Heroin is a highly addictive opioid with devastating effects on individuals, families, and communities. As a fast-acting drug, it quickly alters brain chemistry, leading to intense euphoria followed by a rapid decline into dependence. Repeated use rewires the brain’s reward system, making it increasingly difficult to function without the drug. Many who become addicted find themselves caught in a cycle of escalating use, severe withdrawal symptoms, and an overwhelming need to seek out more heroin.
The dangers of heroin use extend far beyond addiction itself. The drug is commonly injected, leading to an increased risk of infectious diseases such as hepatitis B, hepatitis C, and HIV/AIDS. Other health risks include respiratory depression, organ damage, heart infections, and complications during pregnancy. Heroin use also contributes to high rates of overdose deaths, especially as fentanyl contamination has made the drug even more lethal.
What is heroin?
Heroin is an illegal and highly addictive opioid derived from morphine, a naturally occurring substance found in the seed pod of the opium poppy plant. It is typically processed into a white or brown powder or a sticky, dark substance known as black tar heroin. The powder form is often mixed with other substances like sugar, starch, or powdered milk, while black tar heroin, which is less refined, contains more impurities and is commonly dissolved and injected.
The drug is known for its intense euphoric effects, which occur as it binds to opioid receptors in the brain, altering pain perception and triggering a surge of dopamine. These effects reinforce repeated use, leading to rapid dependence and addiction. Heroin is particularly dangerous due to its unpredictable potency and the presence of harmful additives, which can increase the risk of overdose.
Heroin use carries severe health risks, including respiratory depression, infections, heart problems, and an increased likelihood of contracting hepatitis or HIV/AIDS from needle sharing. While some mistakenly believe that purer forms of heroin are safer because they can be snorted or smoked instead of injected, all forms of heroin carry a high potential for addiction and overdose.
Classified as a Schedule I controlled substance, heroin has no accepted medical use and a high risk of misuse. Despite ongoing prevention efforts, heroin addiction remains a serious public health issue, often linked to the broader opioid crisis. Data from the 2023 National Survey on Drug Use and Health (NSDUH), reports that an estimated 660,000 people aged 12 or older reported using heroin in the past year. The majority of users were among adults aged 26 or older (629,000 individuals), followed by young adults aged 18 to 25 (27,000 people) and adolescents aged 12 to 17 (4,000 people).
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Heroin effects
Heroin is a powerful opioid that alters brain chemistry, leading to immediate and long-lasting effects on both physical and mental health. The drug produces intense euphoria, but this sensation is short-lived, often driving repeated use that quickly leads to tolerance, dependence, and addiction. The way heroin affects an individual depends on the dose, method of use, and frequency of consumption.
Short-term effects of heroin use
Heroin rapidly crosses the blood-brain barrier, where it is converted into morphine and binds to opioid receptors, triggering a powerful rush of euphoria. The speed and intensity of this effect depend on how the drug is used. Injecting or smoking heroin leads to an almost immediate high, while snorting produces a slightly delayed but still potent effect.
Physical effects of heroin use include:
- Warm flushing of the skin
- Dry mouth
- Heavy feeling in the arms and legs
- Nausea and vomiting
- Severe itching
- Drowsiness lasting several hours
- Slowed heart rate and breathing
Psychological and behavioral effects may include:
- Euphoria
- Mental clouding
- Reduced pain perception
- Drowsiness and sedation
- Impaired coordination
- Slowed reaction time
- Confusion or disorientation
One of the most dangerous effects of heroin is respiratory depression, where breathing slows or stops altogether. This can lead to coma, permanent brain damage, or death. The risk is especially high when heroin is mixed with other substances, such as fentanyl, alcohol, or benzodiazepines, which further depress the central nervous system.
Long-term effects of heroin use
Chronic heroin use leads to significant brain and body changes that are difficult to reverse. Over time, the brain adapts to heroin’s presence, making it less responsive to natural rewards and increasing the likelihood of opioid use disorder (OUD). Tolerance develops, requiring higher doses to achieve the same effects, which raises the risk of overdose.
