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What Are the Risks of Injecting Heroin?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Oct 4, 2023 • 8 cited sources

Injecting heroin is extremely risky as it puts heroin directly into the bloodstream along with all of its impurities, toxins and bacteria in the drug or the needle. The effects of heroin are almost instant when injecting the drug, making it impossible to manage dosing, so overdose is a huge risk. 

Additionally, ongoing use of heroin via needles can mean vein damage and scarring in addition to all the problems that come with untreated opioid use disorder (OUD).

Why Is Heroin Such an Incredibly Risky Substance to Use?

Addictive Potential

Heroin is an addictive and illegal substance. Because heroin affects both the brain and the body, people often crave the high and sense of relaxation they experience long before a physical dependence sets in. 

Regular use of the drug can cause the user to build a tolerance to and dependence on the drug. This means that they need more and more of the drug to get high and if they stop using the drug, they experience withdrawal symptoms. 

This cycle of taking drugs to stave off withdrawal symptoms, and needing a higher and higher dose to do that effectively, can put the person at risk of overdose and in a state of constant preoccupation with getting and staying high. Even minimal use of heroin can quickly lead to an OUD.[1]

Effects on Physical & Mental Health

Heroin can cause memory issues and make it harder to think clearly. It can also worsen mental health disorders, such as depression and anxiety.[1] It can also lead to a bevy of physical issues, including gastrointestinal issues, mobility problems and muscle pain. 

Other Ingredients

Heroin is not legally allowed for any use in the U.S., including medicinal purposes, so all heroin is sold on the black market. Street drugs are usually cut with unknown substances, and as a result, they can change significantly in composition and strength from batch to batch. 

These variations mean that no one knows exactly how much heroin they are getting when they take a dose — or what other substances they are getting as well. This increases the risk of accidental overdose that can cause death.[2]

Why Is Injecting Heroin So Dangerous? 

Any method of heroin is extremely dangerous, but injecting heroin (also known as shooting up) brings a host of risks and complications on top of the problems associated with use of the drug alone. These are some of the risks associated with injecting heroin:

  • Injection of heroin directly into the bloodstream triggers an immediate rush with no ability to moderate the dose. This means that if the heroin is cut with fentanyl, xylazine or another potent substance, the person will succumb to overdose before they have a chance to respond. 
  • Another grave risk associated with heroin injection comes with sharing needles and injection equipment with other users. This practice increases the risk of contracting blood-borne infections.[3]
  • Injecting heroin can damage a user’s veins. Repeated injections can cause veins to collapse, making it harder to find usable veins in the future and increasing the risk of infections and complications. Additionally, frequent puncturing of the skin at injection sites leads to scarring, which further harms the body.
  • As is often the case when injecting heroin, users may miss their intended vein and cause further issues. Missed veins may result in skin abscesses, infections or localized tissue damage, which may require medical treatment.

Long-Term Risks of Injecting Heroin 

These are some of the long-term issues associated with injecting heroin:

  • Physical health: Injection use of heroin can lead to respiratory issues, liver and kidney damage, heart infections and skin infections.
  • Vein damage: Repeated injections at the same site may cause veins to collapse, reducing circulation while increasing risk for infections and making it harder to find veins that are suitable for injection.
  • Scarring and abscesses: Heroin use may result in scarring at the injection sites as well as localized abscesses that fill with pus and require draining.
  • Tolerance and dependence: Over time, heroin use can result in tolerance, necessitating higher doses to achieve the same effects and ultimately leading to physical dependence and an OUD.[4]
  • Mental health issues: Long-term heroin use has the potential to cause cognitive impairments that increase over time, memory issues and a worsening of any underlying mental health conditions.
  • Social consequences: When heroin use turns into OUD, it becomes the priority to the exclusion of all else. As a result, relationships are damaged, financial insecurity takes over, employment is impossible and opportunities evaporate.
  • Overdose risks: Long-term heroin users face an increased risk of accidental overdose as their daily dose increases. Increased doses are associated with a higher risk of respiratory depression.

