The number of injecting opiate users in Afghanistan has recently risen dramatically. Through this cross-sectional pilot study, the authors have aimed to assess psychiatric comorbidity and drug use patterns among Afghan opiate users, which might have implications for harm reduction and treatment interventions. The authors conducted semi-structured psychiatric interviews, with a convenience sample of 30 clients of the Médecins du Monde drop-in centre in Kabul. Symptoms were classified according to the WHO International Classification of Diseases, Revision 10. Results show that psychiatric comorbidity is very common, particularly depressive and posttraumatic stress disorders. Ideally, this could be addressed by harm reduction and treatment measures.