Psychological and neurological effects include:
- Cognitive impairment affecting memory, decision-making, and impulse control
- Severe anxiety and depression
- Emotional instability and difficulty regulating behavior
- Persistent drug cravings, even after stopping use
Physical complications of long-term heroin use include:
- Progressive hormonal imbalances
- Damage to the brain’s white matter, leading to difficulty managing stress and emotions
- Chronic constipation and gastrointestinal issues
- Lung infections such as pneumonia and tuberculosis
- Heart infections (endocarditis) from injecting the drug
- Sexual dysfunction in men and irregular menstrual cycles in women
The method of use also plays a role in long-term damage:
- Injection use can lead to collapsed veins, abscesses, and bacterial infections
- Snorting heroin damages nasal tissues, causing chronic nosebleeds and perforation of the septum
- Smoking heroin can cause severe lung damage and respiratory issues
Withdrawal symptoms can begin within hours after the last dose, with symptoms peaking between 24-48 hours and lasting for a week or longer. However, some individuals experience prolonged withdrawal symptoms for months, making it difficult to achieve long-term sobriety without medical intervention.
Additionally, heroin use significantly increases the risk of overdose, especially with the presence of fentanyl—a synthetic opioid 50 times more potent than heroin. Overdose occurs when breathing slows to dangerous levels, leading to unconsciousness, brain damage, or death. Emergency treatment with naloxone (Narcan) can reverse overdose effects, but without immediate medical attention, heroin overdose is often fatal.
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Heroin overdose
Heroin overdose is a serious and potentially deadly event. When someone overdoses on heroin, their body cannot process the drug fast enough, leading to dangerous complications, primarily related to respiratory depression. The risk of overdose is heightened when heroin is mixed with other substances, especially synthetic opioids like fentanyl, which is often found in heroin on the illicit market.
Common symptoms of a heroin or opioid overdose include:
- Shallow or slow breathing
- Pinpoint pupils
- Convulsions or seizures
- Changes in the nervous system
- Loss of consciousness or coma
- Low heart rate and blood pressure
- Cold, clammy skin or bluish lips
While heroin overdose deaths are still significant, the overall number of overdose deaths involving heroin has decreased in recent years. According to data from the Centers for Disease Control and Prevention, in 2022, approximately 7% of all opioid overdose deaths involved heroin, but synthetic opioids, especially illegally made fentanyl (IMF) and its analogs, now dominate the opioid overdose crisis, accounting for the majority of overdose deaths. Most heroin available in the U.S. today is mixed with fentanyl, which increases the risk of overdose. Despite the ongoing opioid crisis, the number of heroin-related deaths showed a positive trend in 2022, as heroin overdose deaths decreased by nearly 36% compared to the previous year. This decline may be due to fewer people starting heroin use, shifts from heroin to fentanyl use, and increased access to naloxone—a life-saving medication that temporarily reverses opioid overdose effects.
Heroin overdose is very possible and can be fatal. An overdose typically occurs when a person consumes enough heroin or a combination of substances to cause a life-threatening reaction. The most critical aspect of a heroin overdose is respiratory depression, where breathing slows down or stops completely. This deprives the brain and other vital organs of oxygen, a condition called anoxia. Without immediate intervention, anoxic brain injury can occur, leading to coma or death. Heroin overdose can also result in unconsciousness, brain damage, and cardiac arrest, all of which make timely treatment essential.
If you suspect someone has overdosed on heroin, call 911 immediately.
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When does heroin misuse turn into addiction?
Heroin misuse can develop into an addiction, clinically known as opioid use disorder. Healthcare providers assess this by using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Signs of addiction include:
- Feeling compelled to use heroin despite its negative impact on social or personal relationships.
- Struggling to stop or cut back on heroin use even after multiple attempts.
- Spending excessive time acquiring, using, or recovering from heroin’s effects.
- Increasing the amount of heroin used to achieve the desired effects, due to the development of tolerance.
- Prioritizing heroin use over work, school, or family obligations.
- Engaging in risky behavior, such as using heroin in dangerous environments or situations.
