Heroin is one of the most dangerous and addictive illicit drugs being used and abused in the U.S. today.
Along with prescription opioid pain medications and the synthetic opioid fentanyl, it still remains a major factor in the ongoing “U.S. Opioid Epidemic.”
Sadly, many people begin using heroin with little idea about how highly addictive the drug is. Before long, they are actively and regularly using the drug, and rapidly become addicted – medically known as heroin or opioid use disorder (HUD/OUD).
Here, we look at heroin from several different angles:
- The drug’s addictive side effects
- How heroin affects the brain
- The physical and mental damage it can do
- Heroin’s role in the U.S. opioid epidemic
- What it’s like to be addicted to heroin, and
- How professional opioid use disorder (OUD) treatment is the only feasible way of successfully finding a long-term, sustainable recovery
Continue reading to learn more about heroin and its alarming potential for addiction.
What is Heroin?
Heroin is a powerful, rapidly-acting and highly addictive drug made from morphine, a natural substance taken from the seed pod of various opium poppy plants grown around the world.
It is classified as an opiate or opioid drug, and is medically described as an opioid analgesic, and a mu-opioid receptor agonist. It’s chemical name is diacetylmorphine.
It can be either a white (the purest form) or a brown powder, or a black, sticky substance known as “black tar heroin.”
Huge opium poppy fields for both the legal production of pharmaceutical morphine and the illegal manufacture of heroin can be found in:
Thailand / Laos / Myanmar
Afghanistan / Pakistan
Mexico / Bolivia / Colombia
Heroin is illegally sold on U.S. streets by criminal drug dealers, or purchased online through the dark web. Obviously, buying heroin in these ways means users have little or no idea what the purchased substance contains, or its strength.
This leaves many users constantly at risk of a potentially fatal overdose.
WARNING #1: Heroin is often “cut” (mixed) with strychnine or other poisons
- Many of these various additives do not fully dissolve, which can clog the blood vessels that lead to the lungs, kidneys or brain, risking the infection and physical damage of vital organs.
WARNING #2: Fentanyl Contamination
- The exceptionally potent synthetic opioid fentanyl or one of its similar chemical analogs is being mixed into virtually every other illicit drug available on the streets of America, including heroin, methamphetamine, cocaine, counterfeit prescription pills, and MDMA (ecstasy).
Heroin: Street Names
According to the U.S. Drug Enforcement Agency (DEA), it has the following street names:
- Big H
- Hell Dust
- Nose drops
Heroin is classed as a Schedule I substance in the U.S. under the Controlled Substances Act, meaning that it has:
- “A high potential for abuse
- No currently accepted medical use in treatment in the United States, and
- A lack of accepted safety for use under medical supervision.”
How is Heroin Used?
Heroin users either inject, sniff, snort, or smoke heroin, and some users mix their heroin with crack cocaine, a dangerous practice known as “speedballing.”
It affects the brain rapidly because it effectively binds to our natural opioid receptors [as described in detail below: How Does Heroin Affect the Brain?].
This results in a flood of the brain’s natural “feel-good” chemical dopamine into the brain’s “reward center.”
Heroin users experience an intense and euphoric high when using the drug, feeling both elated and completely relaxed, with no pain.
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Can You Get Addicted to Heroin After One Use?
Although heroin is extremely potent, highly addictive and produces this intense and powerful feeling of euphoria, it is very doubtful that anyone who uses it for the very first time will become instantly addicted or “hooked” on the drug.
However, heroin can leave first-time users with a psychological craving to try the drug again. With repeated use, an actual addiction to heroin or the development of opioid use disorder (OUD) will normally take several weeks to occur.
The History of Heroin in the U.S.
The use of opium and morphine dates back more than 5,000 years. However, it was only relatively recently in 1805 when French pharmacist Friedrich Sertürner discovered how to chemically isolate morphine.
From then on, the drug was widely used to treat pain and even treat opium addiction – long before it became clear morphine was, itself, highly addictive.
In fact, morphine was used during the American Civil War to treat severe pain in injured soldiers.
In 1874, English chemist Charles Romney Alder Wright began experimenting with morphine and, by accident, created heroin from mixing morphine with various acids. He called the resulting chemical diacetylmorphine – now known as heroin.
