Heroin Addiction: Signs, Symptoms, & Side Effects

Heroin is a highly addictive opioid. Recognizing the signs of heroin addiction can lead to a path of recovery and prevent potentially tragic outcomes.

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.

Physical Signs

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

Behavioral Signs

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

Paraphernalia

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

Related Topic: Identifying Heroin Paraphernalia

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.