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Thomas Christiansen

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Kathleen Oroho Linskey, PharmD

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Updated on 08/06/21

Heroin is a highly addictive drug that is classified as an illegal opioid. Heroin and prescription opioids have been linked to an alarmingly high number of drug overdose deaths. The CDC estimates that about 130 Americans die every day from opioid overdoses. Heroin addiction has affected people from all demographics.

Understanding how to identify heroin and how to recognize its effects are vital to providing appropriate treatment and intervention to begin the path to recovery and healthy living.

What is Heroin?

Heroin is an opioid. Its chemical name is diacetylmorphine because it is a chemically modified version of morphine. Even though it is now classified as an illicit drug in many countries, it was first marketed by a pharmaceutical company in the late 1890s as a cough suppressant. In 1932, after the overwhelming addictive nature of heroin was fully recognized by physicians and the government, the medicinal use of heroin in the United States was outlawed. Heroin is classified as a Schedule I controlled substance in the United States because it is has been determined to have no medicinal value and its misuse is associated with significant danger, including death.

Although heroin has been classified as an illegal substance for many years, the misuse of heroin and the amount of people suffering from heroin addiction has increased dramatically in recent years. The Centers for Disease Control and Prevention (CDC) estimated that heroin-related overdose deaths increased more than five times between the years of 2010 and 2017.

About Heroin Addiction

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What Does Heroin Look Like?

Heroin looks like a brown or white powder or a black, sticky goo.

It is commonly kept with drug paraphernalia, which are specific items used to take it. The types of drug paraphernalia used depend on the individual’s preferred method for using the substance. For example:

  • Injecting heroin typically requires syringes, metal spoons, bottle caps, tin foil or lighters
  • Smoking heroin typically requires a pipe
  • Snorting heroin typically requires hollowed out plastic pen cases or cut-up drinking straws

How is Heroin Used?

When trying to understanding how heroin is used, some of the most frequently asked questions include:

  • Can you take heroin by mouth?
  • Can you smoke heroin?
  • Are there different ways to inject heroin?

Heroin can be taken orally, injected, snorted or smoked. It causes an intense, euphoric high and equally intense withdrawal symptoms when its effects wear off. Injecting heroin is the most commonly used method because it leads to the quickest and most effective high. The two methods of injecting heroin are either into the skin, known as “skin-popping,” or intravenously, known as “mainlining.”

Because heroin is an illegal substance, the supply is not regulated so dealers are not held to any purity standards. To maximize profits from sales or take advantage of desperate or novice buyers, dealers often mix heroin with other powders or substances that resemble heroin to the untrained eye. This practice is known as “cutting” heroin. Commonly, heroin is cut with additives to add weight to increase the sales price, increase its euphoric effects or diminish a side effect that might come from heroin use. Inconsistencies in heroin purity are directly linked with harmful effects from use and fatal overdose. The dangers surrounding the practice of cutting heroin make it very important to understand what is heroin cut with.

Substances Heroin Is Commonly Cut With

There are many different substances that heroin is cut with. Some are harmless and others can be lethal. Some of the common items include:

  • Baking Soda
  • Talcum Powder
  • Fentanyl – a synthetic opioid that is 50-100 times more potent than morphine by weight and has been linked to many fatal overdoses
  • Caffeine – can be used to make heroin into a vapor, making it a practical additive for people who smoke or inhale heroin
  • Flour
  • Sugar
  • Baby Formula 
  • Laundry Detergent
  • Diphenhydramine – an allergy medicine that decreases the itching sensation sometimes felt with heroin injection

Street and Other Names For Heroin

When talked about by dealers, heroin is rarely called heroin. Instead, dealers will talk about the substance using heroin street names.

Some of the street names for heroin include:

  • Big H
  • Black Tar
  • Chiva
  • Hell Dust
  • Horse
  • Negra
  • Smack
  • Thunder

Side Effects of Heroin

Heroin enters the brain quickly and binds to opioid receptors in the brain, causing a rush and euphoric high. However, the rush of desirable and pleasurable feeling comes with many other symptoms and can lead to devastating short-term and long-term effects.

The extent of the negative effects that may result from the use of heroin depends on multiple factors, including:

  • The extent of use (short-term or long-term)
  • The dose of heroin used
  • Other drugs used with heroin
  • The environmental conditions of use (e.g., the use of contaminated or dirty needles to inject heroin)

The short-term heroin side effects include:

  • Warm flushing of the skin
  • Slowed and clouded mental functioning
  • Nausea and vomiting
  • Dry mouth
  • Severe itching
  • Going “on the nod,” a swinging back-and-forth between conscious and semi-conscious state
  • Heavy feeling in the arms and legs
  • Possible overdose symptoms including significantly reduced breathing, coma and death

The long-term heroin side effects include:

  • Insomnia
  • Mental disorders including depression and personality disorders
  • Collapsed veins from frequent injection
  • Increased risk for infections from injecting with contaminated needles
  • Abscesses and skin infections at site(s) of injection
  • Damage to the nose from sniffing or snorting
  • Constipation and stomach cramping
  • Muscle breakdown
  • Liver and kidney disease
  • Sexual dysfunction for men and irregular menstrual cycles for women

How Long Does Heroin Stay In Your System?

Due to the high risks associated with heroin misuse and addiction, drug tests are commonly used by doctors, employers and law enforcement to identify heroin use. The presence of heroin in the body can be detected through the following tests:

  • Urine

    How long does heroin stay in your urine? Because heroin’s break-down products (also called metabolites) are primarily eliminated from the body through urine, the use of heroin is detectable in urine samples for up to three days after the last use depending on the dose, frequency of use and the individual metabolism of the user.

  • Hair

    How long does heroin stay in your hair? Using hair samples to evaluate the presence of a substance in the body is useful because, although it does not quantify the exact amount of drug that was or is in the body, it can provide proof that a person used or was exposed to the drug. Heroin’s metabolites can be detected in scalp hair up to 90 days after the last use.

  • Blood

    How long does heroin stay in your blood? Blood toxicology screens are commonly done in the hospital to determine the presence and amount of the drug(s) in the body at a given moment. This type of test is commonly performed if an overdose is suspected. Blood tests can determine the concentration of heroin in the body for up to 10 minutes after use; however, the metabolites can be detected for about a day and a half after use.

  • Saliva

    How long does heroin stay in your saliva? Saliva drug screenings are becoming popular due to better tests becoming available because these tests are quick and non-invasive. These tests are preferred in situations when a rapid result is useful, such as in workplaces where drug use would affect safety and for roadside testing by law enforcement for impaired drivers. Heroin use can be detected in saliva as soon as two minutes after use and up to 30 to 60 minutes after use, with the longer detection windows possible after heroin is smoked.

  • Breast Milk

    How long does heroin stay in breast milk? If someone is using heroin, they should not breastfeed their child because the baby would be exposed to dangerous, possibly fatal, levels of opiates. Heroin and its break-down products are passed into breast milk and can cause withdrawal symptoms in babies who are exposed during nursing. Heroin’s metabolites have been detected in an infant exposed to breast milk from a nursing mother who used heroin two days prior to an emergency hospital visit. Using heroin while nursing is not safe for the child.

Is Heroin Addictive?

Heroin is a highly addictive drug with undesirable withdrawal symptoms that begin quickly after use. The desirability of the euphoric high and the negative effects of withdrawal symptoms make a user feel a compulsive need to continue to use the substance, even after just one exposure to heroin.

If you or a loved one struggle with heroin addiction and are considering treatment for recovery, call The Recovery Village Palm Beach at Baptist Health to speak with a representative who can get you started on the path to recovery.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.