Soon after its creation, heroin became a popular and widely used medicine in the U.S.; specifically, it was used for:
- Treating moderate to severe pain
- Treating coughs and colds as a form of cough medicine
- Relieving pain after childbirth
- Treating morphine addiction
- Anesthesia for surgical patients
Bayer, the pharmaceutical company, branded diacetylmorphine as heroin in 1898, and marketed the drug as a “non-addictive pain medication” – a move that has resounding similarities with the actions of U.S. pharmaceutical companies prior to the current opioid epidemic.
Although high rates of heroin addiction were being reported in the 1920s, it continued to be frequently prescribed to both children and adults for various ailments.
Heroin finally became illegal in the U.S. in 1924 after the federal government realized how addictive it was, and it remains an illicit Schedule I substance to this day.
What Causes Opioid Addiction & Why is it So Tough to Combat?
TED-Ed with Mike Davis
The full transcription of this TED-Ed video is available here.
In the 1980s and 90s, pharmaceutical companies began to market opioid painkillers aggressively, while actively downplaying their addictive potential. The number of prescriptions skyrocketed, and so did cases of addiction, beginning a crisis that continues today.
What makes opioids so addictive?
Mike Davis explains what we can do to reverse the skyrocketing rates of addiction and overdose.
Heroin: Side Effects
Whether it’s because of a recreational drug user’s curiosity, peer pressure, opioid pain prescriptions no longer being fillable, mental health disorders, behavioral issues, or something else entirely, the euphoric experience of a user’s first hit of heroin stays with them, possibly leading to further use, and then, ultimately, addiction.
So what are the actual side effects of heroin use and how does it affect the brain so dramatically?
Typically, heroin users experience:
- Intense and euphoric “high”
- Decrease in pain levels
- Feelings of elation, happiness and relaxation.
- Excessive fatigue
- Changes in their mental perceptions
How Does Heroin Affect the Brain?
Heroin is described as a mu-opioid receptor agonist. This means it effectively and rapidly binds to the natural opioid receptors in the brain, and activates them.
Normally, our own natural neurotransmitters bind to these receptors in order to control pain, regulate hormones, and keep us feeling good.
However, when the mu-opioid receptors are activated by a powerful drug like heroin, a huge amount of dopamine is released.
It is this rapid rush of dopamine that creates the feeling of intense euphoria felt by heroin users.
The U.S. Opioid Epidemic
The ongoing national opioid epidemic continues to take the lives of Americans at a frightening rate – around 190 opioid-related deaths per day, and the rate continues to worsen.
With the growing use of synthetic opioids, like fentanyl (a drug 50 times stronger than morphine), it will be years before an end to the crisis is in sight.
The opioid epidemic was originally caused by the actions of the U.S. pharmaceutical industry, who assured family physicians across the nation that new opioid medications for treating pain were safe to prescribe, and, importantly, not addictive.
As a result, the medical community – everyone’s tried and trusted family doctor – began prescribing them to patients at insanely high rates.
Before long, it became clear that these medications could indeed be highly addictive, and opioid overdose rates began to increase.
Opioid Epidemic: The Medical Industry Created a Public Health Crisis
Dr. Chris Johnson, MD | TEDx Talks
As an emergency room physician, Dr. Chris Johnson has worked on the front lines of the opioid epidemic. He argues that the epidemic is not an accident, and that the medical industry and its system of incentives have, in fact, created this crisis at the expense of effective, compassionate medicine driven by science.
He is a nationally recognized expert on the opioid epidemic, and has spoken throughout the country on this topic to medical and non-medical audiences alike, and brings an urgent message on the need to reform a medical industry that has prioritized business interests over patient safety.
U.S. Opioid Epidemic: Facts & Stats
In 2017, an estimated 1.7 million Americans suffered from opioid use disorder (OUD) related to prescription opioid medications, with 652,000 suffering specifically from heroin use disorder.
On October 26, 2017, the opioid epidemic was finally and formally declared a national public health emergency by the U.S. Department of Health & Human Services, at the request of the White House.
