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Heroin Addiction: Signs, Symptoms & Medications

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Aug 10, 2023 • 8 cited sources

Signs and symptoms of heroin addiction include unexplained sedation, needle marks on the arms and legs, falling asleep suddenly, and agitation and anxiety in between doses of the drug. People who are addicted to heroin often lie about drug use, miss work or social events, and experience decline in virtually every area of life.

Addiction involves an inability to stop use even if there is a desire to do that. While people may initially be able to hide signs of a heroin addiction, it eventually becomes impossible to do so. 

The recommended treatment for heroin addiction is Medication for Addiction Treatment (MAT), and the preferred medication is usually Suboxone.

Heroin Use

Heroin is a centuries-old drug derived from a poppy plant. People have smoked, injected and swallowed heroin since it was discovered. And they learned how dangerous the drug is if they survived even one overdose episode. 

But today’s heroin is arguably even more dangerous than it’s ever been. Modern dealers mix heroin with much stronger drugs,  resulting in products that can cause a lethal overdose in seconds. 

Even though heroin’s dangers are widely publicized, many people still use the drug. In fact, researchers say the number of people injecting heroin increased between 2002 and 2018.[1] 

People who took and became addicted to pain pills like OxyContin switched to heroin for its affordability and ease of access. Once people start using heroin, it’s very difficult to stop. Treatment programs can help.

What Is Heroin?

Heroin is a powerful opioid drug synthesized from the sap of poppy flowers. Most heroin sold within the United States is grown and processed in other countries before being smuggled into this country and dispensed to dealers for sale. 

Heroin comes in several types, including the following:

  • White: This type looks like a white powder and is typically injected. 
  • Brown: This type looks like dirt or brown sugar, and it’s usually smoked. Some brown types of heroin look like rocks. 
  • Black tar: This type looks like sticky, black tar, and it’s usually smoked or injected. Some types of black tar heroin are mixed with fluids and sold as a liquid. 

Experienced heroin users often equate a lighter color with purity. But dealers can (and do) add toxins and other substances to their products. White-colored heroin could include talc, laxatives or baking soda. Brown or black versions could include coffee or dirt. 

Key Facts About Heroin

  • About 80% of people who use heroin first misused prescription painkillers like Vicodin or OxyContin.[2]
  • About 2% of high school seniors in the United States have tried heroin at least once, and about half of them injected the drug.[3]
  • Long-term heroin users experience reductions in the brain’s white matter, impacting their decision-making abilities and responses to stressful episodes.[4] Changes like this make heroin a drug that is very difficult to quit.
  • In one study in Baltimore, MD, of all people experiencing non-fatal opioid overdoses, 97% of people used heroin. More than half suspected the much stronger drug fentanyl was in the drugs they bought much of the time.[5]

Why Is Heroin Dangerous?

All heroin sold and used within the United States is made in illicit labs and sold by dealers. Officials recognize no legitimate use for the drug, so it’s not sold in any pharmacy or made in a laboratory. Buying, selling or using the drug is illegal. 

Heroin’s legal status is fair, considering the drug’s dangerous nature. Three main risk categories exist

Short-Term Complications

Heroin is a powerful central nervous system depressant, capable of causing an overdose the very first time it’s used. 

Other short-term complications include the following:

  • Constipation 
  • Itching or skin flushing 
  • Pinpoint pupils
  • Rebound headache 
  • Sedation

Long-Term Complications

Most people use heroin via injection. Researchers say abscesses at injection sites are common, often because the drug is tainted with substances that don’t dissolve in the bloodstream.[6]

Other long-term complications include the following:

  • HIV or hepatitis infections from shared needles or risky sex
  • Weight loss or malnutrition
  • Job loss and financial distress
  • Cardiovascular disease due to contaminated drugs 
  • Chronic constipation

Tainted Doses 

Heroin sold on the street is often laced with fentanyl. About half of people who use heroin say they believe fentanyl is in their drugs.[5] But since fentanyl is colorless, odorless and tasteless, the final amount of tainted drugs is likely much higher. 

