Heroin use in the U.S. has been steadily climbing in the last few decades, and it’s now reached astronomical numbers. Sadly, this common drug is one of the most dangerous out there and it can cause overdoses and even death even without long-term use.

If you or a loved one is struggling with heroin addiction, this guide will walk you through all of the warning signs, symptoms, and health effects of this dangerous drug. Heroin addiction is not a hopeless situation, and with the proper treatment, you can recover from this.

What Is Heroin?

Have you ever seen a poppy flower? As beautiful as it is, it has a dark side: it’s used to make heroin and other opiate drugs.

Heroin is made from the Asian opium poppy, grown in both Asia and Latin America. The milky resin of the plant is extracted from its seed pod and that resin is sometimes smoked in its original form as opium. Often, however, the resin is refined to make morphine, a potent pain reliever that you’re probably familiar with. Then, morphine is processed further in a laboratory to make heroin. During this process, it’s often cut with other chemicals and drugs.

Different regions process heroin differently; sometimes, it’s a thick black tar, and in others, it’s a white or brown powder. Heroin is most often injected into the veins with a needle, but some people smoke, snort, or inhale it.

Street drug names for heroin include dope, junk, black tar, smack, big H, and snow.

Heroin Addiction Statistics

Compared with other drugs like alcohol or marijuana, overall heroin use is low. However, considering the vastly damaging and even deadly effects of heroin use, the number is still much too high.

  • Between 250,000 and 1,000,000 people in the U.S. are estimated to use heroin on any given year; this number has been steadily increasing since 2007.
  • Heroin overdose deaths have increased nearly ten-fold since 1999 but they have also started trending downward in the last few years.
  • Nearly 15,000 people overdosed on heroin in 2018.
  • 1 in 15 people who abuse prescription drugs will try heroin within 10 years.
  • Heroin use has mostly increased for people between the ages of 18 and 25.
  • About 80% of people who use heroin started out abusing prescription drugs.
  • Individuals that abuse cannabis are 3 times more likely to become addicted to heroin.
  • Young white males (18 to 25) who live in cities are the most high-risk group for heroin addiction.
  • People who inject drugs, including heroin, account for 10% of all new HIV infections.
  • Nearly half of young people (18 to 24) who inject drugs like heroin share syringes, which vastly increases the risk of contracting diseases like HIV and Hepatitis C.

Warning Signs of Heroin Addiction


Unlike other substances like alcohol, people who use heroin often know they have an addiction. That doesn’t mean that people who start using heroin intend to become addicted; however, heroin use isn’t as easy to rationalize as other legal drugs. We’ll discuss what differentiates heroin addiction from occasional use in the next section.

If you’re worried that someone you love is using heroin, here are some warning signs to look out for:

  • Needle track marks: Many people who use heroin inject the drug into their veins. If you see needle marks on someone’s arms or other body parts, it may be a telltale sign that they’re using heroin. Track marks usually look like small red dots or bruises. However, it’s important to consider that most people who are new to using heroin opt to smoke or snort it first and then gradually start injecting it to get a quicker high. Just because someone doesn’t have track marks doesn’t mean that they aren’t using.
  • Bloodshot eyes: Like many drugs, heroin can cause your eyes to become bloodshot. If someone constantly has red eyes, it might mean that they’re using heroin or another drug like alcohol or marijuana.
  • Sudden weight loss: Heroin use is known to cause many different weight loss problems as it is linked to nutrient deficiency and a decrease in appetite. If someone you know is dramatically losing weight without intending to, this may be a sign of heroin or other drug use.
  • Constant hacking cough: This sign is often present among people who smoke heroin (rather than inject it). If someone you know is regularly coughing for no reason, then that may be a sign that they’re smoking heroin or another drug.
  • Small pupils: If someone is high on heroin, their pupils will get smaller. If they’re withdrawing from heroin, their pupils will be bigger than normal.
  • Disheveled appearance: Many people stop taking care of themselves when they become addicted to heroin. If someone has stopped showering or practicing proper hygiene, this may be a sign that they’re suffering from heroin addiction.
  • Signs of skin picking or itching: Heroin use releases histamine, which is what also causes allergies. If someone has scabs or wounds on their skin, is constantly itching themselves, or presents with other allergy symptoms (like sneezing or sniffing), this could be a sign they’re using.
  • Slow or uncoordinated movement: Being high on heroin usually causes people to move slowly and act disoriented. Sometimes, they may seem jittery and restless for a while, but then suddenly nod off.

