Opiate dependence (heroin) | Diagnosis & treatments available in Turkey 2025

Understanding the composition of Heroin

Heroin, a semi-synthetic opiate derived from morphine extracted from the opium poppy, is a psychoactive substance with highly addictive properties. Its abuse is considered one of the most serious public health problems because of the significant risks it poses to individuals and society.

Composition and appearance

In its pure form, heroin is a fine white powder with a bitter taste. However, the illicit substance is usually mixed with other substances to increase its volume and yield. Substances commonly used to adulterate heroin include sugar, cornstarch, quinine and, increasingly, fentanyl, an extremely potent synthetic opioid. This adulteration results in a wide variability in this illicit product's composition, color, and consistency, which can range from a white powder to a brown, granular substance to a sticky gum.

Methods of use and associated risks

Heroin can be taken in a variety of ways:

• Nasal inhalation: the powder is inhaled through the nose.
• Smoking: The substance is heated and inhaled into the lungs (a technique known as “chasing the dragon”).
• Injection: The powder, dissolved in water, is injected intravenously or subcutaneously.

Due to its highly addictive effects and significant health risks, heroin is an illegal substance in most countries. The sale, possession and production of heroin are strictly regulated and punishable by law, except for exceptional authorization for medical, scientific or industrial purposes.

Consequences of heroin use

Repeated heroin use has a significant impact on a person's physical and mental health.

Mental health consequences

Heroin adversely affects cognitive and emotional functioning. Users often develop psychiatric disorders, particularly major depressive disorder and generalized anxiety disorder. In addition, the substance profoundly alters the perception of reality, impairs learning and memory, and significantly reduces impulse control. These cognitive changes can progress to psychotic states and in some cases lead to suicidal ideation.

Physical health consequences

In addition to the known neurological consequences, heroin use also has harmful effects on physical health:

Injection-related infectious complications

Injecting heroin, often in combination with the sharing of unsterile equipment, puts users at high risk of contracting serious viral infections such as HIV, hepatitis B and hepatitis C. These infections can develop into serious chronic diseases, including liver damage and immune disorders. There is also an increased risk of bacterial super-infection leading to abscesses and endocarditis.

Systemic disorders

Chronic heroin use profoundly alters the functioning of many organs. These include:

• Sleep disturbances (insomnia, hypersomnia) and impaired quality of life.
• Severe digestive disorders (chronic constipation, nausea, vomiting) leading to malnutrition.
• Cardiovascular damage (arrhythmias, infective endocarditis),which may increase the risk of premature death.
• Endocrine disruption (irregular menstrual cycles, sexual dysfunction),affecting fertility and reproductive health.

Risk of overdose

Heroin rapidly affects the central nervous system, leading to severe respiratory depression, coma, and even death. The risk of overdose is increased by the rapid development of tolerance, which leads users to increase their doses, and by the concomitant use of other depressant substances (alcohol, benzodiazepines).

Diagnosis of heroin addiction in Turkey

The treatment of heroin addiction in Turkey is based on a multidisciplinary approach, of which the initial diagnosis is the most crucial phase. It allows a precise assessment of the patient's situation and the definition of an appropriate treatment strategy.

The aims of the initial diagnosis of heroin use are to:

• Assess the severity of the addiction: A thorough assessment helps determine the patient's level of dependence, from occasional use to severe dependence, and thus influences the duration and intensity of treatment.
• An assessment of general health: The diagnosis identifies any physical (infectious diseases, heart disease, etc.) and psychological (depression, anxiety) comorbidities associated with heroin use.
• Detection of complications: A thorough examination looks for complications associated with drug use, such as infections, neurological disorders, or liver damage.
• Assess motivation: Diagnosis allows us to assess the patient's level of commitment to the recovery process, a key factor in therapeutic success.

Development of a treatment program

Based on the data collected during the diagnosis, a multidisciplinary team (physicians, psychologists, and social workers) in Turkey developed a personalized treatment program.

This program may include:

• Weaning methods: The choice of weaning method (rapid weaning, gradual weaning, drug substitution) depends on the severity of the addiction and the patient's state of health.
• Psychotherapies: Cognitive-behavioral psychotherapy and group therapy are often used to help patients modify addictive behaviors and develop coping skills.
• Medication treatment: Medications may be prescribed to relieve withdrawal symptoms, treat comorbidities, and prevent relapse.
• Rehabilitation: Social and vocational rehabilitation is essential to help patients regain their social status.

The patient is referred to specialists for appropriate treatment if chronic comorbidities are diagnosed. Complementary studies (MRI, ultrasound, endoscopy, etc.) may be performed to refine the diagnosis and determine specific treatment.

Treatment of opiate (Heroin) dependence in Turkey

Substitution treatment for opiates, especially heroin, is based on the controlled administration of opiate agonist drugs. These substances have a pharmacological effect similar to that of illicit opiates, stabilizing the patient's condition and significantly reducing withdrawal symptoms.

In addition to simple drug substitution, this treatment includes an essential dimension of medico-psychosocial support. This comprehensive approach aims to:

• Prevent relapse by alleviating withdrawal symptoms and reducing the urge to use illicit substances.
• Improve the patient's quality of life by enabling him or her to rebuild a coherent life project and a stable social and professional environment.
• Promote the management of co-morbidities such as infectious diseases, psychiatric disorders or social problems that are often associated with opiate use.

The duration of substitution treatment is individual and adapted to each patient. It may be short-term, aimed at rapid withdrawal, or long-term maintenance, comparable to chronic treatment of a disease such as diabetes. The goal is to maintain the patient's stability and avoid relapse, with gradual consideration of tapering or discontinuation when clinical conditions allow.

The most commonly used substitution medications are methadone, buprenorphine (in the form of Subutex® or Suboxone®) and their generics. The choice of treatment and dosage is made by the physician based on the patient's clinical condition, history of drug use, and treatment goals.