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Aims  To estimate the annual incidence of heroin use in Spain.

Participants and design  Data on individuals' year of first heroin use (from 1971 to 2005), year of first heroin treatment between 1991 and 2005 and most frequent route of heroin administration when presenting to treatment were obtained from the Spanish Drug Observatory Register and used to calculate the delay between onset and treatment. By using a log‐linear model approach it was possible to correct for missing observations (heroin users who presented for treatment before 1991 and those who had still not presented by the end of 2005) and to estimate heroin incidence over time.

Findings  The estimated incidence of problematic heroin use in the population aged 15–44 peaked at 190 per 100 000 in 1980—after rising rapidly from less than 40 per 100 000 in 1971—and fell subsequently to about 8 per 100 000 in 2005. On average …