Heroin is a powerful opioid drug that can have a devastating effect on a person’s health, job, and family life, including addiction, overdose, and even death. Heroin use can impact anyone, no matter their economic status, education, or family background. However, heroin addiction is treatable and there is hope for you or a loved one who is using heroin.
What is Heroin?
Heroin is a very addictive opioid derived from morphine, which is extracted from seed pods of certain kinds of poppy plants.1 Opioids affect nerve cells in both the brain and body and are often used as prescription pain relievers, but can also create sensations of euphoria (intense excitement).17 Heroin is classified by the DEA as a Schedule I drug, meaning that it is highly addictive and has no legitimate medical use.1
Heroin sold on the street is often mixed with additives or fillers.1 These substances can include sugar, powdered milk, various starches, a drug known as quinine, or even illicitly manufactured fentanyl.1
What Does Heroin Look Like?
Heroin can be found in various forms including brown or white powder, or a sticky, gummy substance known as black tar heroin.1 When heroin is in powder form, it can be smoked, snorted, or mixed with water and injected. Injection is one of the more common ways that a person uses heroin.18
History of Heroin
Heroin is derived from morphine, a substance found in opium poppy plants that are primarily grown in Southeast Asia, Southwest Asia, Mexico, and Columbia.1 Unlike prescription opioids, which can be helpful when used as directed by a doctor, heroin cannot be prescribed.1
Morphine, a well-known opioid painkiller, has been used as far back as the late 1700s, with historical figures such as Benjamin Franklin using it to control pain.2 Morphine was used to manage different types of pain including war wounds and women’s menstrual pain. Laudanum, a mixture of alcohol and opium, was widely distributed, and morphine was also made into pills for soldiers to use during the Civil War, leading to many becoming addicted.2
Eventually, doctors would develop heroin in a lab from opium in 1898, and it was initially hailed as a miracle drug for treating coughs and pain.3 The potential for addiction and overdose started to become apparent to many in the medical profession. However, the danger of heroin was not fully validated by many, and despite warnings from numerous doctors, it was not outlawed in the U.S. until 1920.3
What is Heroin Addiction?
Heroin addiction, or heroin use disorder, is a medical disease characterized by the continued uncontrollable use of heroin despite it causing significant problems in a person’s life, and negatively impacting day-to-day functioning.4, 9
Heroin’s addictive power results from the way the body adapts to the drug. With continued use, a person requires more heroin to feel the same effects (tolerance). When a person tries to quit using heroin or drastically reduces use, they will feel very uncomfortable withdrawal symptoms after their body has developed a dependence on heroin.10, 11, 12
The way a person uses heroin may affect how they develop an addiction.6 Smoking or injecting heroin causes the substance to reach the brain faster, which may lead to a greater risk of a person developing a heroin addiction.6
Signs of Heroin Addiction
The signs and symptoms of heroin addiction can be different from one person to the next. This may be due to factors such as genetics, how much heroin is used, and how often it’s used.
Since addiction signs and symptoms can vary from person to person, diagnosing a substance use disorder is best done by a medical professional. However, if you or a loved one are struggling with heroin addiction, the following criteria from the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) can help to recognize potential substance misuse:8
- Taking more heroin than was originally intended.
- Having cravings to use heroin.
- Using heroin in risky situations, such as driving.
- Using heroin with the knowledge that it makes a physical or mental condition worse.
- Being unable to stop using heroin.
- Increased family or interpersonal conflict stemming from heroin use.
- Spending a lot of time and energy finding and using heroin.
- Being unable to fulfill family and/or work responsibilities due to heroin use.
- Giving up things that were once important, such as sports, hobbies, or other leisure pursuits, to use heroin.
- Developing a tolerance to heroin, which means their body gets used to heroin’s effects and they need to take more and more heroin to get the same effects.
- Becoming physically dependent on heroin, which means that he or she shows signs of withdrawal when heroin is stopped or significantly reduced.
Effects of Heroin
There are short-term immediate effects of heroin as well as effects that may be experienced because of long-term heroin use. Heroin attaches to the opioid receptors in the brain and creates effects that impact pleasure, respiration, pain, and sleep.9
The short-term effects of heroin include:9
- Dry mouth.
- Heavy feelings in the legs and arms.
- Fluctuating levels of consciousness.
- Nausea and/or vomiting.
- Clouded thinking.
The effects of long-term heroin use can include:9
- Depression and other mental health issues.
- Chronic constipation.
- Sexual dysfunction in men.
- Problems with the liver and kidneys.
- Menstrual cycle irregularity in women.
- Pneumonia and other lung issues.
- Collapsed and/or abscessed veins in people who inject heroin.
- Infection of the heart lining or valves in people who inject heroin.
- Damage to nose tissue in people who snort heroin.
Heroin Withdrawal Symptoms
When a person develops a dependence on heroin, they will experience symptoms of heroin withdrawal if heroin is withheld, or they significantly reduce the amount of heroin they take. When the body is used to having heroin, it needs an ongoing dose of heroin to feel normal. Within about 8–12 hours of the last use of heroin, a person may experience:10, 11
- Cold sensations and goosebumps.
- Sleep problems.
- Muscle and bone pain.
- Severe drug cravings.