Keep in mind that we’re not providing this information to label or stereotype what someone suffering from heroin addiction looks like. People addicted to heroin come in all genders, races, ethnicities, and sizes. Rather, this information is meant to help family members and loved ones identify when someone dear to them is suffering and take steps to get them the help they need.

Symptoms of Heroin Addiction

Heroin addiction is classified under opioid use disorder in the DSM-V (the Diagnostic Statistical Manual Fifth Edition, which is the American Psychiatric Association’s (APA) complete manual for categorizing and diagnosing mental health disorders). Note that this diagnosis covers the abuse of all opioids, including heroin, opium, and prescription drugs like Fentanyl.

If you’re looking for an official psychiatric diagnosis that you are suffering from heroin addiction, these are the diagnostic criteria that a professional would use. (Symptoms are often written in clinical language that can be hard to understand for most people. We’ve written a layperson’s explanation of each symptom in italics to make it as simple as possible.)

  1. Opioids are often taken in larger amounts or over a longer period than intended.
    You didn’t mean to get addicted to heroin; you only meant to try it once. But you’ve been using heroin for a lot longer than you expected to, and when you use, you end up using more than you planned.
  2. There is a persistent desire or unsuccessful effort to cut down or control opioid use.
    You know that your heroin use is a problem, and you’ve even tried to stop — but it’s too difficult, and you end up going back to it.
  3. A great deal of time is spent on activities necessary to obtain the opioid, use the opioid, or recover from its effects.
    You’re usually either high on heroin, or trying to get high. Sometimes, when you can’t get access to it, you feel the pain of withdrawing from heroin.
  4. Craving, or a strong desire to use opioids.
    When you’re not high on heroin, you’re thinking about heroin. You want to use it so badly that it’s often hard to think about anything else.
  5. Recurrent opioid use resulting in failure to fulfill major role obligations at work, school, or home.
    Your heroin use is starting to cause serious problems in your life. You’re missing work or school to use, and you’re getting into arguments with your loved ones.
  6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
    Friends and family members have expressed worry about your heroin use and ask you to stop. You end up either arguing with them or lying to them about how much you’re really using. You love them dearly, but you still can’t seem to stop using them.
  7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
    You’re skipping work either because you’re high or because you’re trying to get high. You find yourself starting to flake out on your friends, even those you really enjoy being around. It feels like there’s not enough time in the day to use heroin and do everything else you used to do.
  8. Recurrent opioid use in situations in which it is physically hazardous.
    You swore to yourself when you started that you wouldn’t do anything “stupid” because of heroin, but now you find yourself engaging in dangerous behaviors. Maybe you’re going to unsafe parts of town to score or driving while high.
  9. Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by opioids.
    You have a mental or physical illness, and you know that heroin makes it worse. Even so, you keep using.
  10. Tolerance, as defined by either of the following: (a) a need for markedly increased amounts of opioids to achieve intoxication or desired effect and (b) markedly diminished effect with continued use of the same amount of an opioid.
    Previously you only needed to use a little bit of heroin, and maybe you used to snort or smoke it. Now, you find that you’re using more and more, and you’ve started shooting it up for a quicker and more intense high.
  11. Withdrawal, as manifested by either of the following: (a) the characteristic opioid withdrawal syndrome and (b) the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms.
    When you try to stop using, the withdrawal is intense. You find yourself in pain with symptoms like stomach cramps and fever. You end up using heroin or another opioid again just to stop the pain.

Heroin Addiction: Effects and Health Consequences


Heroin and other opioids are one of the most damaging substances for our mental and physical health. Not only is it harmful, but it can be truly dangerous and even fatal; opioids are responsible for more overdose deaths than any other drug.

Here are the most common physical and mental health effects of heroin, so you can understand exactly what this drug does to our bodies and our minds.

Short-Term (Immediate) Effects

Immediately after you take heroin, whether you smoke it, snort it, or inject it, you’ll very quickly start experiencing both physical and mental effects. As soon as heroin enters the brain, it turns back into morphine and interacts with your body’s opioid receptors, causing a “rush”. The “rush” feels like pleasure, but even in the short term, heroin can be deadly.

