Heroin addiction, formally known as heroin substance use disorder, results in intense physical and psychological dependence.1 Heroin is an illegal substance made from the poppy’s extracts. Poppies are also used to produce codeine, hydrocodone, and oxycodone, all prescription opioids that are highly addictive and are prescribed for severe pain.
What Is Heroin?
Heroin is an illegal and dangerous opioid that is derived from morphine, a prescription opioid. Once morphine is treated, it becomes the powdery, crumbly substance known as heroin. The color ranges from white to dark brown or black. Heroin is “cooked” into liquid form then injected into the veins or under the skin. Heroin can also be smoked through a pipe.
Heroin activates the brain’s opioid receptors faster than our body can produce natural endorphins and dopamine. These chemicals activate the reward system in the brain causing a rush or sense of pleasure and relaxation. For this reason, heroin is abused as a recreational drug as a form of escaping one’s reality.
It can be very easy to become addicted to heroin over time as the body and brain become altered from heroin use. When heroin is suddenly stopped, the body will go into physical withdrawals which although are not life-threatening, they can be extremely uncomfortable resulting in the increased urge to use again.
Physical & Psychological Effects of Heroin Addiction
The effects of heroin can be harmful and life threatening. When heroin use becomes a priority, a person’s entire world revolves around this drug. The person experiences change in their behavior, as well as physical and psychological changes. You may notice that your loved one has become erratic and more aggressive, they are depressed, they prefer to be alone and therefore withdrawal from friends and family and their behaviors are abnormal.
There are many different side effects of heroin use. Based on my experience with working in addiction, I have provided a list of the short and long-term effects of heroin use.
Short-Term Effects of Heroin
People who use heroin report feeling a “rush” (a surge of pleasure, or euphoria).
There are other common short-term effects of heroin, including:
- Warm flushing of the skin
- Dry mouth
- Heavy feeling in the arms and legs
- Nausea and vomiting
- Intense itching
- Decreased mental functioning
- Nodding, a back-and-forth state of being conscious and semi-conscious
Long-Term Effects of Heroin
People who use heroin over the long term may develop:
- Insomnia
- Collapsed veins
- Infection of the heart lining and valves
- Skin abscesses (swollen tissue filled with pus)
- Constipation and stomach cramping
- Liver and kidney disease
- Lung complications, including pneumonia
- Mental disorders such as depression and antisocial personality disorder
- Sexual dysfunction for men
- Irregular menstrual cycles for women
Other Potential Effects
Heroin often contains added ingredients or components, such as starch or sugar, that can clog blood vessels. Harmful effects can lead to damage to the lungs, liver, kidneys, or brain, that can be permanent. Additionally, sharing needles increases the risk of contracting blood borne infectious diseases such as HIV and hepatitis.2
Signs & Symptoms of Heroin Addiction
Heroin is highly addictive and heroin addiction ranges from mild to severe. Overtime, tolerance or need for more of the drug to get the desired effects will increase, resulting in a higher potential for overdose, which is often lethal. Heroin addiction results in lifestyle complications such as health problems, relationship turmoil and failure to meet responsibilities at home, work, or school. Learning to identify the ways heroin is used and what the drug looks like can help you recognize heroin use in someone you love.
Heroin can be injected or smoked. Needles, pipes, spoons and lighters are often used. In some cases, people who are addicted to heroin use rubber tubing or elastic bands as tourniquets for easier access to their veins. These makeshift tourniquets help them inject heroin into veins that have been damaged by regular heroin use.
Physical signs associated with heroin use include:
- Slow or irregular breathing
- Itchy or flushed skin
- Nausea and vomiting
- Constipation and stomach pains
- Drowsiness
- Loss of consciousness
- Constricted or small pupils
- Slurred or incoherent speech
Psychological and behavioral signs associated with heroin use include:
- Depression
- Anxiety
- Irritability
- Mood swings
- Lying or deceptive behavior
- Avoiding eye contact with others
- Loss of motivation
- Lack of interest in hobbies or activities
- Decreasing quality of performance at school or work
- Withdrawal from friends and family
- Hostile behavior toward loved ones
- Repeatedly stealing or borrowing money from others
- Wearing long sleeves or pants to hide needle marks
- Lower attention to personal hygiene
Heroin Overdose
Most drug overdoses in the United States are opioid-related and heroin is a major component in this. It is nearly impossible to tell what heroin is cut with and how pure it is, and therefore the user is risking their life when using heroin because of its production in labs and distribution on the street. As a result, individuals can overdose and die during their first experience with heroin or during their 70th experience. Because of so many unknowns, this drug is considered extremely lethal.
Heroin Withdrawal
Heroin withdrawal occurs when a person stops or reduces use. Withdrawal symptoms are often uncomfortable and even painful, and often result in continued heroin use in order to avoid these unpleasant withdrawal effects.
Stopping heroin use suddenly may lead to severe withdrawal. Symptoms of withdrawal can begin as early as a few hours after the drug was last taken, peaks on day two or three and can continue for at least one to two weeks. The length of withdrawal is based on several factors such as dosage, duration of use, and tolerance, and can vary from one individual to another based on their gender, weight, and metabolism.
