Very few teenagers use heroin today. In 2023, fewer than 4,000 adolescents aged 12 to 17 reported using heroin in the past year, representing less than 0.1% of that age group. While any teen heroin use is concerning, the numbers are at historic lows and have been declining steadily for over two decades.
Current Numbers in Context
The 2023 National Survey on Drug Use and Health, conducted by SAMHSA, estimated that roughly 660,000 people aged 12 or older used heroin in the past year. Adolescents made up the smallest share of that total by a wide margin. About 4,000 teens aged 12 to 17 reported past-year use, compared to 27,000 young adults aged 18 to 25 and 629,000 adults 26 and older. For teens, the rate rounds down to less than 0.1%, meaning heroin use among this age group is statistically rare.
These numbers are so small that federal researchers note they can’t even calculate certain estimates, like heroin use disorder rates among adolescents, with enough statistical precision to report them.
A Two-Decade Decline
The Monitoring the Future survey, which has tracked drug use among 8th, 10th, and 12th graders since the 1970s, confirms this picture. Heroin use peaked among teens at the end of the 1990s and has been falling ever since. By 2024, annual heroin use was at 0.2% or less across all three grade levels. That means roughly 2 out of every 1,000 students or fewer reported any heroin use in the past year.
This decline has been sustained and consistent. There are no signs of a rebound. Today’s teenagers are less likely to use heroin than any generation of teens tracked by the survey.
Why Teens Still Face Opioid Risk
The low heroin numbers don’t tell the full story of teen opioid risk. The broader opioid crisis has shifted. Illicitly manufactured fentanyl now contaminates many street drugs, including counterfeit pills that look like prescription medications. A teen who never intends to use heroin can still be exposed to synthetic opioids through pills bought online or from peers. Fentanyl is far more potent than heroin and has driven overdose deaths upward even as heroin use itself has dropped.
This matters because the pathway to opioid harm for teenagers today looks different than it did 20 years ago. The risk is less about heroin specifically and more about accidental fentanyl exposure through other substances.
Effects on the Developing Brain
For the small number of teens who do use heroin, the consequences can be especially severe. The adolescent brain is still developing, particularly the areas responsible for decision-making, impulse control, and stress management. Repeated heroin use changes the brain’s physical structure and disrupts its hormonal and chemical balance in ways that are not easily reversed.
Research from the National Institute on Drug Abuse shows that heroin damages the brain’s white matter, the tissue that connects different brain regions and allows them to communicate. This damage affects the ability to make sound decisions, regulate behavior, and cope with stress. In an adult brain that has finished developing, these effects are serious. In a teenage brain still under construction, they can be particularly disruptive to normal growth.
Heroin also builds tolerance and physical dependence quickly. Tolerance means the same dose stops producing the same effect, pushing users toward higher and more dangerous amounts. Physical dependence means the body adjusts to the drug’s presence, and stopping abruptly triggers withdrawal symptoms like severe pain, nausea, and intense cravings. These biological mechanisms make heroin one of the most difficult substances to quit without help.
The Treatment Gap
Among teens who develop opioid use disorder, whether from heroin, prescription painkillers, or fentanyl, most don’t get treatment. A 2025 analysis published in Health Affairs found that only about 31% of adolescents aged 12 to 17 with opioid use disorder received any substance use treatment in the previous year. That means roughly 7 out of 10 teens with a diagnosable opioid problem went without professional help.
The reasons for this gap are layered. Teens often depend on parents or guardians to access treatment, and families may not recognize the signs of opioid misuse. Stigma plays a role too, as does the limited availability of adolescent-specific treatment programs in many parts of the country. Evidence-based treatments for opioid use disorder exist and work well for adolescents, but the challenge remains getting teens connected to them.