In 1996 an innovative multidisciplinary community drug service for adolescents was established in Stoke on Trent, UK. For the first time the profile of adolescent heroin dependents who access the service is described. A picture of extreme vulnerability emerges: early age (mean = 11.8 years) of initiation into substance use, rapid development of heroin dependence, concurrent polypro use, injecting behavior and deliberate self-harm. Retention in treatment was achieved in 80%, despite a background of social deprivation and criminality. This local information extends and confirms national data. The policy response must be the establishment and outcome evaluation of n few pilot projects.