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Is It Possible to Be a Functional Heroin User?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Jan 14, 2024 • 9 cited sources

Yes, it is possible to be ‘functional’ while sometimes using heroin. However, even if a person using heroin functions adequately in certain areas of life for a period of time, there is always the risk of decompensation in the future. This means that they may be unable to maintain functioning and coping skills and may experience significant distress, anxiety, depression and other disturbances as their heroin addiction progresses.

In addition, heroin overdose is always a potential risk, especially since dealers often cut heroin with deadly opioids like fentanyl and carfentanil, and this can lead to death.[1]

Defining “Functional” Heroin Use

More than 10 million people misused an opioid in 2019 and about 745,000 of them used heroin. About 438,000 of these people were living with an active addiction to the drug, but it is not as easy to nail down how many people were living with a heroin addiction while still remaining functional.[2] Why? 

Functional Heroin Users Don’t Resemble the Stereotype 

Much like a person with alcohol use disorder who is high-functioning, the term functional heroin user describes an individual using heroin without it having significant impacts on their life. They may be getting along well with their loved ones, caring for dependents, working, etc. 

A functioning person with heroin addiction may be someone whom you would never think of as having an addiction. They might be your neighbor, sit near you in church, or be the parent of your child’s friend. 

They do not meet the stereotype of a person using heroin that is portrayed in the media. That is, they are not homeless, jobless or committing crimes to support their addiction. They have not been abandoned by their families due to their ongoing heroin use. And often, their heroin use, which may have begun due to experimentation or an opioid prescription, is now characterized by using just enough to maintain normalcy and avoid withdrawal symptoms.

Functioning Often Depends on the Loved Ones 

While some people misuing heroin may believe that they are functioning well in every area of life, often that “functioning” depends on the people around them—friends, family members, and colleagues—who accommodate or enable the addiction.[3]

Experts say that an individual may believe they are high-functioning because of their own ability to control their heroin use and uphold their lives, but often, it is their loved ones maintaining this facade. And when their loved ones decide to stop enabling, often functioning decreases dramatically.[3]

Currently Functioning vs. Functional Heroin User

In spite of this apparent functioning, heroin use still poses enormous risks. There will likely come a time when their use will escalate and they will no longer be able to function, or they will experience an overdose. 

Thus, anyone using heroin – “functional” or not – warrants help to discontinue use. At the end of the day, functional heroin addiction is still an addiction, and addiction is progressive, meaning it gets worse over time. This is why some experts prefer to say “currently functioning” with an addiction. [3]

Am I a Functioning Heroin Addict?

Denial, the illusion of control and hiding heroin use are hallmarks of functional heroin addiction. If you find yourself denying that you have a problem or that your heroin use is an issue then you might have a functional heroin addiction. 

Here are some signs you may be a functional heroin user:

  • You see no issue with your heroin use because of the lack of consequences.
  • You’ve convinced yourself you don’t have a heroin addiction because your use doesn’t disrupt your work or home life.
  • You justify your use because of a medical issue it helps, such as chronic pain.
  • You justify your use as a way to simply stave off heroin withdrawal symptoms.
  • You experience strong cravings for heroin.
  • You have had to increase your heroin dose over time to keep withdrawal symptoms at bay.
  • Being unable to travel because you need to stay close to your dealer.
  • Hiding your heroin use from loved ones and colleagues.
  • Performing exceptionally at work because you know you need the money for heroin.

Denial and hiding heroin use are hallmarks of functional heroin addiction.

How to Tell if Your Loved One Might be a “Functional” Heroin User

If you think your loved one might be using heroin but appears to function in life overall, ask yourself these questions:

  • Has your loved one exhibited significant changes in appearance, hygiene, style of dress, and diminished self-care? 
  • Does your loved one often disappear for long periods of time without explanation or without a good explanation?
  • Is your loved one evasive when you ask questions about money they’ve spent or the people they text or talk to on the phone?
  • Are you finding out things about your loved one from other people, such as problems at work, issues at the bank, or unpaid bills? 
  • Does your loved one often seem sick or tired, exhibiting symptoms of the flu when no one else seems to be ill? 
  • Has your loved one lost a lot of weight suddenly? Do they often have pinpoint pupils or seem to “nod out” while talking to you or spending time with family? 
  • Does your loved one seem reserved and isolated from the family and generally disinterested in what’s happening with other people? 
  • Have you ever found secret hiding places where things like burnt spoons, syringes, cookers, or cottons are stashed? 
  • Have you noticed changes in physical appearance like decreased hygiene?
  • Have you noticed money missing that your loved one doesn’t have an explanation for?

If you answered “yes” to some of these questions, heroin use might be to blame.

Long-Term Consequences of Functional Heroin Use

Even if a person is able to maintain a relatively functional level of heroin use for an extended period of time, they will still experience the harmful physical and mental health effects of long-term heroin use. 

Some of these risks of chronic heroin use include:[4],[5]

  • Erectile dysfunction
  • Infertility
  • Reduced libido
  • Osteoporosis
  • Fractures
  • Depression
  • Suicidality
  • Sleep-related breathing problems
  • Increased sensitivity to pain
  • Suppressed immune system
  • Bowel obstruction
  • Chronic constipation
  • Heart attack
  • Increased risk of overdose

Other harmful effects depend on how someone may be using heroin. For example, snorting heroin can lead to chronic sinusitis, severe nasal damage and even a hole in the nasal septum.[5]

Meanwhile, injecting heroin can cause a myriad of harms, including:[5]

  • Abscesses and track lines
  • HIV and hepatitis
  • Cellulitis
  • Collapsed veins
  • Bacterial infection of the heart
  • Tuberculosis

The Risk of an Overdose

One of the biggest risks of continued heroin use is that of tolerance and overdose. Tolerance develops over time, which means that people need higher and higher doses of heroin to experience desired effects. And if they are simply using it to alleviate withdrawal symptoms, they will need ever-growing doses to achieve this. 