Increased Risk of Blood-Borne Diseases

Blood-borne infections are transmitted through direct contact with infected blood or body fluids. They are a particular threat to people who inject drugs like heroin, as sharing needles and equipment facilitates their spread.

These are some of the most commonly transmitted illnesses among those who inject heroin:

HIV (Human Immunodeficiency Virus)

HIV is a virus that assaults the body’s immune system, specifically CD4 T cells that play an integral role in protecting against infections.[5] As the immune system weakens, people become more prone to infections and cancers that require medical intervention. 

Sharing needles contaminated with HIV-infected blood puts individuals at risk of contracting the virus and eventually developing acquired immunodeficiency syndrome (AIDS).

Hepatitis B & C

Hepatitis B and C are viral infections that mainly affect the liver.[6] Most cases are acute, but chronic infections can be more serious. 

These viruses spread through infected blood, sexual contact or from mother to child during childbirth. Sharing contaminated needles increases the risk over time.

Chronic infections can lead to severe liver damage, cirrhosis and an increased risk of liver cancer.

Is There a Higher Risk of Overdose With Heroin Injection?

When injected directly into the bloodstream, heroin reaches the brain faster and all at once compared to taking the drug orally. Normally, the liver helps filter and process drugs taken orally, reducing their potency and delaying their effects, but injecting heroin bypasses this filtering process.

Heroin binds to opioid receptors in the brain that regulate pain and pleasure.[7] By doing so, it slows down the central nervous system, resulting in reduced breathing and heart rate. The body has protective mechanisms to prevent an excessive buildup of opioids in the brain, but injecting heroin overwhelms these defenses, leading to dangerous slowdowns in function that can be fatal.

The risk of overdose is higher with injected heroin because its potency and purity on the street varies widely. Users may unknowingly take larger and more potent doses than intended. This increases the likelihood of a life-threatening overdose.

How Bicycle Health Can Help

Injecting heroin can quickly lead to an opioid use disorder, which comes with significant risks. And each use of heroin could result in fatal overdose. 

However, there is hope for those with OUD. Medication for Addiction Treatment (MAT), using medications like Suboxone (buprenorphine and naloxone), can help individuals to safely stop all use of heroin for good.[8] With Suboxone, you can avoid the discomfort of withdrawal, when the risk of relapse is often highest, and maintain long-term recovery.

Bicycle Health is a top provider of MAT with extensive experience in helping people recover and live long, healthy lives in recovery. If you would like to learn more about the possibilities available to you through our program, contact us today. We’re ready to help you take the first step.

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. Substance use and co-occurring mental disorders. National Institute of Mental Health. Published March 2023. Accessed July 27, 2023.
  2. Jones C, Logan J, Gladden RM, Bohm M. Vital Signs: Demographic and substance use trends among heroin users — United States, 2002–2013. Centers for Disease Control and Prevention. Published July 10, 2015. Accessed July 27, 2023.
  3. Risk of HIV. Centers for Disease Control and Prevention. Published April 21, 2021. Accessed July 27, 2023.
  4. Kesten, J. M., Holder, E., Ayres, R., Ellis, P., Taylor, S., Hickman, M., & Henderson, G. Changes in the development of opioid tolerance on re-exposure among people who use heroin: A qualitative study. PLOS ONE. 2022;17(6).
  5. HIV. World Health Organization. Accessed July 27, 2023.
  6. Hepatitis B & C. Published September 20, 2022. Accessed July 27, 2023.
  7. Light — not pain killing drugs — used to activate brain’s opioid receptors. Washington University in St. Louis. Published April 30, 2015. Accessed July 27, 2023.
  8. Carroll JJ, Asher A, Krishnasamy V, & Dowel D. Linking people with opioid use disorder to medication treatment: a technical package of policy, programs, and practices. Centers for Disease Control and Prevention. Published 2022. Accessed July 27, 2023.

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