Heroin Rehab in New York City
Street heroin in New York City has been almost entirely replaced by illicit fentanyl — which is 50 times more potent and dramatically more likely to cause overdose death, particularly when mixed with xylazine. In 2024, fentanyl was involved in 73% of NYC's 2,192 overdose deaths. People who believe they are using heroin are almost certainly using fentanyl, and the dosing unpredictability makes every use event a potential overdose. Source: NYC Special Narcotics Prosecutor.
Is heroin still being sold in NYC?
What is sold as heroin in New York City today is overwhelmingly illicit fentanyl — either mixed with heroin in small quantities or sold as pure fentanyl. Drug traffickers shifted to fentanyl because it is cheaper to produce and more profitable per dose. Users who believe they are buying heroin cannot distinguish it from fentanyl without drug checking services. NYC operates drug checking services at several syringe service programs — but the safest path out of fentanyl dependency is supervised detox and inpatient treatment.
What is fentanyl-xylazine and why is it more dangerous?
Fentanyl is commonly cut with xylazine — a veterinary tranquilizer that extends the sedative effect and is cheap to source. Xylazine is not an opioid, so naloxone (Narcan) does not reverse xylazine-related sedation. A person experiencing a fentanyl-xylazine overdose may briefly respond to naloxone and then lose consciousness again. Xylazine also causes severe, recurring skin wounds at injection sites that can become necrotic. In 2024, xylazine was present in 21% of NYC overdose deaths.
What is medication-assisted treatment for heroin or fentanyl?
Medication-assisted treatment (MAT) uses FDA-approved medications — primarily buprenorphine (Suboxone), methadone, or naltrexone (Vivitrol) — to manage cravings, suppress withdrawal, and reduce overdose risk. MAT is the gold standard for opioid use disorder and significantly reduces overdose mortality. Buprenorphine and methadone are opioid partial agonists that stabilize brain chemistry without producing the euphoria of illicit opioids. Naltrexone is an opioid antagonist that blocks the effect of opioids entirely — it requires full detox before initiation.
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What does heroin or fentanyl detox feel like?
Opioid withdrawal is described as an intense flu combined with severe anxiety, insomnia, muscle cramps, nausea, vomiting, and an overwhelming compulsion to use. It is rarely life-threatening but is almost universally described as unbearable without medication. Medical detox using buprenorphine reduces withdrawal severity dramatically within hours of the first dose. The acute withdrawal phase for fentanyl typically lasts 5 to 10 days; post-acute withdrawal symptoms (PAWS) — including fatigue, mood disturbance, and sleep disruption — can persist for weeks to months.