Heroin is an opioid and it is a chemically modified version of morphine (heroin’s chemical name is diacetylmorphine), first marketed by a pharmaceutical company in the late 1890s as a cough suppressant. It was also thought that heroin provided the same medicinal benefits for pain relief as morphine without the side effects associated with morphine. However, when the overwhelming addictive nature of heroin was recognized by physicians and the government, the medicinal use of heroin was outlawed in the United States in 1932. 

Heroin is currently classified as a Schedule I controlled substance in the United States due to it having no medicinal value and its misuse being associated with significant danger, including death.

Heroin was recognized for its addictive characteristics since the early 1900s when regulations and laws were enacted in many countries to classify the substance as an illegal drug. However, recently, and coinciding with the upsurge of abuse and addiction to prescription opioid painkillers, the misuse of heroin and the amount of people suffering from heroin addiction has increased dramatically.

The misuse of heroin is dangerous. The Centers for Disease Control and Prevention (CDC) estimates that heroin-related overdose deaths increased more than 5 times between the years of 2010 and 2017. Currently, heroin addiction is an epidemic that has affected people of all demographics, including groups that were historically identified as low-risk, including women and people with higher incomes.

Understanding the addictive characteristics of heroin and being aware of the signs and symptoms of heroin addiction are vital to providing intervention and appropriate treatment to begin the path to recovery and healthy living.

How is Heroin Abused?

Heroin use causes an intense, euphoric high and equally intense withdrawal symptoms when its effects wear off. Heroin can be taken orally, injected, snorted or smoked. Injecting heroin, either into the skin, known as “skin-popping”, or intravenously, known as “mainlining”, is the most commonly used method because it leads to the quickest and most effective “high”. Heroin is commonly used along with other drugs or alcohol. One example is mixing crack cocaine with heroin to create a “speedball.”

The euphoric sensation and feelings of relaxation caused by the use of heroin begins wearing off three to five hours after use, depending on the dose. It is common for experienced heroin users to use heroin multiple times in a day to prevent withdrawal symptoms. The signs of snorting heroin, smoking heroin and injecting heroin are relatively similar.

Signs of Heroin Use

Because of the relatively short duration of action for heroin, people with addiction cycle through psychological and physical behaviors in a single day. Habitual heroin users shift between a docile and relaxed state during the high then to an irritable and aggressive state when withdrawal symptoms start. Knowing the signs of heroin abuse and addiction is important in recognizing a substance use disorder and providing a path to recovery from heroin abuse.

Because the opioid epidemic has resulted in the widespread abuse of opioids, answering the generalized question, “What does a heroin addict look like,” is not easy.  Heroin addiction symptoms include physical and behavioral effects. The physical signs of heroin addiction and abuse include effects related to using the substance and effects related to withdrawal.

The physical effects of heroin use include:

  • Pinpoint pupils
  • Marks on the skin from injection, also known as “track marks”
  • Slowed breathing
  • Slowed heartbeat
  • Slowed digestion and constipation
  • Blue lips or fingernails
  • Nausea
  • Fatigue
  • Dry mouth

The physical symptoms of withdrawal from heroin include:

  • Muscle or bone pain
  • Chills
  • Vomiting
  • Insomnia
  • Feeling itchy
  • Feeling nervous

In addition to the physical signs of heroin use, certain behaviors can indicate a substance use disorder. The behavioral signs of heroin addiction and abuse include behaviors resulting from the psychological effects of heroin as well as drug-seeking behaviors associated with addiction.

Behaviors due to psychological effects of heroin include:

  • Slowed thinking
  • Lacking coordination
  • Mood changes
  • Shielding of heroin needle marks on body, especially heroin track marks on arms
  • Increased risk-taking behavior
  • Destructive behavior for maintaining social relationships

Drug-seeking behaviors associated with addiction include:

  • Compulsive desires to use substances to alleviate withdrawal symptoms
  • Disregarding personal safety or interpersonal relationships to use substances
  • Diminished sense of responsibility to obligations at work, school or home
  • Decreased satisfaction from typical sources of enjoyment such as family and hobbies
  • Theft of money or belongings to maintain financial means to access drugs

Heroin looks like a white or brown powder or a black, sticky goo, and it is commonly kept with specific tools used to take it, also known as drug paraphernalia. The specific tools needed to use heroin are commonly referred to as a heroin kit.

The types of heroin paraphernalia used depends on the individual’s preferred method for using the substance. For example:

  • For injecting heroin: paraphernalia includes syringes (heroin needles), metal spoons (heroin spoons), bottle caps, tin foil and lighters
  • For smoking heroin: paraphernalia includes pipes
  • For snorting heroin: paraphernalia includes hollowed out plastic pen cases or cut-up drinking straws

Side Effects of Heroin Abuse

Heroin abuse symptoms 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 the extent of use (short term or long term), the dose of heroin used, other drugs used with heroin and the environmental conditions of use (e.g., the use of dirty or contaminated needles to inject heroin).

