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How to Tell if Someone Is Using Heroin

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Aug 14, 2023 • 9 cited sources

There are some clear signs that someone is using heroin, and there are some signs that are a little harder to detect. But if you know what to look for, you might be able to step in and help someone you love.

Heroin is a powerful, addictive substance people can snort, smoke or inject. While some people are comfortable using heroin openly, many keep their habits secret. Understanding what heroin use looks like can allow families to provide support and discuss lifesaving treatment options. 

10 Signs of Possible Heroin Use

People who use heroin may share some characteristics and habits that highlight their drug use. These are some of the signs researchers say are common among people with an active heroin habit:

Possession of Drug Paraphernalia 

Heroin is usually obtained in powder form. People must use tools to snort or transform the powder into an injectable liquid. 

Common types of heroin paraphernalia include the following:

  • Spoons, especially if the bottoms are blackened by smoke or fire
  • Lighters
  • Needles 
  • Tourniquets 
  • Metal straws 

Paraphernalia can be hard to identify, as tools can be disguised to look like innocent items.[1] But spotting tools could indicate someone you love is using. They may keep these items in their room, their car or their bags. 

Track Marks (or a Need to Hide Them)

While heroin can be sniffed or snorted, injection use is rising among drug users. Researchers say injection drug use rates rose 110% within the last decade among 20-year-old individuals entering treatment programs.[2] 

Each needle entry leaves a small, bloody hole behind. People with an ongoing heroin habit may have several injection sites dotting their arms. You may see them, or you may notice that the person always wears long-sleeved shirts to cover them. 

Unexplained Sedation 

Heroin is a powerful sedative drug, and it works within minutes.[3] Immediately after injection, heroin users enter a twilight state between sleeping and waking. 

Their voices blur, and they may be unable to follow conversations. They may drift into and out of sleep with jerking movements. Users call this state being “on the nod.” 

If someone enters these states frequently with no other known cause, heroin use could be to blame. 

Missing Money or Valuable Objects

Heroin isn’t an expensive drug. In the early 1980s, a gram cost about $2,200. Now, it costs less than $500.[4] But as addictions deepen, people lose the ability to hold down jobs. They may need to steal to keep a heroin habit alive. 

People with opioid use disorder (OUD) can drain bank accounts, sell family items (like cars), take out loans, and make other poor decisions to feed their ongoing addictions. Families that suspect OUD should keep a close eye on their loved one’s financial health, so they can step in and hold a conversation as needed. 

New Friends or Contacts

Heroin is illegal in all states, and buying it from dispensaries or pharmacies is impossible. People with a habit must form connections with dealers, and sometimes, they bring these people home with them to test products or make purchases. 

As OUD deepens, some people who use heroin feel more comfortable with others who share their obsession. They may bring new friends home to use drugs together, or they may allow other heroin users to sleep on their floors or couches when they need to.

Making new friends isn’t a sign of weakness or addiction. Forming new connections is important for everyone. But if these new friends have some of the signs of heroin use discussed here, they could indicate the person you love is using drugs.

Unexplained Absences

Some people who use heroin can maintain a normal life, heading to work on schedule without missing a shift. But some people spend so much time getting, taking or recovering from heroin that they have little time left for everyday routines. They may miss work repeatedly, and they may have no valid reason for doing so.

Someone who misses work or school opportunities could be dealing with a physical or mental health crisis. It’s always wise to ask what’s happening and how you can help. But if the person can’t cite a problem or asks for privacy, drug use could be to blame, particularly if other signs of heroin use are present.

Lack of Interest in Former Hobbies or Sports

Addictions are time-consuming. People using heroin may not engage in the activities they once loved, as they spend more time getting, using or recovering from heroin. They may be unable to explain why this change is happening, and they may get uncomfortable or even angry when you ask. 

Weight Loss

Researchers say people with heroin addiction often eat infrequently, and when they do, they consume sugary snacks rather than healthy foods.[5] 

Some people with heroin addiction develop sudden, dramatic and noticeable weight loss. If someone loses a lot of weight with no known cause, it could be caused by drugs. 

Mysterious Illnesses

Heroin isn’t safe, and chronic users can develop many significant problems that require medical care. For example, track marks can become painful and infected, requiring minor surgeries and antibiotics. People who use heroin can also fall due to severe sedation, and this can sometimes result in serious injuries. 

If the person seems ill or is suddenly accident-prone, drugs might be the cause. 

At Least One Overdose

As addiction deepens, people need larger doses to produce a high. In time, they can take so much that they overwhelm their nervous systems and slip into a life-threatening, coma-like state. 

Heroin is often contaminated by other substances, including sedatives. For example, the tranquilizer xylazine was detected in 31% of overdose cases in Philadelphia.[6] Even when people take heroin doses that seem safe, they could face contamination and death.

Anyone who experiences an overdose is dealing with an opioid misuse issue. Anyone who overdoses more than once is likely dealing with opioid use disorder and needs help. 

Why Is Heroin Addiction Dangerous?

More than 106,000 people died of overdoses in the United States in 2021.[7] Opioids like heroin are to blame for many of these deaths. Anyone who misuses opioids can experience an overdose at any time, and the next one could cause death.

People who use heroin can also experience major health problems, including the following:[8]

  • Miscarriages 
  • Heart infections 
  • Overdoses 
  • Hepatitis 

Heroin addictions also cause major suffering. Keeping drug misuse secret is difficult, and dealing with health problems is even harder. The longer the problem lasts, the deeper the scars left behind. Recovery is always possible, but the earlier the invention, the better the long-term outcomes.

How Is Heroin Addiction Treated?

Doctors use medications to help people adjust from heroin intoxication to sobriety. This process is called withdrawal management, and it’s the first step toward recovery. Without ongoing treatment, people often relapse to heroin after they complete withdrawal management programs.[9]

Heroin addiction requires long-lasting treatment programs that combine medications and therapy. These Medication for Addiction Treatment (MAT) programs last as long as the person needs to avoid relapsing to substance misuse. For some people, medications support their recovery for the rest of their lives. 

If you or someone you love is using heroin, an MAT program may be right for you. Reach out to us here at Bicycle Health to learn more.

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. Drug Paraphernalia Fast Facts. National Drug Intelligence Center. Accessed March 2023.
  2. Understanding Suburban Heroin Use. Illinois Consortium on Drug Policy. Accessed March 2023.
  3. What is Heroin and What Does It Feel Like? Drug Policy Alliance. Accessed March 2023.
  4. The Costs of Heroin and Naloxone: A Tragic Snapshot of the Opioid Crisis. Stat. November 2018. Accessed March 2023.
  5. Eating Patterns Among Heroin Users: A Qualitative Study with Implications for Nutritional Interventions. Addiction. March 2012. Accessed March 2023.
  6. Increasing Presence of Xylazine in Heroin and/or Fentanyl Deaths, Philadelphia, Pennsylvania, 2010 to 2019. Injury Prevention. July 2021. Accessed March 2023.
  7. Drug Overdose Death Rates. National Institute on Drug Abuse. February 2023. Accessed March 2023.
  8. Heroin. U.S. National Library of Medicine. March 2021. Accessed March 2023.
  9. Withdrawal Management. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. 2009. Accessed March 2023.

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