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Is Heroin a Gateway Drug?

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Aug 14, 2023 • 11 cited sources

A gateway drug is not a medical term, but more of a colloquial term. It usually refers to any substance whose use can ultimately lead to misuse of other “more dangerous” substances.[1]

It is hard to define whether or not heroin can be defined as a “gateway” drug. On one hand, Heroin is considered to be a highly addictive and dangerous drug already, with no accepted medical use. So if one is using it, they are already “past the gateway” in some sense. 

On the other hand, it could be considered a “gateway” drug for even more dangerous or potent drugs such as fentanyl. Additionally, intranasal heroin can be considered a “gateway” to intravenous drug use, which can itself have a number of unique risks.

How Has Heroin Become a Gateway Drug in Recent Years?

Heroin could be considered a “gateway” drug toward use of more dangerous substances such as fentanyl. People often start using heroin for a few reasons, including: 

  • Barriers to getting pain medications: The over prescription and misuse of prescription opioids led to changes in law that make it difficult for patients to get opioid prescription refills, which means that many patients are unable to get pills.[3] For patients who developed a dependence on opioids through a prescription and now find it difficult to manage that opioid use disorder (OUD) through prescriptions alone, heroin may seem like the only option to avoid withdrawal.
  • High cost of prescription opioids: Heroin is relatively cheap compared to prescription pills. Thus, some individuals purchase it because it is cheaper and easier to obtain than prescription pain killers. [2] 
  • Lack of education: Despite the ongoing efforts to communicate the risks of opioid use, many patients are still uneducated about or unaware of the risks of long term use of these substances and may not adequately appreciate the dangers of their recreational use. 
  • Mental health issues: Underlying mental health issues or illnesses may drive individuals to self medicate with substances including heroin. 

Heroin Use Statistics & Data

  • Among Americans over the age of 12, about 1.1 million reported past-year use of heroin, according to the 2021 National Survey on Drug Use and Health, and about 1 million people in that age group were living with a heroin use disorder.[8]
  • Narcan, also known as naloxone, is a drug that can reverse a heroin overdose and save lives. As of 2014, nearly 27,000 lives were estimated to be saved with Narcan kits passed out to friends and family members of people living with an opioid use disorder.[10]

Change in Heroin Use: Cause & Effect

Heroin use in the United States has changed over the last few decades. The drug has become increasingly more addictive to users as potency levels have increased. It is also progressively more available and in demand due to the highly addictive nature of the drug and decreased access to prescription opioid medications. 

A few of the changes in heroin use over the past decades include the following: 

  • Increase in use: The number of people using heroin in the United States has increased significantly in recent years, particularly among young adults and those who may have previously started with use of prescription opioids. 
  • Shift in demographics: Heroin use has shifted from primarily urban, inner-city populations to suburban and rural areas, thanks to the prolific use of prescription painkillers followed by a pullback on accessibility to those medications. 
  • Emergence of heroin from new sources: Heroin is available in black tar form and as a brownish white powder. Different forms now come from South America, Mexico, Afghanistan or Asia. 
  • Increase in treatment admissions: The number of individuals seeking treatment for heroin use has also increased, reflecting the growing impact of the drug on individuals and their families and an understanding of the deadly nature of addiction to the drug.

These changes demonstrate the ongoing challenges posed by heroin use and the need for continued efforts to address the issue and provide support to those who need it. If you’ve been using heroin and can’t stop, reach out for help today. With medications, therapy and professional help, you can leave heroin use in your past.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. Gateway drug Definition & Meaning. Merriam-Webster. January 2023. Accessed January 2023.
  2. Prescription Opioids and Heroin Research Report: Heroin Use Is Driven by Its Low Cost and High Availability. National Institute on Drug Abuse. January 2018. Accessed January 2023.
  3. States Likely to Resist CDC Proposal Easing Opioid Access. PEW Trust. March 2022. Accessed January 2023.
  4. Heroin. U.S. National Library of Medicine. May 2021. Accessed January 2023.
  5. Heroin Overdose Data. Centers for Disease Control and Prevention. June 2022. Accessed January 2023.
  6. Heroin. United Nations. Accessed January 2023.
  7. 2019 National Drug Threat Assessment. Drug Enforcement Administration. December 2019. Accessed January 2023.
  8. 2021 NSDUH Annual National Report. Substance Abuse and Mental Health Services Administration. January 2023. Accessed January 2023.
  9. Heroin Fast Facts. National Drug Intelligence Center. Accessed January 2023.
  10. Opioid Overdose Prevention Programs Providing Naloxone to Laypersons — United States, 2014. Centers for Disease Control and Prevention. June 2015. Accessed January 2023.
  11. Fentanyl Facts. Centers for Disease Control and Prevention. February 2022. Accessed January 2023.

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