This immediate heroin “rush” is usually accompanied by:

  • Dry mouth
  • Pinpoint pupils or constricted pupils
  • Severe itchiness (heroin releases histamines in the body, which cause an allergic reaction)
  • Warm or flushed skin
  • A heavy feeling in the limbs
  • Slowed breathing and heart rate, which can sometimes lead to overdose and death

The Serious Risk of Heroin Overdose

Overdosing on heroin is a common and very serious problem; around 15 thousand people die from heroin overdose every year. Overdose happens when you take more heroin than your body can handle, which results in your systems shutting down. Heroin slows down breathing and heart rate, and overdosing causes these mechanisms to slow down so much that you can no longer recover on your own.

Treatment is available for heroin overdose, and it that can save your life, but it’s not always timely enough or successful. The risk of overdosing from heroin has gone up since the introduction of lab-created opioids, like Fentanyl, to the market. Most people don’t know that their street drug (like heroin) has been laced with Fentanyl, so they can overdose accidentally even if they’re careful.

Long-Term Consequences

Although heroin is risky in the short term, it can be even more harmful when you use it over a long period of time. Long-term heroin use can change the literal structure of your brain and put you at risk for a whole host of physical and mental health problems.

Changes in the Brain

Long-term heroin use causes physical changes in the brain’s systems, many of which are hard to reverse even if you quit. Some research has shown that heroin can cause your brain’s white matter (brain tissue that’s made up of nerve fibers, which are responsible for connecting the different regions of your brain and make it all work together) to deteriorate. This can lead to problems like poor decision-making, an inability to control behavior, and poor reactions to stress.

Lung Problems

Like we talked about earlier, heroin use slows down breathing to an unhealthy rate. This, combined with the overall bad health of most people who use heroin, often causes an increased risk for lung diseases like tuberculosis and bronchitis.

Increased Risk for HIV, Hepatitis C, and Other Diseases

This is specific to people who choose to inject heroin with a needle. Anybody who uses needles to inject drugs, especially if they share needles with others, is more at risk of getting blood-borne contagious infections like HIV and Hepatitis B and C, as well as other infectious diseases.

Collapsed Veins

Another issue specific to those who inject heroin is that long-term injecting can lead to collapsed and scarred veins. This happens when the needle goes in at a bad angle, causing it to go into one side of the vein and out the other. When a vein is collapsed or “blown”, it means that blood can’t flow freely through that vein anymore. This can cause medical complications like heart problems.

Bacterial Infections

Injecting heroin can also lead to bacterial injections in blood vessels and heart valves, as well as abscesses in other parts of the body. Often, heroin is laced with other substances like Fentanyl without the person knowing it. These other (cheaper) substances can get clogged in the blood vessels because they don’t dissolve as easily, which leads to infections in the blood and organs.

Mental Illness

People who use heroin are at a higher risk for many different mental illnesses, including depression, antisocial personality disorder (referred to commonly as sociopathy), and others. One study found that up to half of people who use heroin and other opiate suffered from depression. This is likely due to both the structural changes in the brain caused by heroin as well as life problems.

Relationship and Work Problems

One of the symptoms of heroin addiction is needing and continuing to use the drug despite the problems it’s causing in your life. Once heroin addiction reaches an advanced stage, many people start skipping workdays either because of the pain of withdrawal or because they’re high. Their valued relationships start to crumble because they can’t stop using despite their loved ones begging them to.

These are only some of the most common and dangerous effects of both short-term and long-term heroin use. Heroin and other opiates are some of the most dangerous substances out there, and using them can, quite literally, kill you.

Help for Heroin Addiction Is Out There

The good news is that there is hope; recovery from heroin addiction is possible. If you’re battling a heroin addiction, it’s crucial that you get the help you need. You’re not alone, and treatment is available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.

You can also use RehabAid’s search feature to find the best treatment option for you. Help is out there for heroin addiction, and with the right treatment you can beat this disorder once and for all.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

Cornford, C., & Close, H. (2016). The physical health of people who inject drugs: complexities, challenges, and continuity. The British journal of general practice: the journal of the Royal College of General Practitioners, 66(647), 286–287. https://doi.org/10.3399/bjgp16X685333.

Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatment. Science & practice perspectives, 1(1), 13–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851054.

McIntosh, C., & Ritson, B. (2001). Treating depression complicated by substance misuse. Advances in Psychiatric Treatment, 7(5), 357-364. https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/treating-depression-complicated-by-substance-misuse/E88007047F906A1BC51820051F5E2034.

Medical Disclaimer

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