Many people think that if you use heroin or other illegal drugs you can't possibly be healthy. This isn't necessarily true. Most of the health problems that users have are not due to their drug use, but to poverty and poor nutrition and the circumstances that people often use in. Hepatitis B and C and HIV are not transmitted through heroin, they are transmitted through infected blood and by sharing injecting equipment. If you use sterile equipment every time, and don't let anything that has come into contact with infected blood contaminate your hit, you can avoid Hep B, Hep C and HIV.

Other problems, such as tooth decay and malnutrition, can also be minimised. Opiates like heroin and methadone reduce the saliva in your mouth which increases tooth decay; however, brushing your teeth twice a day, regular flossing and chewing sugar-free gum can reduce tooth decay. Ask your dental service about gels that can ease dry mouth syndrome and reduce decay. Drink plenty of water, less sweet drinks.

It can be difficult to eat well when you don't have much money. However, fresh fruit and vegetables are generally cheaper than take-away and junk food. A high fibre diet reduces constipation, which can be a problem if you're using a lot. A good diet can ensure that you maintain good health.

Other health-related problems that some users suffer from, such as septicaemia (blood poisoning), endocarditis (an infection of the heart), and abscesses (see information on these problems above), all result from non-sterile injecting practices. If you follow best practice safer injecting procedures (see 'Safer injecting', above) you should not run the risk of these types of ailments.

Overdoses are another life-threatening health risk that accompanies heroin use. Using an illicit substance can make it difficult to be sure of exactly how much you can use, particularly if you buy off unknown and different 'dealers' and/or you use very infrequently or you are not on a methadone or buprenorphine program. However, most overdoses result from using heroin with alcohol or pills, which enhance the effects of heroin. If you use other drugs (in particular other central nervous system depressants) as well as heroin, you may need less heroin than usual. The risks of overdose can be minimised by practising safer using (e.g. not using on your own, etc) and by being informed about drug interactions. See Chapter 3, What Causes a Drug Overdose? for further information on this topic.

Having Hep C may make you more likely to experience liver problems, so it is important to be aware that nearly all drugs (including alcohol and prescription drugs) are processed through the liver. Some drugs are more harmful to the liver than others. Opiates such as heroin and morphine are not as hard on the liver as drugs like alcohol, but all drugs can put a strain on the liver, especially if it is already damaged. Other drugs like ectasy, ice and cocaine are probably even harder on the liver than opioids like heroin.

If you continue using drugs, some strategies you can follow to reduce harm are to: