Heroin and Interactions with Other Drugs: The Dangers and Effects

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Springboard Recovery provides effective treatment for substance use & mental health disorders.

Evan Leonard MS, MMS, PA-C

Dr. Leonard is a Doctor of Medical Science and a clinical anatomist. He has practiced in both internal and emergency medicine and has published several, peer-reviewed articles and a medical book chapter.

Heroin is a highly addictive, dangerous drug, but the risks are even greater when it is combined with other drugs. People who use heroin along with other substances are often unaware of the interactions that can occur. In some cases, combining other drugs with heroin can be fatal. People need to know about the risks when they combine heroin with other drugs. Here, we have compiled a list of various drug interactions and side effects that people experience when they take heroin and another substance together.
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First of All, What is Heroin?

Heroin is an opiate drug that is made from morphine. Morphine comes from the seed pod of the opium poppy plant, which is grown in areas like Mexico, Southeast and Southwest Asia and Colombia. It is a Schedule I Substance under the Controlled Substances Act because it is known to be highly addictive.

This drug has been a known drug of abuse for a very long time. It is often “cut” with other substances, such as starch, powdered milk or baking soda. In its purest form, heroin comes as a white powder that has a bitter taste. Black tar heroin is much less pure and it is either sticky like roofing tar or hard like a piece of coal.

Black tar heroin is usually dissolved, diluted and injected into a vein. But newer users might be more interested in smoking or snorting a purer form of the drug. Eventually, people tend to gravitate toward injecting it in order to get a more intense high.

Why do People Abuse Heroin?

Unfortunately, many people turn to heroin after having first abused prescription opioids. Once they no longer have access to them, heroin appears to be a viable option to either treat their pain or get them high.

According to the National Institute on Drug Abuse, prescription opioid use is a major risk factor for heroin abuse. In fact:

  • From data that was collected between 2002 and 2012, it was found that heroin abuse was 19 times more common among people who had reported nonmedical prescription painkiller use.
  • One study involving young, urban injection drug users found that 86% of them had first used opioid pain relievers nonmedically prior to using heroin.
  • These individuals’ initial drug use involved medications given to them by friends, family members and through their own personal prescriptions.
  • Among people who began abusing opioid drugs in the 2000s, 75% stated that their first opioid was a prescription medication.
  • This is quite a shift from studies in the 1960s, when more than 80% of people began abusing opioids by using heroin.
  • When examining national population data, it was found that close to 80% of heroin users first used drugs like Vicodin and Oxycodone before switching to heroin.

Does Heroin Cause Drug Tolerance?

Most heroin users are very familiar with the term, “Chasing the Dragon.” This phrase refers to the very first high users experience when they try this drug. Subsequently, the next high and those that follow are never quite as intense; yet people are always trying to achieve that same feeling. They may chase the dragon, but they never catch him.

This is called forming a drug tolerance, and it typically happens with most substances. It does not take long at all for the body to get used to the amount of the drug a person is using. Once it does, the effects are diminished and the high is not quite the same.

To counteract this, people will often increase the dosage of their drug of choice; at least until they reach a dangerously unsafe level. At that point, it is very common for people to consider adding other drugs into the mix. This accentuates their high and possibly gives it a new dimension, which is also very alluring and satisfying.

Combining Heroin with Other Drugs

People who have been abusing heroin may eventually consider combining it with other drugs to get a better high, like we mentioned earlier. There are several drugs that they might attempt to pair with it.

Both heroin and alcohol are central nervous system depressants. They have the same types of overall effects, even though they do different things in the body. Heroin affects the opioid receptors in the brain and body, whereas alcohol affects the release of GABA and NMDA. Both can cause people to feel a euphoric high that is relaxing and sedating.

Using both drugs together can affect the neurotransmitter, dopamine, and dramatically increase its availability in the brain. The heroin/alcohol combination enhances the effects of both drugs to produce sensations that are very different from using either drug by itself.

The effects of abusing heroin and alcohol together include:

  • A decrease in breathing rate, heart rate and blood pressure.
  • Problems with balance and motor coordination.
  • Excessive fatigue and relaxation.
  • Loss of inhibitions.
  • Problems with attention and concentration.
  • Difficulty creating new memories.
  • An increase in negative emotional states, including an increase in depression and anxiety.

Using heroin and alcohol together can lead to an overdose on either drug because the threshold is lowered when they are used together. The effects of this combination can also cause people to engage in risky behaviors or even become suicidal.

One of the biggest concerns with using heroin and alcohol together is the effect the two drugs can have on a person’s breathing rate. The risk of anoxia (the complete cutoff of oxygen to the brain and other organs) is very real. When oxygen is not as available to the brain, certain parts of the brain can begin to die off after just a few minutes. This means that if the person survives, they may suffer because of long-term cognitive defects that are irreversible.

