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Does Heroin Cause Hallucinations? How & Why

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Feb 20, 2024 • 12 cited sources

Heroin use does not usually in and of itself cause hallucinations. 

Hallucinations are a type of perceptual disturbance in sight, hearing, feeling, smelling or tasting. These disturbances cause the person to perceive things and feelings that are not real. 

Hallucinations can range from mild and brief to intense and persistent. They can sometimes be a sign of a more serious condition, such as delirium or psychosis.

Heroin is an opioid medication. Opioid medications do not routinely or usually cause hallucinations. 

There have been reports of opioid-induced hallucinations in rare circumstances, particularly in relation to severely ill patients during end-of-life care.[1] However this is likely due to a combination of factors, including severe illness or concurrent use of other substances.

If hallucinations are plaguing someone you love for any reason, it is important to reach out for help. There may be another medical issue at play. 

What Are Hallucinations?

Hallucinations are perceptual experiences that occur in the absence of any external stimuli.[2] They can involve seeing, hearing, feeling, smelling or tasting things that are not actually there but that feel very real to the individual experiencing them. 

The exact mechanisms that cause hallucinations are not fully understood, but they are thought to involve a complex interaction of various brain regions, including the visual and auditory cortex, the thalamus and the limbic system.[3] 

Why Might Hallucinations Occur When Using Heroin? 

Heroin is a powerful opioid that can have profound effects on the central nervous system, including altering the perception of sensory information and behavioral responses to stimuli.[4] While heroin alone does not usually cause hallucinations, it might do so for the following reasons: 

  • If a person is combining heroin with other drugs that cause hallucinations, this may be the cause. For example, there are classes of medications called hallucinogens (such as PCP, magic mushrooms or ecstasy) that may prompt hallucinations, particularly if combined with heroin. 
  • If a person uses alcohol or withdraws from alcohol, they may experience visual hallucinations. This may or may not be exacerbated by concurrent opioid/heroin use. 
  • If a person uses cocaine, they may experience tactile hallucinations, such as the sensation of “bugs crawling on the skin”. This may or may not be exacerbated by concurrent opioid/heroin use. 

Contributing Factors to Hallucinations 

If a person has a severe underlying illness, they may become delirious after using heroin, which may cause hallucinations.

The following mental health conditions can cause hallucinations:[8]

  • Schizophrenia
  • Schizoaffective disorder 
  • Major depressive disorder
  • Bipolar disorder  

Some physical illnesses cause hallucinations too, including the following:[8]

  • Dementia 
  • Alzheimer’s disease
  • Parkinson’s disease 
  • Charles Bonnet syndrome 
  • Migraines
  • Seizures 
  • Tumors 
  • Creutzfeldt-Jakob disease 

Using heroin while dealing with any of these conditions could increase the risk of hallucinations. If your body is already struggling to maintain a close connection with reality, adding heroin can make things so much worse. 

If you are using heroin and having hallucinations, talk to your doctor, as there may be another underlying medical or psychological reason for your symptoms. New onset hallucinations can be serious, and you should seek medical attention if they occur.

Identifying Heroin-Related Hallucinations 

Hallucinations involve a break with reality. People experiencing a heroin hallucination are experiencing things that outsiders are not.

Several types of hallucinations exist, including the following:[9]

  • Tactile: The person may feel something crawling on the skin. Some people feel like they can perceive their organs moving. 
  • Auditory: The person may hear footsteps, voices, music, or other sounds that others cannot. 
  • Visual: The person may see patterns, lights, or people that others cannot. 
  • Olfactory: The person may smell things that others cannot. 

Some people who hallucinate are frightened by the experience. They recognize that they are seeing or smelling things that others cannot. 

Others may not believe that they are hallucinating, as their experiences seem to come from deep inside of their senses. For example, they may believe their auditory hallucinations are simply strong or persistent thoughts.[10]

What to Do if Someone Is Hallucinating 

Whether the hallucinations are caused by heroin or some other trigger, they can be frightening and dangerous. The person can harm themselves or others while experiencing things that others are not. 

Take these steps to help someone who is hallucinating:[11]

  • Speak slowly, calmly and quietly. 
  • Refer to the person by their name, or if you don’t know them, ask them how they would like to be addressed.
  • Reduce stimuli by turning off radios, televisions and bright lights. 
  • Ask the person to describe what they are seeing, hearing or feeling. 
  • Tell the person you don’t see, hear or feel those things, but that you believe they are experiencing them. 
  • Ask the person to focus on you and your voice, not anything else. 

Stay with the person and monitor their symptoms. If your gentle voice and calming presence makes the hallucinations weaker and easier to tolerate, keep doing what you are doing. Ensure that the person stays awake, alert and breathing. Don’t let them take any more heroin — remove it from the room if you have to. 

If you can’t calm the person, or you think there’s a risk of harm, you likely need outside help. Medications like naloxone can remove all heroin from the person’s system and trigger immediate withdrawal. Keep this medication on hand, and use it if needed. 

If naloxone doesn’t help, or the person is in immediate danger and won’t let you help, call 911 and ask the operator for instructions. Doctors can use medications like benzodiazepines to reduce opioid-related hallucinations.[12] However, the person will need help in a hospital or clinic for this type of care. 

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. Opioid-induced Hallucinations: A Review of the Literature, Pathophysiology, Diagnosis, and Treatment. International Anesthesia Research Society. Published April 2019. Accessed January 2023. 
  2. On the Neurobiology of Hallucinations. Journal of Psychiatry and Neuroscience. Published July 2009. Accessed January 2023.
  3. ‘Reality’ Is Constructed by Your Brain. Here’s What That Means, and Why It Matters. Wu Tsai Neurosciences Institute, Stanford University. Published June 2020. Accessed January 2023.
  4. What Are the Long-Term Effects of Heroin Use? National Institute on Drug Abuse. Published June 2018. Accessed January 2023. 
  5. Psychotic Symptoms in Heroin Withdrawal: A Case Report. Cureus. Published January 2021. Accessed January 2023. 
  6. Prevalence and Classification of Hallucinations in Multiple Sensory Modalities in Schizophrenia Spectrum Disorders. Schizophrenia Research. Published October 2016. Accessed January 2023. 
  7. Traumatic Brain Injury and Neuropsychiatric Complications. Indian Journal of Psychological Medicine. Published March 2017. Accessed January 2023. 
  8. Teeple R, Caplan J, Stern T. Visual hallucinations: Differential diagnosis and treatment. The Primary Care Companion to the Journal of Clinical Psychiatry. 2009;11(1):26-32. 
  9. Hallucinations. U.S. National Library of Medicine. Published April 30, 2022. Accessed December 22, 2023. 
  10. Myers S. What is it like to hallucinate? National Alliance on Mental Illness. Published May 18, 2020. Accessed December 22, 2023. 
  11. Hallucinations and delusions: How to respond. Canada Public Safety. Published March 2005. Accessed December 22, 2023. 
  12. Sivanesan E, Gitlin M, Candiotti K. Opioid-induced hallucinations: A review of the literature, pathophysiology, diagnosis, and treatment. Anesthesia and Analgesia. 2016;123(4):836-843.

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