Physical Signs

Heroin enters the brain rapidly and quickly binds to certain receptors called opioid receptors. The desirable “high” experienced is reported by heroin users as a “rush”. However, the rush of pleasurable feelings is accompanied by multiple short-term effects of heroin, including:

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

Long-Term Effects

Heroin enters the brain rapidly and quickly binds to certain receptors called opioid receptors. The desirable “high” experienced is reported by heroin users as a “rush”. However, the rush of pleasurable feelings is accompanied by multiple short-term effects of heroin, including:

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

Side Effects of Polysubstance Abuse

The CDC estimates that more than nine in ten people who have used heroin have also used at least one other drug. A common practice in polysubstance abuse is to mix an “upper” such as the stimulants cocaine or methamphetamine with a “downer” such as heroin. Mixing meth and heroin is referred to as a “Goofball” and a cocaine and heroin mix is sometimes called a “Bombita” or “Speedball”. Polysubstance abuse is dangerous because the symptoms of overdose from one drug may either be masked or exaggerated by the use of another drug.

Causes of Heroin Addiction

There are many reasons why a person may initially use heroin recreationally. For some, it may be the first time misusing a substance, while for others it may be an option that is next in line after a tolerance has been developed to another substance of abuse. One common and concerning cause for heroin addiction and misuse is the need for the individual to “self-medicate” to cope with mental health disorders.

Another concerning risk factor for heroin use and addiction is prescription opioid misuse. Prescription opioids and heroin have similar effects. However, heroin typically is a convenient and lower-cost alternative when other opioids of choice become too difficult to acquire. Heroin is a highly addictive drug with undesirable withdrawal symptoms. These two characteristics may make a user feel a compulsive need to continue to use the substance, even after the initial exposure to heroin.

Heroin Withdrawal Symptoms

Heroin withdrawal is uncomfortable and the desire to not endure withdrawal symptoms feeds into the compulsive drug-seeking behaviors that are consistent with heroin abuse and addiction.

Signs of heroin withdrawal include:

  • Muscle or bone pain
  • Chills
  • Vomiting
  • Insomnia
  • Feeling itchy
  • Feeling nervous

Heroin withdrawal symptoms can be managed through supportive care measures and can be mitigated by certain medications, such as clonidine, methadone and buprenorphine. Heroin withdrawal should be managed by an experienced healthcare professional to ensure that all the physical and psychological needs of the individual are met to achieve the best chance for a successful recovery.

Heroin Abuse Facts & Statistics

Heroin use has increased in recent years across many demographics, including men and women, all income levels and most age groups. The greatest increases for heroin use are seen with young adults ages 18 to 25 years old. Some interesting facts regarding heroin abuse include:

  • Prevalence in men and women – According to the National Institute on Drug Abuse, research indicates that men are more likely to use larger amounts of heroin, far more time and are more likely to inject heroin. Also, studies show that women are more likely to be influenced to use heroin by drug-using sexual partners or social pressures.
  • Teen heroin abuse – Due to increased education regarding the dangers of heroin and the increased vigilance in watching for early signs for at-risk behaviors associated with heroin abuse, teen heroin abuse is declining. The Monitoring the Future Study, conducted by the National Institute on Drug Abuse, shows that annual prevalence of heroin use reached around its lowest levels among 8th, 10th, and 12th graders in 2017 and 2018 relative to the late 1990s and early 2000s.
  • Across demographics – Even though strides have been made in combating the increasing prevalence of heroin use among certain groups, heroin addiction and abuse continues to be a common contributor to the increase in opioid overdose deaths recorded across all demographics. Opioid overdose deaths continue to increase exponentially. The largest and fastest increases have been seen in the Latino and black communities. The CDC estimates that overdose fatalities in the Latino and black communities have increased by 52.4% and 83.9%, respectively, between 2014 and 2016, compared to 45.8% for non-hispanic whites. One of the reasons for this is the limited availability of bilingual treatment options, and cultural barriers that prevent emergency calls to 9-1-1.

Heroin Abuse and Treatment Trends in South Florida

Florida has recently experienced a surge in drug overdose deaths — a majority involving the misuse of opioids. According to the National Institute on Drug Abuse, the age-adjusted rate of drug overdose deaths increased by 5.9% in Florida between 2016 and 2017, from 23.7 per 100,000 to 25.1 per 100,000, higher than the national average. The conscious effort by physicians to reduce the prescribing of opioid pain relievers helped buffer the increase; however, the increased availability of illegal drugs that are mixed and “cut” with other substances, such as fentanyl, increases the risk for overdose death.