Withdrawal symptoms include:
- Restlessness
- Severe muscle and bone pain
- Stomach cramps
- Headaches
- Sleep problems
- Diarrhea and vomiting
- Cold flashes with goosebumps
- Sweating
- Uncontrollable leg movements (“kicking the habit”)
- Dilated pupils
Heroin users in recovery may experience post acute withdrawal syndrome which can include the following symptoms:
- Poor sleep
- Restlessness
- Poor concentration
- Mood swings
- Fatigue/tiredness
- Increased depression or anxiety
- Panic attacks
- Irritability
- Memory loss
Treatment for Heroin Addiction
Treatment options for heroin addiction is as unique as the individual seeking treatment. There are a variety of effective treatments available for heroin addiction, both behavioral and pharmacological, to help restore some degree of normalcy to the body and brain. Three treatment options are outpatient counseling/therapy, inpatient treatment, and medication assisted treatment (MAT). Research shows that many people benefit the most from using both behavioral treatment and MAT.3
Outpatient Counseling/Therapy
There are many effective behavioral treatments available for heroin use. The delivery of these services is provided by mental health providers in private practice and residential programs in an individual and/or group setting.
These programs typically offer forms of behavioral therapy such as:
- Cognitive-behavioral therapy: Helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs.
- Multidimensional family therapy: Developed for adolescents with drug abuse problems as well as their families, and addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
- Motivational interviewing: Makes the most of people’s readiness to change their behavior and enter treatment.
- Motivational incentives (contingency management): Uses positive reinforcement to encourage abstinence from drugs.
Inpatient/Rehab Treatment
There are a variety of inpatient/rehab centers throughout the country that focus on specific individual populations and offer a variety of treatment modalities. Every facility is a bit different, but all have structured routines that include daily counseling/therapy, group sessions, and activities. Some activities include art therapy, music therapy, hiking, meditation, and exercise. Inpatient rehab centers usually enroll clients for 30-60 days depending on the severity of their addiction.
After inpatient treatment, clients are encouraged to continue a lower level of treatment such as a Partial Hospitalization Program (PHP),Intensive Outpatient Treatment (IOP), or standard outpatient treatment (OP). Once the individual has completed treatment, most reputable treatment programs will strongly encourage aftercare which involves engaging in a community support addiction group and continuing outpatient therapy on a weekly or monthly basis.
Medication-Assisted Treatment
Because heroin withdrawal symptoms are so intense and painful, medication may be used to alleviate some of the initial symptoms associated with physical withdrawal. Clients undergoing medication assisted treatment are often given some form of opioid under the direct supervision of a medical physician. Medication assisted treatment has been proven to reduce cravings and future use, especially when used in the long-term.
It is important to note that some medications used for medication assisted treatment are opioid derivatives and therefore can result in opioid addiction, overdose, and withdrawal. Therefore MAT is a delicate balancing act.
Examples of medications used in MAT include:
- Methadone: Methadone or Dolophine is a long-acting, low-potent opioid that has been around for decades to help treat opioid addiction. Long-term treatment is most effective but it can also be used for short term detox purposes. It is common to see clients on methadone for months or years after completing intensive treatment for heroin use disorder.
- Buprenorphine: Buprenorphine is a partial opiate agonist that stimulates the same opioid receptors in the brain that are impacted by heroin. Buprenorphine significantly reduces cravings and withdrawal symptoms and is also helpful for individuals with chronic pain. Since buprenorphine and methadone act on opioid receptors, they are given during the acute detoxification stage to help ease withdrawal effects.
- Naltrexone: Also known as Revia or Vivitrol, Naltrexone blocks the receptors that cause the euphoric feeling from heroin. Naltrexone does not ease the withdrawal symptoms or cravings, but instead, takes away the euphoric high and helps prevent future relapses by causing withdrawal symptoms. Naltrexone should not be used during the acute withdrawal phase or if there are any opioids present in the body because it will cause opioid withdrawal.
- Suboxone: A combination of Buprenorphine and Naltrexone. Since naloxone is a drug that rapidly treats opioid overdose by kicking the opioids off of their receptors in the brain pushing the individual into active withdrawals, when a client is on Suboxone and attempts to use opioids, the naloxone will cause mild withdrawals. Therefore this combination of buprenorphine and naloxone helps alleviate opioid cravings and withdrawal symptoms and can be used in both the withdrawal phase and the maintenance phase.
How to Get Help for a Heroin Addiction
Overcoming a heroin addiction typically involves in-patient care. There are many resources available for those looking to get help, which vary by state and region. A good place to start is to use the SAMHSA Treatment Services Locator to see what is available near you.
Heroin Addiction Statistics
Heroin, especially heroin mixed with fentanyl, has been a major contributor to the opioid crisis in the United States.Heroin is a street opioid drug that has helped to contribute to the opioid crisis today.
According to the most recent study by the National Center for Drug Abuse Statistics:3
- Approximately 494,000 Americans over the age of 12 are regular heroin users
- In 2017, 886,000 Americans used heroin at least once
- About 25% of people who try heroin will become addicted
- In 2017, 81,000 Americans tried heroin for the first time
- Over 15,000 Americans died from a heroin overdose in 2017
- 808,000 people reported past-year heroin use in 2018
- Nearly 115,000 people died from heroin overdoses between 1999 2018
- Poison control centers report that 5,300 children were accidentally exposed to heroin and fentanyl in 2018
- In 2018, the rate of heroin-involved opioid deaths was 7 times higher than it was 9 years before
- About 5% of people with an opioid use disorder will try heroin