The legality of marijuana has made it one of the most commonly used drugs in the United States. There are many states that have legalized it for both medical and recreational use, and more are added to the list every year. The National Institute on Drug Abuse has reported that in 2018, more than 11.8 million young adults have used the drug within the last year. Since that time, that number is sure to have increased.

Heroin and marijuana are very different from each other, even though both are known as depressant drugs. It is not uncommon for people to purchase marijuana on the streets only to find later that it has been laced with heroin. The combination can result in a powerful high, but it is also quite dangerous to use the two drugs together.

Some of the common effects of using heroin and weed in combination include:

  • A slower breathing rate and heart rate
  • Confusion
  • Loss of consciousness
  • Nausea and/or vomiting
  • Diarrhea

A person who has never used heroin before, but who uses it along with marijuana puts themselves at risk for a fatal overdose.

Benzodiazepines are prescription medications that can help people cope with anxiety and other physical ailments. Ativan, Valium and Xanax are just a few examples. Although they can be therapeutic, they can also be abused, which they often are.

When a person is using heroin and they add a benzodiazepine drug into the mix, the combination can be a deadly one. On their own, benzos can inhibit breathing rates; especially when they are taken in higher doses than prescribed. When combined with heroin – which also has a depressive effect on respiration – it increases the likelihood of overdosing and death.

The National Institute on Drug Abuse has reported that in 2019, 16% of all overdose deaths that involved opioid drugs also involved benzodiazepines. The number of people filling these prescriptions has increased by 67% from 1996 to 2013, and the quantity of each prescription has increased as well.

Unfortunately, the use of opioids along with benzodiazepines has become very common. Many people use heroin and benzos at the same time in an attempt to achieve a more euphoric high. But it is a dangerous combination that can result in death.

Cocaine is a stimulant drug, which makes it very different from heroin, which is a depressant. But it is common for people to combine the two together, and the result is something called a speedball.

When using a speedball, people will either inject both drugs into a vein at the same time, or they will snort them together. Mixing these two drugs can result in a much more intense, longer-lasting high than a person can experience by just taking either drug by itself.

Heroin’s effects include slower breathing rates and even respiratory failure in some cases. But cocaine is the opposite because it is a stimulant. People who abuse cocaine typically experience an increased heart rate, higher energy levels and rapid breathing rates. People who use this combination of drugs may be attempting to cancel out the negative effects of both substances. But taking them together can actually amplify those negative effects instead.

Speedballing produces a push-pull effect in the body. Cocaine causes the body to need more oxygen whereas heroin makes it more difficult to breathe. This can put an incredible amount of strain on the lungs, heart and brain.

Some additional side effects of speedballing include:

  • Blurred vision
  • Becoming confused or incoherent
  • Becoming paranoid
  • Mental impairment because of a lack of sleep
  • Drowsiness
  • Uncontrollable body movements

Some of the potentially fatal side effects of using heroin and cocaine together include the risk of stroke, a heart attack, respiratory failure and an aneurysm.

What is a Cross Addiction?

The term, cross addiction refers to the use of more than one drug or having more than one addictive behavior. This is also called addiction transfer or Addiction Interaction Disorder. A lot of people who abuse heroin also abuse at least one other drug, such as any of the ones listed above.

Cross addictions are very dangerous because they often increase the risk of an overdose. It is very important for people to get help for both substance abuse problems. Otherwise, treatment will not have been effective, and the individual is likely to relapse on both drugs.

Getting Substance Abuse Treatment for a Cross Addiction

A person who is addicted to heroin and at least one other drug will need to go through both detox and rehab in order to recover effectively. Addiction treatment staff should consider both substances when determining the type of care that is needed.

A person who is addicted to heroin will need to go through the detoxification process to help with their withdrawal symptoms. Medication assisted treatment is the best option because it is designed to help people who are addicted to opioid drugs.

But additional treatment may be needed depending on the other drug the person is using. For example, if they are also addicted to cocaine, they may need medical and/or holistic detox as well.

Drug rehab is there to help people determine the cause of their addictions and offer the proper treatment through therapy and medications if needed. This is an essential part of the recovery process; especially for those who have co-occurring disorders.

A co-occurring disorder is a mental health issue that can occur alongside a person’s substance abuse problem. They are common in about 50% of the people who come to drug and alcohol treatment.

Dual diagnosis treatment is essential for people with co-occurring disorders because it effectively treats the reason for their substance abuse problem. In turn, this reduces the risk of relapse in the future.

Get More Information About Heroin Drug Interactions and Treatment Options for Recovery

At SpringBoard Recovery, we have worked with many people who were addicted to heroin as well as at least one other drug. We offer a high-quality outpatient rehab program as well as sober living services for those who need them.

Are you ready to take the next step and change your life for the better? Would you like to know more about heroin drug interactions and getting treatment? Please contact us today.

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