Over the past decade, heroin use among young people has been increasing. In recognizing this increase in heroin use and the need for effective treatment, this article begins with a look at the clinical characteristics of adolescent heroin users. The time frame involved from use to dependence is highly individual and depends on familial, psychiatric, and environmental factors. On the other hand, tolerance can develop in less than 10 days. The article continues with a review of treatment approaches and those specific to youth. Adult research demonstrates that maintenance therapy for opiate dependent patients is associated with a dramatic reduction in drug use, associating criminal behavior and intravenous use. When presenting with early heroin use, a major treatment decision is how to detoxify them. Detoxification can be accomplished with methadone the most widely used opiate agonists. Treatment for heroin-using youths requires an approach combining psychosocial treatments, psychiatric medication management, and pharmacotherapy for opioid dependence. The model program, Adolescent Development Program (1969) is described which offers methadone treatment specifically for adolescents and young adults. In general, the same factors seen as having influenced treatment retention in adult patients apply to adolescent treatment as well. References