Yes, it is possible to be a functional heroin user. However, even if a heroin user functions adequately in certain areas of life for a period of time, there is always the risk of decompensation in the future. In addition, overdose is always a potential risk, and this can lead to death.
Defining “Functional” Heroin Use
It is estimated that more than 10 million people misused an opioid in 2019 and about 745,000 of them used heroin. About 438,000 of these people were living with an active addiction to the drug, but it is not as easy to nail down how many people were living with a heroin addiction while still remaining functional. Why?
“Functional heroin user” describes an individual using heroin without it having significant impacts on their life. They may be getting along well with their loved ones, taking care of dependents, holding a job, etc. A functioning heroin addict may be someone whom you would never think of as having an addiction. They might be your neighbor, sit near you in church, or be the parent of your child’s friend.
They do not meet the “stereotype” of a heroin user. That is, they are not homeless, jobless, or committing crimes to support their addiction. They have not been abandoned by their families due to their ongoing drug use.
In spite of this apparent functioning, heroin use still poses enormous risks. There will likely come a time where their use will escalate and they will no longer be able to function, or they will experience an overdose. Thus, anyone using heroin - “functional” or not - warrants help to discontinue use.
Signs of a Functioning Heroin User
Close friends and family may notice some signs of heroin use:
- Changes in physical appearance: When heroin is taking up more and more of someone’s time, they care less about taking care of themselves. This can show up as weight loss, disheveled clothing, decreased hygiene, and fatigue due to lack of restorative sleep.
- Changes in behavior: Being under the influence can also change how a person acts and reacts. Other people’s lives, former goals and hobbies, and commitments at work become less important as the primary focus turns to getting more heroin. This can mean a lack of follow-through that puts a strain on relationships at home and at work.
- Unexplained missing money: Heroin is expensive, and the more frequent the use, the harder it is to hide the money spent to cover the cost of maintaining a steady supply of the drug. Financial problems are a hallmark of substance use disorders, and functional or not, this will quickly become a problem for heroin users.
- Problems at work or in relationships: Changes in behavior, shifts in mood, inattention, missing money, and not showing up physically or emotionally for the people in their lives can quickly add up to big problems in the closest relationships of functional heroin users.
How to Tell if Your Loved One Might be a “Functional” Heroin User
If you think your loved one might be using heroin but appears to function in life all right overall, ask yourself these questions:
- Has your loved one exhibited significant changes in appearance, hygiene, style of dress, and diminished self-care?
- Does your loved one often disappear for long periods of time without explanation or without a good explanation)?
- Is your loved one evasive when you ask questions about money they’ve spent or the people they text or talk to on the phone?
- Are you finding out things about your loved one from other people, such as problems at work, issues at the bank, or unpaid bills?
- Does your loved one often seem sick or tired, exhibiting symptoms of the flu when no one else seems to be ill?
- Has your loved one lost a lot of weight suddenly? Do they often have pinpoint pupils or seem to “nod out” while talking to you or spending time with family?
- Does your loved one seem reserved and isolated from the family and generally disinterested in what’s happening with other people?
- Have you ever found secret hiding places where things like burnt spoons, syringes, cookers, or cottons are stashed?
If you answered “yes” to some of these questions, heroin use might be to blame.
Treatment Options for a High-Functioning User
Treatment for anyone living with a heroin use disorder will include a number of different components:
- Medication such as Suboxone (buprenorphine/naloxone) or methadone
- Medication to address other underlying medical and/or mental health conditions
- Personal therapy to talk through underlying issues and get to the triggers behind substance misuse 
- Family therapy to rebuild trust in relationships and help children work through their experience
- Support groups to connect the individual with people who also struggle with heroin use and are working toward recovery, such as Narcotics Anonymous or SMART Recovery
One of the concerns of functional heroin users is that their condition is usually unknown by their friends and family and their employers and they may fear that seeking treatment will mean they have to reveal their condition. Measures can be taken to ensure discretion when seeking help. If you have concerns about keeping a heroin use disorder private, ask for help in maintaining confidentiality. Concerns about confidentiality should never be a barrier to getting the help you need.
The important thing for individuals with functional heroin use is to prevent progression to non-functional heroin use. There is hope in recovery for functional heroin users.