- Discontinuing activities or hobbies that were once enjoyable because of heroin use.
- Experiencing cravings or an overwhelming urge to use heroin.
- Using heroin despite knowing it is contributing to physical or mental health issues.
- Enduring withdrawal symptoms when attempting to stop or reduce heroin consumption.
- Continuing heroin use even as it interferes with daily life and responsibilities.
This progression of behaviors can signify the shift from misuse to a full-blown addiction, characterized by both physical and psychological dependence.
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Heroin withdrawal
Heroin withdrawal occurs when a person who is physically dependent on the drug reduces or stops using it. The body, which has become accustomed to the presence of heroin, reacts to its absence with a series of physical and emotional symptoms. For many individuals struggling with heroin addiction, these symptoms are so intense that they can prevent someone from attempting recovery, creating a major barrier to seeking help and support.
Heroin withdrawal symptoms can be extremely uncomfortable and may include:
- Restlessness
- Severe muscle aches and bone pain
- Trouble sleeping or insomnia
- Nausea and vomiting
- Diarrhea
- Cold flashes with goosebumps
- Uncontrolled leg movements
- Anxiety or panic attacks
- Irritability
- Increased heart rate
- Runny nose
- Sweating and shaking
- Flu-like symptoms, such as fever
- Severe cravings for heroin
The peak of heroin withdrawal often brings a combination of extreme anxiety, tremors, and muscle cramps, with many individuals reporting significant joint and bone pain. These physical symptoms can be debilitating, and the emotional toll is equally severe, with feelings of irritability and anxiety making it hard to focus on anything other than the urge to use heroin again.
One of the most difficult aspects of heroin withdrawal is the length of time these symptoms can persist. While the most intense physical symptoms typically peak within 24 to 48 hours after the last dose, the psychological symptoms, including cravings, can last for weeks or even months. Even after the body has detoxed from the drug, many individuals still deal with lingering emotional and mental discomfort, such as anxiety, depression, and a desire to escape the distressing feelings of withdrawal.
The desire to feel “normal” again and the constant battle with discomfort puts those in recovery at a high risk of relapse. When someone who has recently stopped using heroin begins using again, their tolerance may have lowered, meaning a dose that would have been safe in the past could now be fatal, leading to overdose and respiratory failure.
Heroin withdrawal can be a frightening and painful process, but with medical detox and support, individuals can safely manage the symptoms and work towards long-term recovery. Effective treatment combines medications to ease the withdrawal process, along with behavioral therapy to address the underlying addiction and prevent relapse.
Heroin addiction treatment
Heroin addiction is a tough battle, but it’s one that can be won with the right support and treatment. The journey to recovery usually starts with detox, but the real work begins when someone learns how to manage cravings, triggers, and the underlying reasons they turned to heroin in the first place. Successful treatment for heroin addiction usually combines medications and therapy, and often requires ongoing care and support.
Medically assisted detox
The first step in treatment is usually medically assisted detox. This is when someone who’s been using heroin regularly stops using the drug and begins to clear it from their system. Withdrawal symptoms can be pretty intense, including things like muscle pain, sweating, insomnia, and vomiting. While these symptoms aren’t usually life-threatening, they can be difficult enough to make people want to keep using. Having a medical team oversee detox helps make this process safer and more comfortable, so individuals can start recovery on the right foot.
Medication-assisted treatment (MAT)
After detox, the next step is usually medication-assisted treatment (MAT). MAT helps people stay off heroin by reducing cravings and withdrawal symptoms. It’s been proven to increase the chances of staying clean and staying engaged in treatment. There are several medications available that can make this part of the process more manageable:
- Methadone: This medication works by blocking the effects of heroin and reducing cravings. It’s been around since the 1960s and is still used in treatment clinics today. It’s a long-acting medication, so it helps keep cravings at bay throughout the day.
- Buprenorphine (Subutex®): Buprenorphine works in a similar way to methadone but has less of an effect, which makes it a good option for people who want to avoid the “high” that heroin or methadone can produce. Some formulations of buprenorphine, like Suboxone®, also include naloxone to prevent misuse.