Heroin Overdose

Heroin overdoses are dangerous and can lead to serious injuries and death. The chance of surviving a heroin overdose is directly linked to how quickly someone receives medical attention. Narcan (naloxone) is a medication that reverses respiratory failure resulting from a heroin overdose. Naloxone works quickly, but the amount needed to reverse an overdose is dependent on the amount and type of drugs causing the overdose.

Signs of heroin overdose include:

  • Limp body
  • Shallow or slow breathing
  • Pale or ashen skin
  • Loss of consciousness

If you or someone you know experiences these signs of heroin overdose, it is very important to call 9-1-1 and seek immediate medical attention. The sooner that appropriate medical care is rendered, the better the chance of survival.

How to Find Help for Heroin Addiction

Recovery is possible for heroin addiction. Great strides have been made in the treatment of heroin addiction. When deciding to break the cycle of addiction, it is best to seek out the help of trained healthcare professionals. Specially trained and expert healthcare professionals can provide a personalized approach, including medication-assisted treatment, appropriate psychological support and effective treatment for conditions including infections or diseases, that may have developed during an individual’s use of heroin.

Intervention

To start the path to recovery, a stimulus is typically necessary. Because heroin addiction takes complete control of an individual’s life, an intervention from family and friends may be needed to convince the individual that recovery is an option and achievable. A coordinated intervention can prove to a person struggling with addiction that his or her health, safety and happiness is important to the people who care about him or her. Guidance from a trained addiction specialist on how to properly carry out an intervention can help ensure the best outcome from the intervention and the choice to follow the path of recovery.

Treatment Options for Heroin Addiction

Because heroin is highly addictive, a coordinated treatment program facilitated by trained healthcare professionals and individualized to a person’s unique circumstances and needs ensures the best chances for recovery. Successful heroin addiction treatment involves many components and may include the following:

  • Detox – During medical heroin detox, a person’s body is cleansed of drugs and alcohol while under the care of medical professionals who help to manage various withdrawal symptoms. Although it is not always necessary to begin heroin rehab with medical detox, many heroin rehab centers do so because it promotes a commitment to recovery and reduces physical discomfort.
  • Residential Treatment – Residential treatment is provided in a setting where a person lives on-site at a rehab center to receive more intensive levels of care. Residential treatment is ideal for people who are just starting recovery and may require a higher degree of monitoring and support.
  • Outpatient Treatment – Outpatient treatment is a type of treatment that allows people to live at home but participate in program sessions at a rehab center during the day. This type of treatment program gives people the flexibility to maintain a job and keep up with most of their current day-to-day responsibilities. The number of sessions that a person needs will depend on their individual recovery plan but can range from part-time sessions occurring once or twice per week to a full-time outpatient program with daily sessions.
  • Dual Diagnosis – It is common for people suffering from substance use disorders and addiction to have co-occurring mental health conditions. A person with a dual diagnosis has an addictive disorder as well as a mental illness or mood disorder such as anxiety, bipolar disorder or depression. The mental illness or mood disorder may be the reason a person developed a heroin addiction; therefore, appropriate treatment of the mental illness or mood disorder is crucial to a successful rehab program.

Key Points: Understanding Heroin Abuse

Some key points to remember about heroin and heroin abuse are:

  • Heroin is an opioid and is a chemically modified version of morphine
  • Heroin is a highly addictive, illegal substance and its misuse is associated with significant dangers, including death
  • Heroin-related overdose deaths increased more than five times between the years of 2010 and 2017
  • Heroin can be taken orally, injected, snorted or smoked. Injecting heroin is the most commonly used method because it leads to the quickest high
  • Heroin is commonly used along with other drugs or alcohol
  • There are physical and behavioral signs of heroin abuse and addiction, such as pinpoint pupils and lack of coordination
  • Drug paraphernalia commonly used for heroin includes needles, metal spoons and pipes
  • Because of the short duration of action for heroin, heroin users cycle through between many psychological and physical effects in a single day.
  • Heroin withdrawal symptoms can be very intense and can include muscle and bone pain, sleep disturbances, diarrhea, vomiting and severe cravings to use heroin
  • Heroin overdose can be deadly
  • Signs of heroin overdose include pale or ashen skin, loss of consciousness, slowed breathing or limp body.
  • Recovery from heroin addiction is possible and there are many treatments, including medicines and behavioral therapies
  • The most successful heroin addiction treatment programs are those that are individualized and meet the unique needs of each person
  • Medical professionals that are specially trained in treating heroin addiction can identify other infections, illnesses or co-occurring conditions that may have led to or resulted from the misuse of 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.