdose becomes much more possible. In addition, injecting anything should be considered extremely hazardous just because of the possibilities of infection with various blood-borne diseases. Intravenous drug injection is one of the highest causes for diseases such as AIDS, hepatitis, and numerous other diseases.

But it isn't just heroin that should concern you. Heroin use is usually a signal of other undesirable behavior. Chances are that they are breaking a number of the rules of society, including drug use and criminal acts. Indeed, some surveys show that many, if not most, heroin users had extensive criminal careers before they started using heroin. Speaking from personal experience, I have personally known a number of heroin addicts over the years. Many of them are now dead but surprisingly enough, it wasn't heroin that killed most of them. Most of them were killed by things like alcohol abuse, auto wrecks, diseases, and similar problems.

So what is the good news?

Could there be any good news about the use of heroin? Actually, yes.

The good news is that most people do not continue to use heroin, even after they have tried it. If someone in your family has tried heroin, the odds are better than even that eventually they will get their head together and decided that heroin is not for them. I know that it may not seem that there is any hope at the moment, and it will certainly be a tough time in your life but, overall, the odds are with you. Sooner or later, most people will quit using heroin. On average, it will be about five percent per year. If you can hang on for ten years, odds are at least 50-50 that your family member will make it to the other side.