As a person with functional heroin addiction continues to use higher doses, their risk of experiencing an overdose increases. This is particularly true for heroin because it’s illegal and the only place to purchase it is on the street—which means it’s unregulated and may be cut with dangerous drugs like carfentanil and fentanyl. 

And while harm reduction techniques like fentanyl test strips can help keep people safe, some high-functioning users may not have the time or motivation to use these tests, especially if they are sneaking off to the bathroom to use heroin.

Signs of a Heroin Overdose

A heroin overdose is a life-threatening medical emergency that causes severe respiratory depression. Here are the signs of a heroin overdose: [6]

  • Clammy, pale skin
  • Slowed or stopped heartbeat
  • Slowed or stopped breathing
  • Purple or blue lips or fingernails
  • Limp body
  • Vomiting or making gurgling noises
  • Inability to speak
  • Inability to be awakened
  • Coma

If you suspect someone has overdosed, call 911 immediately and stay by their side. If you have naloxone (Narcan) available, administer that in order to reverse the effects of an opioid overdose.

Heroin Addiction is a Progressive Condition

Heroin addiction, or heroin use disorder, is a progressive condition. People can be diagnosed with a mild, moderate or severe addiction, based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 

However, if they don’t get treatment and continue to use heroin, a mild addiction can become moderate and then severe. Because it’s a progressive condition, it worsens over time, causing more and more impairment and dysfunction. 

While someone may be able to function at work, home or school now, it may not always be that way. They may find that their heroin use has gotten out of control and is now affecting various parts of their life.

Moreover, heroin addiction is affected by stressors and major life events. If a functional heroin user loses their job, then they won’t be able to afford heroin or other opioids anymore and this could have catastrophic consequences. 

Maintaining Confidentiality When Seeking Treatment

Privacy and confidentiality are often top priorities for functional heroin users seeking addiction treatment. This may be because they are in a high-powered career and are worried about stigma, discrimination and reputation. 

Thankfully, there are several laws that help keep medical records private and rehab confidential. Having peace of mind can help encourage a person to seek treatment.

HIPAA and Protected Patient Information

Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law created to protect patient medical information from being shared without their knowledge or consent. Moreover, HIPAA includes security rules around protected health information in health records. This information may include health status, demographics, rehab location and beyond.

This means that no one will find out about a person’s heroin addiction treatment without their consent, and they are able to keep this information private.

Confidential Drug Rehab

People seeking treatment for heroin use disorder have protections in place thanks to the Code of Federal Regulations Title 42 Part 2. This law protects a patient’s addiction diagnosis and treatment information, which can’t be shared without consent. 

At Bicycle Health, we guarantee confidentiality when receiving opioid use disorder treatment through our online provider. We will never disclose your information without your consent. Additionally, we are committed to top-notch telehealth security. All of our communication occurs via our password-protected phone application. Our Zoom rooms are password-protected and are never recorded, and our data is encrypted to ensure confidentiality.

Treatment Options for a High-Functioning User

Treatment for anyone living with a heroin use disorder will include a number of different components: [7],[8],[9]

  • Medication such as Suboxone (buprenorphine/naloxone), Sublocade, or methadone
  • Medication to address other underlying medical and/or mental health conditions
  • Personal therapy to talk through underlying issues and get to the triggers behind substance misuse 
  • Family therapy to rebuild trust in relationships and help children work through their experience
  • Support groups to connect the individual with people who also struggle with heroin use and are working toward recovery, such as Narcotics Anonymous or SMART Recovery

One of the concerns of functional heroin users is that their condition is usually unknown by their friends and family and their employers and they may fear that seeking treatment will mean they have to reveal their condition. Measures can be taken to ensure discretion when seeking help. If you have concerns about keeping a heroin use disorder private, ask for help in maintaining confidentiality. Concerns about confidentiality should never be a barrier to getting the help you need. 

The important thing for individuals with functional heroin use is to prevent progression to non-functional heroin use. There is hope in recovery for functional heroin users.

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. Inside the Secret Lives of Functioning Heroin Addicts. CNN. February 2018. Accessed April 2022.
  2. Key Substance Use and Mental Health Indicators in the United States: Results From the 2019 National Survey on Drug Use and Health. September 2020. Accessed April 2022. 
  3. Glauser W. “High-functioning addicts”: intervening before trouble hits. CMAJ. 2014;186(1):19. doi:10.1503/cmaj.109-4667
  4. Von Korff M, Kolodny A, Deyo RA, Chou R. Long-term opioid therapy reconsidered. Ann Intern Med. 2011;155(5):325-328. doi:10.7326/0003-4819-155-5-201109060-00011
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  6. Opioid Overdose. Substance Abuse and Mental Health Services Administration. December 2023. Accessed December 2023. 
  7. Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration (SAMHSA). March 2022. Accessed April 2022. 
  8. Drug Facts: Treatment Approaches for Drug Addiction. National Institute on Drug Abuse. January 2019. Accessed April 2022. 
  9. SMART Recovery. Accessed April 2022.

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