Overview
What is Heroin and Opioids?
Heroin is a highly addictive opioid drug derived from morphine, which is extracted from the opium poppy. In Kenya, it is known as "unga" on the street. It is part of a broader opioid crisis that also includes misuse of prescription painkillers such as tramadol, codeine, and pethidine.
Kenya sits on the primary trafficking route for heroin from Afghanistan through East Africa to Europe and North America. This proximity to supply has resulted in significant local consumption, particularly in Mombasa and coastal towns including Malindi and Kilifi.
Heroin can be smoked, sniffed, or injected. Injection carries additional risks including HIV and hepatitis infection from shared needles. The Kenya Harm Reduction Programme and MAT programmes in Mombasa, Malindi, Kilifi, and Nairobi exist specifically to address this.
What it does to the brain and body
How does it work?
Why people use it
What draws people to it?
The initial euphoric effect of heroin is described by users as unlike anything else. For people in chronic pain, severe depression, or trauma, this temporary obliteration of suffering is powerfully compelling.
Poverty, unemployment, and the high availability of cheap heroin in coastal Kenya create conditions where initiation is common. Once dependent, the cost of supporting the addiction drives crime and further social deterioration.
Many people who become addicted to heroin started with prescription opioids such as tramadol or codeine that were obtained legally or illegally. Cross-addiction between prescription and street opioids is a significant pathway.
Short-term effects
What happens when someone uses it?
These effects can occur even with first-time or occasional use.
- Intense euphoria and a sensation of warmth flooding the body
- Heavy sedation and drowsiness ("on the nod")
- Profound pain relief
- Nausea and vomiting, particularly in new users
- Slowed breathing and heart rate
- Loss of consciousness at higher doses
Long-term effects
What happens with regular or prolonged use?
- Severe physical dependence that develops within weeks of regular use
- HIV infection and hepatitis B and C from sharing needles
- Abscesses and infections at injection sites
- Heart valve infections (endocarditis) from injecting
- Severe malnutrition and general physical deterioration
- Total disruption of family, employment, and social life
- High risk of fatal overdose, which can occur even in experienced users
Recognising a problem
Signs that use may have become a problem
These signs apply to the person using the substance and can also help family members or friends recognise when help is needed.
- The track marks (scars from injecting) on arms, legs, or other sites
- Pinpoint (very small) pupils
- Extreme drowsiness or nodding off at inappropriate times
- Selling possessions, stealing, or other criminal behaviour to fund use
- Withdrawal symptoms when unable to use: restlessness, muscle aches, vomiting, sweating
- Dramatic weight loss and deteriorating hygiene
Addiction and dependence
How addictive is it?
Heroin is one of the most addictive substances known. Physical dependence can develop after just a few days of regular use. The withdrawal is physically agonising, and the craving for relief becomes the primary driver of behaviour.
Addiction to heroin is a chronic condition that requires medical treatment. Medically Assisted Treatment (MAT) with methadone or buprenorphine is the most effective intervention available and is available at licensed centres in Kenya.
Overdose and acute danger
When does it become immediately dangerous?
- Heroin overdose kills by stopping breathing. This is a medical emergency.
- Signs: the person is unresponsive or cannot be woken, breathing is very slow or absent, lips or fingernails are blue
- Gurgling or rattling breathing sounds indicate the airway is blocked
- Pupils are very small (pinpoint)
- Call 999 immediately. If naloxone is available, give it. Put the person in the recovery position and stay with them.
Withdrawal
What happens when someone tries to stop?
Who is most affected
Groups particularly at risk in Kenya
Mombasa, Malindi, Kilifi, and other coastal towns have Kenya's highest heroin use rates, reflecting the drug's availability along trafficking routes. Mombasa has operational MAT programmes.
Young men aged 18 to 35 are the primary users. Many started on other substances before transitioning to heroin.
People who inject drugs (PWID) have significantly higher HIV prevalence than the general population in Kenya. MAT programmes are a key HIV prevention intervention in the country's national HIV strategy.
In Kenya
What the data says about Kenya
Heroin trafficking through Kenya increased significantly in the 1990s and 2000s as Kenya became a major transit point on the Afghanistan-to-Europe route. Local consumption followed the trafficking routes.
Kenya has operational Medically Assisted Treatment (MAT) programmes in Nairobi, Mombasa, Malindi, Kilifi, and other coastal towns, managed under NACADA and Ministry of Health guidelines. Methadone and buprenorphine are used.
HIV prevalence among people who inject drugs in Mombasa has been documented at over 20 percent in some studies, more than three times the national HIV prevalence. MAT is therefore simultaneously an addiction treatment and an HIV prevention programme.
Across East and Central Africa
How is it used in the wider region?
| Country | Local name(s) | Context and notes |
|---|---|---|
| Tanzania | Unga, Brown sugar | Tanzania, particularly Dar es Salaam and Zanzibar, has significant heroin use. Injecting heroin is an established public health problem. MAT programmes exist but have limited reach. |
| Uganda | Brown, Kanga | Uganda is primarily a transit country but local consumption is growing, particularly in Kampala. |
| Ethiopia | Unga, Brown | Heroin use is documented in Addis Ababa and eastern Ethiopia near trafficking routes. |
| South Africa | Smack, H, Brown | South Africa has established MAT programmes in Cape Town, Durban, and Johannesburg. Significant HIV and hepatitis co-infection among PWID. |
| Mauritius | Brown, Ladans | Mauritius has one of the most established MAT programmes in Africa, with a national heroin addiction treatment service. |
Getting help
Where to turn in Kenya
NACADA Helpline
Free, confidential counselling and referral to treatment centres near you. Available 24 hours a day.
Mathari National Hospital
Kenya's main national psychiatric and substance use treatment facility in Nairobi. Inpatient and outpatient services.
County referral hospitals
Every county in Kenya has a mental health and substance use service. Ask at your nearest hospital or health centre.
MAT Clinics (Mombasa)
Methadone and buprenorphine treatment for opioid use disorder. Supervised daily dosing with psychosocial support.
Sources
References
- National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA). (2022). National Survey on the Status of Drugs and Substance Use in Kenya 2022. Nairobi: NACADA.
- NACADA. (2017). National Guidelines for Medically Assisted Treatment in Kenya. Nairobi: NACADA/Ministry of Health.
- PLOS One. (2025). The burden of unlawful use of opioids in Africa: A scoping review. doi:10.1371/journal.pone.0317036
- ISS Africa. (2025). Kenya's growing role in global meth production.