In 2019, nearly 50,000 people died in the U.S. from opioid-related overdoses, through the use, abuse and subsequent addiction to prescription pain medications, fentanyl, heroin, and other opioids.
Additionally, according to the National Vital Statistics System, part of the Center for Disease Control & Prevention (CDC), heroin was involved in nearly a fifth of all drug overdose deaths (19.8%) during the year.
“This is the highest number of overdose deaths ever recorded in a 12-month period. We are seeing an increase in drug consumption, difficulty in accessing life-saving treatments for substance use disorders, and a tragic rise in overdose deaths.
In 2020, the opioid death rate rose to nearly 70,000 – around three-quarters (74.7%) of all drug overdose deaths (93,331) during the year, and an increase of nearly 30% from overall drug mortality in 2019.
Latest Update: The CDC’s latest provisional data reports that the percentage rate for fatal drug overdoses is still rising, now standing at nearly 31%.
Heroin: The Cheap Alternative to Prescription Opioids?
Medical research over the last decade has suggested that the misuse of opioid prescriptions by some people may open the door to heroin use later in their lives – such is the devastating impact of opioid use disorder.
The transition is equally dramatic – from prescription medications to an illicit Schedule I street drug, and from family physicians to backstreet criminal drug dealers.
According to the NIDA, here’s a summary of known data:
- 21-29% of patients prescribed opioids for chronic pain misuse them
- Between 8-12% of people using an opioid for chronic pain develop an OUD
- An estimated 4-6% who misuse prescription opioids transition to heroin
- Around 80% of people who use heroin first misused prescription opioids
Additionally, a recent study of heroin users in the Chicago metro area identified 3 main paths to heroin use disorder:
- Polydrug use (i.e., simultaneous use of multiple substances) to heroin use
- Prescription opioid abuse to heroin use, and
- Cocaine use to heroin use (to “come down“)
The actual likelihood of developing an OUD from prescription opioids depends on many factors, including:
- Familial history of substance abuse and addiction
- Genetics / sex / medical history
- Type of opioid medication, eg. OxyContin
- Length of time a person is prescribed opioids, and
- Length of time afterwards that people continue misusing opioids (whether as prescribed or otherwise).
The relationship between prescription opioid abuse and increases in heroin use in the U.S. is constantly under scrutiny, as the substances are part of the same opioid drug category, and overlap in several important ways.
Currently available research clearly demonstrates:
- Prescription opioid use is a risk factor for heroin use
- Heroin use is rare in prescription drug users
- Prescription opioids and heroin have similar effects, and different risk factors
- A subset of people who abuse prescription opioids may progress to heroin use
- Increased drug availability is associated with increased use and overdose
- Heroin use is driven by its low cost and high availability
- Emphasis is needed on both prevention and treatment
Heroin: Short & Long Term Effects
The longer a person uses and abuses heroin is directly linked to the amount of mental and physical damage they can potentially inflict upon their health and wellbeing.
Apart from the obvious euphoric high, the short-term and, in particular, the long-term effects of heroin abuse can be severe, causing extensive and permanent damage to vital organs, including the brain, and can lead to a drastically reduced life expectancy.
Additionally, with the illicit heroin supply now becoming more and more contaminated with the synthetic opioid fentanyl and similar substances, the greater is the likelihood of a potentially fatal heroin overdose.
Short-Term Effects of Heroin Use
- Euphoric high (3-5 hours)
- Decrease in pupil size
- Decreased heart rate
- Reduced respiration*
- Diminished cognition
- Flushed skin
- Runny nose
- Extreme fatigue
- Dry mouth
- Heavy limbs
- Appetite loss
- Severe itching
*Important: Reduced respiration (or slow breathing rate) is of particular concern. Sometimes this can lead to the heroin user falling into a coma, or even suffering irreparable brain damage.
Long-Term Effects of Heroin Use
The long-term use and abuse of heroin impacts the entire physical body, causing severe and long-standing conditions related to the vital organs.
This includes the human brain and a number of its important functions, where the damage done by heroin is often irreversible.
Heroin & The Brain
Repeated heroin use and abuse changes both the physical structure and the physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are difficult to reverse.
