Heroin
smack · brown · gear · diamorphine
What does current UK evidence show?
England and Wales registrations mentioning heroin or morphine fell from 1,415 in 2024 to 1,210 in 2025; the official category combines the two substances. Heroin/morphine was implicated in 468 Scottish drug use deaths in 2025, the first annual increase since 2019. Heroin remains central to opioid deaths and treatment need. WAND suggested lower sampled consumption over time, but nitazene adulteration and incomplete rapid-harm data prevent a simple falling-risk conclusion.
Overview
Identity, legal classification, form and pharmacological context
- Drug category
- Opioids
- Common names
- smack, brown, gear, diamorphine
- Typical forms
- Usually a brown or off-white powder in the UK illicit market; appearance cannot establish contents or strength
- Routes
- Most commonly smoked or injected; it may also be snorted
- UK legal classification
- Class ADiamorphine is controlled as a Class A drug.Check government source ↗
- Concise pharmacology
- Acts primarily at opioid receptors, producing analgesia, sedation and respiratory depression.
Main harms
Concise clinical and polydrug picture
Reduced consciousness and slowed or stopped breathing are the principal overdose risks.
Dependence, constipation, endocrine effects and repeated overdose risk can develop.
Withdrawal can include agitation, pain, diarrhoea, vomiting, insomnia and intense craving.
Benzodiazepines, alcohol, gabapentinoids and other sedatives increase respiratory-depression risk.
Injecting adds infection, vein damage and blood-borne virus risks. Variable strength and synthetic-opioid adulteration make dose difficult to judge.
Current intelligence status
Assessment, confidence and direction
England and Wales registrations mentioning heroin or morphine fell from 1,415 in 2024 to 1,210 in 2025; the official category combines the two substances. Heroin/morphine was implicated in 468 Scottish drug use deaths in 2025, the first annual increase since 2019. Heroin remains central to opioid deaths and treatment need. WAND suggested lower sampled consumption over time, but nitazene adulteration and incomplete rapid-harm data prevent a simple falling-risk conclusion.
Reason: Direct official statistics or confirmed analytical evidence support the defined signal. Interpretation remains limited to each source’s geography, period and method.
Principal source limits: NRS calls this series drug use deaths. Substance implication overlaps and does not prove sole causation. Nitazene testing expanded, including etonitazene in May 2025; 2025 versus 2024 rate difference is not statistically significant. Deaths are counted by registration year; 62.7% of the 2025 registrations concern earlier deaths. Substance mentions overlap and do not prove sole causation.
Geography and reference periods are given in each linked source card below. The rating is an editorial evidence judgement, not a probability, clinical risk score or TD priority.The assessment reflects the latest linked evidence and is not a universal severity rating.
Operational implications
Evidence-supported prompts for professional response
Maintain naloxone, same-day treatment access, testing routes and rapid overdose review; treat market disruption as a synthetic-opioid preparedness trigger.
Record substance, sold identity, route, frequency and combinations; review overdose and withdrawal needs.
Prioritise airway and breathing, give naloxone for suspected opioid overdose and continue supportive care.
Triangulate treatment, mortality, testing, hospital and frontline evidence before assigning a local trend.
Related intelligence
Continue into connected platform evidence
Sources & limitations
Direct evidence links, reference periods and status
Drug-related deaths in Scotland, 2025
Published23 Sep 2026Reference period2025 registrations
NRS calls this series drug use deaths. Substance implication overlaps and does not prove sole causation. Nitazene testing expanded, including etonitazene in May 2025; 2025 versus 2024 rate difference is not statistically significant.Deaths related to drug poisoning in England and Wales: 2025 registrations
Published4 Nov 2026Reference period2025 registrations; 2024 occurrences
Deaths are counted by registration year; 62.7% of the 2025 registrations concern earlier deaths. Substance mentions overlap and do not prove sole causation.Adult substance misuse treatment statistics
Published04 Dec 2025Reference periodEngland · 2024–25
Treatment contact reflects recorded service need and access in England, not population prevalence.WAND wastewater analysis
Published13 Apr 2026; revised 8 Oct 2026Reference periodEngland annual estimates · Aug 2024–Jul 2025; 16-site trend · Jan–Apr 2021–2025
The 8 October revision changed methodology and reporting, including uncertainty presentation and trend descriptions. Table 1 national ranges and Table 2 standard errors describe different estimates. The 16-site series is not a national annual total; wastewater cannot count people using drugs. Heroin estimates have particular biomarker limitations.RADAR quarterly report
Published27 Oct 2026Reference periodScottish streams differ: suspected deaths June–August; forensic toxicology April–June 2026
Rapid Scottish intelligence combines several systems; figures may be revised and are not directly comparable with UK-wide statistics.Heroin drug profile
PublishedSource page undatedReference periodPharmacology and routes
European profile; product contents and routes vary by UK area and setting.