Fentanyl is an opioid, just like heroin. But it’s up to 50 times stronger, and a tiny amount could be enough to kill.[7]

Dealers add fentanyl because it’s cheaper to make, easier to smuggle and results in an addictive product that keeps users coming back for more. But dosing is haphazard, and it’s far too common for people to buy doses that are strong enough to kill. 

Heroin Withdrawal & Overdose

Heroin is so powerful that it causes persistent changes in the brain and body. Two of them, withdrawal and overdose, are experienced by almost everyone who uses heroin over the long term. 

What Is Withdrawal?

After long-term opioid exposure, cells don’t work properly without the drug. People feel very sick when they try to quit heroin use abruptly, but they may also feel withdrawal symptoms between doses. 

Withdrawal symptoms can include the following:

  • Sweating
  • Shaking
  • Nausea
  • Diarrhea
  • Muscle aches
  • Deep heroin cravings

What Is Overdose?

Taking too much heroin, or using heroin tainted with fentanyl, can lead to severe central nervous system depression. This is an overdose. More than 9,000 overdose deaths were caused by heroin in 2021.[8] 

People who are overdosing have the following symptoms:

  • Cold skin
  • Blue-tinged fingernails and lips 
  • Slow or absent breath
  • Slow or absent heartbeat 
  • Unconsciousness

Quick treatment with naloxone (Narcan) can reverse an overdose in minutes. Without it, people can die, and many do.

Signs & Symptoms of Heroin Addiction 

People who use heroin display a collection of symptoms, both physical and mental, even if they want to hide the addiction.

Physical signs of heroin addiction include the following:

  • Needle marks on the arms and legs 
  • Frequent infections around needle marks 
  • Unexplained sedation 
  • Going “on the nod” or drifting into and out of sleep regularly
  • Agitation or anxiety between doses 

Behavioral signs of heroin addiction include the following:

  • Financial difficulties due to the cost of heroin
  • Lying about drug use
  • Unexplained absences from home, work or school
  • Lack of interest in things the person once enjoyed

Signs that it’s time for treatment include the following:

  • Frequent failed attempts to quit using heroin
  • Fear of quitting 
  • Lack of control over heroin use
  • Severe consequences looming, including job loss or homelessness

How Does Treatment Help?

Medication for Addiction Treatment (MAT) programs are the gold standard for treating heroin addiction. Instead of expecting people to endure sickness and drug cravings, doctors use medications to correct imbalances and allow the brain to heal. 

MAT therapies begin with detox, allowing people to quit using heroin. They continue after detox, helping people to resist their heroin cravings without relapsing to drug use. 

MAT programs often use buprenorphine/naloxone combinations (Suboxone), as they don’t cause intoxication and are approved for at-home use. You can use these therapies as long as they’re helpful. Many people use them indefinitely.

Get started with Bicycle Health by scheduling an appointment. Visit with trained professionals via telemedicine techniques and pick up your prescription at a pharmacy near you. Contact us to find out more and get started.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Reported Heroin Use, Use Disorder, and Injection Among Adults in the United States, 2002 to 2018. JAMA February 2020. Accessed April 2023.
  2. Heroin DrugFacts. National Institute on Drug Abuse. December 2022. Accessed April 2023.
  3. Heroin Fast Facts. National Drug Intelligence Center. Accessed April 2023.
  4. What Are the Long-Term Effects of Heroin Use? National Institute on Drug Abuse. June 2018. Accessed April 2023.
  5. Fentanyl-Contaminated Drugs and Non-Fatal Overdose Among People Who Inject Drugs in Baltimore, MD. Harm Reduction Journal July 2018. Accessed April 2023.
  6. The Textures of Heroin: User Perspectives on “Black Tar” and Powder Heroin in Two US Cities. Journal of Psychoactive Drugs 2016. Accessed April 2023.
  7. Fentanyl Facts. Centers for Disease Control and Prevention. February 2022. Accessed April 2023.
  8. Drug Overdose Death Rates. National Institute on Drug Abuse. February 2023. Accessed April 2023.

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