These types of brain damage and functional impairment can include:
- Structural changes to the brain’s reward center
- Decreased control over the respiratory system, resulting in shallow, slow or irregular breathing
- Low intake of oxygen, leading to reduced function in the vital organs and possibly organ damage, including the brain itself
- Reduction in white matter, which can affect decision-making, the regulation of behavior, and normal and healthy responses to stressful situations
- Dementia-like syndrome, similar to Alzheimer’s disease
- Severe cognitive impairment
Heroin, particularly over an extended period, will produce profound degrees of tolerance and physical dependence:
- Tolerance results in more and more of the drug being required by the user to achieve the same effects.
- Physical dependence is when the body adapts to the constant presence of the drug. Severe and rapid withdrawal symptoms occur if the heroin use is abruptly reduced or stopped entirely.
Heroin & The Body
In addition to the various forms of damage to the brain, the long-term effects of heroin use, including the sharing of unsterilized needles and other drug paraphernalia, can cause the following bodily damage:
- Liver disease
- Kidney disease
- Heart infections
- Rheumatological issues
- Pulmonary infections
- Diminished sex drive
- Skin abscesses and infections
Heroin: Use or Abuse, Addiction & Overdose Risks
A recreational heroin user who can literally take the drug or leave it, and has no clear signs of a dependence on the drug either, is one of the fortunate ones.
However, for many others, a hit or two of heroin a day quickly becomes a regular necessity to satisfy their dependence. This is an example of drug abuse and drug dependence, needing a regular “fix” to simply feel normal.
It can get worse, and often does. Without treatment, the next stop is heroin addiction – heroin use disorder.
Being addicted to heroin consumes absolutely everything else in your life. It is not just your main focus – it’s your only focus.
The addiction is further strengthened by the rapid onset of withdrawal symptoms if a heroin fix doesn’t arrive on time.
At this point, there is the distinct possibility the brain is suffering irreversible damage, and the hormonal and neural systems have become so unbalanced it will take years of living heroin-free to repair the damage.
Additionally, normal dopamine production is a thing of the past – there is no way that the brain in its current state can produce enough of the organ’s “happy chemical” so the addict feels reasonably normal, let alone the feeling of being happy.
Physical Signs of Heroin Use & Abuse
There are several signs that indicate that a person has been using heroin on a regular basis in the short-term. They are easy to spot when people know what to look for, and they can include:
- Nausea / Vomiting
- Nervous / Anxious
- Feeling chilly
- Poor sleep patterns
- Return of bodily pain
Physical, Psychological & Social Signs of Heroin Addiction
- Needle track marks (on the arms and elsewhere)
- Infections at injection sites
- Experiencing withdrawal symptoms when not using
- Poor sleep
Pattern / Insomnia
- Continuing heroin use despite knowing the clear health risks
- Unable to stop using on their own
- Risky behavior when trying to access a new heroin supply
- Obsession with heroin
- Using heroin as “self-medication”
- Decreased cognition and decision-making
- Agitation and irritability
- Memory loss
- Isolated from loved ones, family and non-using friends
- Lack of self-care, eg. untidy appearance
- Socializing with other heroin users (known or unknown)
- Struggling with finances / legal issues
- No activity with normal pastimes
- Increased tolerance to heroin
- Being deceptive, eg. stealing and lying
- Employment issues
The High Risk of Heroin Overdose
Opioids were the main catalysts behind the record number of fatal drug overdoses seen during 2020, and, as we stated previously, the risk of overdose has significantly increased with contamination of the normal illegal drug supply by the synthetic opioid fentanyl.
Heroin Overdose Statistics
According to historical heroin overdose data from the NIDA:
- In 1999, the number of heroin overdoses was considered extremely low in the U.S.
- By around 2013, the issue had worsened and it was estimated 10,000 people in total had died from a heroin overdose
- This figure continued to increase annually, reaching 15,000 in 2016
- A significant number of these fatal overdoses were a result of poly drug use (mixing two or more drugs to magnify their effects)
- In 2019, indicating a stabilization of the issue, there were just over 14,000 fatal heroin overdoses
How Can I Identify a Heroin Overdose?