While these symptoms are highly uncomfortable and unpleasant, heroin withdrawal does not typically result in serious complications or fatalities.10 However, medical supervision during heroin withdrawal can help manage or minimize the unpleasant side effects of withdrawal, and reduce the risk of returning to heroin use.12
Symptoms and Risks of Heroin Overdose
Anybody who uses heroin is at risk of experiencing a life-threatening opioid overdose. People who are at increased risk of overdose include those who mix heroin with alcohol, benzodiazepines, or other opioid drugs, whether legal or illegal.
Heroin is increasingly being laced with illicitly manufactured fentanyl, often without the buyer’s knowledge. Fentanyl is a cheap but incredibly potent opioid, which means the effects of the drug are stronger at lower doses than heroin. Should a heroin user take the same amount of fentanyl-laced heroin that they usually do with regular non-fentanyl-laced heroin, it greatly increases the risk of overdose.19
People who have a history of using heroin or other opioids but haven’t used drugs in a long time may be at a heightened risk of overdose if they return to opioid use. This can occur because a person’s body loses the tolerance to heroin built up during chronic use. If they start using again at the same dose but decreased tolerance, they are at high risk of overdosing.13
The signs of an overdose include:13
- Lips and fingernails turning bluish or purplish.
- Being unable to wake up, or total loss of consciousness.
- Slowed, shallow, or stopped breathing, often with gurgling or choking sounds.
Heroin or another opioid overdose can be life-threatening. If you witness an overdose, call 9-1-1 immediately.
Heroin Addiction Treatment
Heroin treatment typically begins with detox to help the person clear the body of heroin and other substances and is followed by formal drug rehab treatment. Detox alone is rarely sufficient to support long-term abstinence.
A key principle of effective heroin treatment is that it’s individualized to meet a person’s specific needs. Treatment for heroin addiction may occur in both inpatient and outpatient settings, and usually involves a combination of behavioral therapy and medication.14
Detox is the process by which a person gets a substance like heroin out of their body. Detox can occur in a variety of settings, including inpatient, residential, and outpatient drug treatment programs.12
Medical detox typically includes medication to help manage withdrawal symptoms and maximize patient comfort. Buprenorphine or methadone, which are both drugs used to treat opioid use disorder, can be started during withdrawal. Taking one of these medications can significantly reduce drug cravings and minimize, or sometimes even eliminate other withdrawal symptoms.
Both drugs can be taken after detox and throughout treatment. They may also be continued after treatment to help a person avoid using heroin or other opioids.12
A third drug used to treat opioid use disorder, naltrexone, requires that a person stop using heroin for at least 7 days before being administered.15
Inpatient treatment offers 24/7 support and structure with varying levels of medical supervision. Services may include heroin detox, and treatment for people who have co-occurring medical or mental health conditions that need monitoring or support.16
Outpatient treatment programs, where patients live at home or offsite, also offers varying levels of care and intensity. Outpatient treatment can include detox and rehab treatment. Some programs meet only a few hours each week while others meet for more.
Intensive outpatient programs (IOP) meet at least 9 hours per week, usually 3 days a week for 3 hours at a time. There are also programs known as partial hospitalization programs (PHP), which meet 20 hours per week. The types of treatment used in outpatient programs may be like those used during inpatient treatment.16
While medication can be an important part of treatment for heroin and other opioid use disorders, behavioral therapy is also critical. Some of the most common types of behavioral therapy used to treat heroin addiction include:9
- Cognitive-behavioral therapy (CBT) is used to change people’s patterns of thought around the use of drugs and teach them healthier ways to cope with drug-related triggers.
- Contingency management is a behavioral therapy approach that uses rewards and incentives to encourage people to abstain from drug or alcohol use. For example, people can earn points or vouchers after attending a certain number of self-help groups, or for having a series of negative drug tests. These vouchers can be traded in for things like movie tickets or essential items like diapers or baby formula.
Get Help with Quitting Heroin
If you or your loved one need heroin addiction treatment, there is no need to struggle alone. Call American Addiction Centers (AAC) to speak to a caring admissions navigator who can help you understand treatment options, check insurance coverage, and start the road to recovery today.
- The United States Drug Enforcement Administration. (2020). Drug fact sheet: Heroin.
- Trickey, E. (2018). Inside the story of America’s 19th-century opiate addiction.
- United Nations. (1953). History of Heroin.
- American Psychiatric Association. (2020). What is a substance use disorder?
- Kiryakova, T., Karayasheva, D., Mileva, B., & Alexandrov, A. (2019). Illicit drugs: External signs of drug addiction.
- National Institute on Drug Abuse. (2021). What are the long-term effects of heroin use?
- Hasin, D.S., O’Brien, C.P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., & Grant, B.F. (2013). DSM-5 criteria for substance use disorders: recommendations and rationale.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- National Institute on Drug Abuse. (2021). Heroin DrugFacts.
- World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings.
- National Institute on Drug Abuse. (2020). Commonly used drugs chart.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- Substance Abuse and Mental Health Services Administration. (2018). SAMHSA Opioid Overdose Prevention Toolkit.
- National Institute on Drug Abuse. (2018). Principles of effective treatment: A research-based guide.
- Substance Abuse and Mental Health Services Administration. (2020). TIP 63: Medications for Opioid Use Disorder.
- American Society of Addiction Medicine. (n.d.). What is the ASAM criteria?
- National Institute on Drug Abuse. (n.d). Opioids.
- National Institute on Drug Abuse. (2021). Heroin.
- National Institute on Drug Abuse. (21021). Fentanyl DrugFacts.