- Naltrexone (Vivitrol®): Naltrexone is an opioid antagonist—it blocks the effects of heroin entirely. It doesn’t cause addiction or sedation, and the extended-release injection version (Vivitrol®) is given once a month, which can make it easier for people to stay on track.
The right medication is chosen based on a person’s needs and where they are in the recovery process. Sometimes, it’s about starting with something that helps ease withdrawal, and later transitioning to a medication that helps block cravings and keep them clean for good.
Therapy and counseling
While medication can help with physical symptoms, therapy is what helps someone heal emotionally and mentally. There are a variety of therapy options to choose from, but here are a few that tend to work well for heroin addiction:
- Cognitive-Behavioral Therapy (CBT): CBT focuses on changing negative thinking and unhealthy behaviors. It helps people understand why they use drugs and gives them tools to manage the triggers that lead to cravings or relapse.
- Contingency Management: This approach offers rewards for positive behavior, like staying sober or passing drug tests. These rewards might be small things like vouchers for healthy activities, but they add up and help reinforce staying clean.
- 12-Step Facilitation: Many people find support in groups like Narcotics Anonymous or Alcoholics Anonymous. These programs help individuals connect with others who understand what they’re going through and encourage long-term sobriety.
Long-term support and aftercare
Recovery from heroin addiction doesn’t end when a treatment program finishes. In fact, the months or even years after treatment can be the most challenging part. Continuing care is crucial, and this often includes regular outpatient therapy, ongoing support groups, or even living in a sober living facility to stay surrounded by positive influences.
For people with mental health challenges, treatment often includes dual diagnosis care to treat both the addiction and any other issues, like depression or anxiety, that may be contributing to the substance use.
Family involvement can also be incredibly beneficial. Counseling that includes loved ones can help rebuild relationships, offer emotional support, and keep everyone on the same page during recovery.
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Sources
- National Institute on Drug Abuse. (August 2021). Heroin Research Report. Overview.
- Centers for Disease Control and Prevention. (October 2024). Heroin.
- Drug Enforcement Administration. (July 2018). Drug scheduling.
- National Institute on Drug Abuse. (August 2021). Heroin Research Report. What is heroin and how is it used?
- National Institute on Drug Abuse. (June 2021). Fentanyl DrugFacts.
- Center for Behavioral Health and Statistics and Quality. (July 2024). Key Substance Use and Mental Health Indicators in the United States: Results from the 2023 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Rockville, MD.
- National Institute on Drug Abuse. (August 2021). Heroin Research Report. What are the immediate (short-term) effects of heroin use?
- National Institute on Drug Abuse. (August 2021). Heroin Research Report. What are the long-term effects of heroin use?
- National Institute on Drug Abuse. (September 2023). Commonly Used Drug Charts. Heroin.
- National Institute on Drug Abuse. (January 2024). Opioid Use Disorder.
- National Institute on Drug Abuse. (August 2021). Heroin Research Report. What are the treatments for heroin use disorder?
- Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
About the content
Written by: Carli Simmonds. Carli Simmonds holds a Master of Arts in Community Health Psychology from Northeastern University. From a young age, she witnessed the challenges her community faced with substance abuse, addiction, and mental health challenges, inspiring her dedication to the field.
Medical reviewed by: Jodi Tarantino, LICSW. Jodi is an experienced, licensed Independent Clinical Social Worker (LICSW) and Program Director with over 20 years of experience in Behavioral Healthcare, demonstrating expertise in substance use disorders, mental health disorders, crisis intervention, training development, and program development. She is a skilled leader in business development with a Master of Social Work (MSW) in Community and Administrative Practice from the University of New Hampshire.
Red Ribbon Recovery is committed to delivering transparent, up-to-date, and medically accurate information. All content is carefully written and reviewed by experienced professionals to ensure clarity and reliability. During the editorial and medical review process, our team fact-checks information using reputable sources. Our goal is to create content that is informative, easy to understand and helpful to our visitors.
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