A heroin overdose can either occur rapidly – within 10 minutes – or slowly – perhaps 3 hours after the last use, and anywhere in between, time-wise.
However, it is rare for someone to die quickly if they have overdosed on heroin, so there is time for them to be saved if prompt action is taken.
If you suspect someone has overdosed on heroin (or another opioid or powerful drug), call 911 immediately. Additionally, if the person is in possession of the opioid overdose reversal medication, naloxone (described below), immediately use it as directed.
Staying with the person is now paramount, as the emergency services need to be advised of the use of naloxone.
The main signs of a heroin overdose can include:
- Muscles limp and unresponsive
- Respiratory depression
- Skin coloration
- Purplish lips and fingernails
- Loss of consciousness
- Small pupils
- Inability to speak / incoherent speech
- Irregular heart rate
What is Naloxone?
Naloxone is a medicine that rapidly reverses an opioid overdose. It is an “opioid antagonist,” meaning it rapidly attaches to opioid receptors, and reverses and blocks the effects of other opioids.
Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped – one the main reasons overdoses can become fatal.
However, naloxone has no effect on someone who does not have opioids in their system, and it should not be used as a type of treatment for opioid use disorder (OUD).
Administering Naloxone: Naloxone can be given in a number of ways, depending upon the brand – either as a nasal spray, or as an injection into the muscle, under the skin, or into the veins.
Additional information about opioid overdose response is available here: Substance Abuse and Mental Health Administration’s (SAMHSA) Opioid Overdose Prevention Toolkit.
IMPORTANT: The majority of U.S. states now have “Good Samaritan” laws in place (although they can vary from state-to-state). This means those who provide emergency aid to the overdose victim (friends, other drug users, and even bystanders and passers-by) are exempt from any legal proceedings relating to civil liability simply because they helped.
Heroin: Detox, Treatment & Recovery
Heroin Detox: Withdrawal Symptoms
The safest way to “detox” (the process of detoxification) from heroin is with a professional, medically supervised detox.
Attempting to detox from heroin solely on your own (known as going “cold turkey”) can be exceptionally dangerous as the withdrawal symptoms can be severe, leading to a high risk of medical issues, relapse and, later, overdose.
Remember, a detox will only help a person become heroin-free, without medical risks – and ready for drug rehab. It does nothing to treat the causes of the addiction. The psychological addiction to heroin has to be professionally treated, along with any mental health issues, behavioral problems, or experiences of trauma.
Types of Heroin Detox Programs
Heroin Addiction Rehab
- One-to-One Counseling Therapy
- Specific Therapies, such as Cognitive Behavior Therapy (CDT)
- Group Support, and
- Family Therapy
Types of Drug Rehab Treatment Programs
SpringBoard Recovery Provides Heroin Addiction Treatment
Learn More about Recovery from Heroin Addiction: Get Help Today
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- Drug Enforcement Agency (DEA). Drug Fact Sheet: Heroin. June, 2020. Available at DEA.gov.
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- Binghamton University, New York. Civil War on drugs: Doctoral candidate explores the nation’s first opioid epidemic. August, 2021. Available at Binghamton.edu–
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- U.S. Centers for Disease Control & Prevention (CDC): Provisional Drug Overdose Death Counts” System. August, 2021. Available at CDC.gov.
- Alzheimer’s Association. What is Alzheimer’s? 2021. Available at ALZ.org.
- HIV.gov. Hepatitis B & C. April, 2020. Available at HIV.gov.
- Council of Residency Directors in Emergency Medicine (CORD). Good Samaritan Laws. 2021. Available at CORDEM.org.
- Substance Abuse and Mental Health Administration (SAMHSA). Opioid Overdose Prevention Toolkit. 2018. Available at SAMHSA.gov.
- Substance Abuse and Mental Health Administration (SAMHSA). Medication-Assisted Treatment. 2021. Available at SAMHSA.gov.
- National Institute on Drug Abuse (NIDA). Comorbidity: Substance Use & Other Mental Disorders. June, 2021. Available at DrugAbuse.gov.
- U.S. National Library of Medicine: “Definition of Partial Hospitalization.” August, 2021. Available at NLM.NIH.gov.