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Heroin Overdose | All You Need to Know

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Oct 4, 2023 • 13 cited sources

Heroin overdose is a serious health threat to those who use the drug in any amount or capacity. According to data compiled by the National Center for Health Statistics (NCHS), as of 2021, there were approximately 9,137 drug overdose deaths connected to the use of heroin.[1] 

Due to its highly addictive nature and its ability to suppress the central nervous system, using any amount of the drug can lead to fatal overdose. Any level of use should be addressed proactively. 

What Is an Overdose?

An overdose is a medical emergency that occurs when someone consumes or is exposed to so much of any substance — drugs, alcohol or any substance — that their  normal physiological processes are overwhelmed to the point that medical intervention is required.[2] In most cases, if medical assistance is not received in time, death can occur. 

Heroin Overdose Data

Research shows variations in sex, age, behaviors and geographic regions when it comes to heroin overdose.


Men have a two to three times higher overdose mortality rates when using opioids such as fentanyl and heroin.[3] 


From 1999 to 2019, people between the ages of 35 and 54 had the highest rates of heroin use and overdose among all age groups in the U.S.[4] 

This may be surprising to some who believe that overdose risks should be higher among younger users, but the fact is that physiology becomes more volatile with long-time heroin use. As daily dose averages rise with ongoing use, these two factors together can mean an increased risk of heroin overdose. 


Individuals at risk of heroin overdose often exhibit certain recognizable patterns of behavior, including frequent and consistent heroin use at increasingly higher doses. Many also engage in the risky practice of mixing heroin with alcohol, benzodiazepines, or cocaine, which further increases the likelihood of overdose. 

In 2020, more than 19% of opioid overdose fatalities were linked to heroin.[5]

Geographic Regions

The opioid epidemic has negatively impacted almost every region in the United States, with some experiencing higher heroin overdose death rates than others. For example, states in the northeastern and midwestern regions saw high heroin overdose deaths compared to other regions of the country.[6]

Use of the drug moved from being primarily a problem affecting inner-city areas to a problem hitting the suburbs and rural regions as well. 

Symptoms of Heroin Overdose

The symptoms of a heroin overdose include physical, behavioral and psychological indications.[7-9]

Physical SymptomsBehavioral SymptomsPsychological Symptoms
Slow or shallow breathing Gasping for breath or difficulty breathingSevere drowsiness or sedation 
Choking or gurgling soundsUnable to speak clearly or coherentlyConfusion or disorientation
Blue lips or fingertips (cyanosis)Extreme dizziness or loss of balanceHallucinations or delirium
Cold, clammy skinImpaired coordination or stumblingEuphoria or extreme calmness
Weak or erratic pulseLoss of consciousness or unresponsivenessFeelings of anxiety or panic
Low blood pressureAgitation or restlessnessDepersonalization (feeling detached)
Faint heartbeat or cardiac arrestSweating profuselySlurred speech
Nausea or vomitingPacing or inability to sit still
ConstipationPinpoint pupils (very small pupils)
Drowsiness or nodding offItching or scratching
Confusion or disorientationNeglecting personal hygiene
Coma or unresponsive stateLoss of consciousness or unresponsiveness
Slow reaction times

Dangers of Heroin Cut With Fentanyl

Fentanyl is a synthetic opioid that is highly potent, estimated to be about 50 to 100 times stronger than morphine and about 50 times stronger than heroin.[10] 

The addition of fentanyl to heroin significantly increases the risk of overdose and death. Very small amounts of fentanyl can be lethal, and users usually don’t know if fentanyl is in the heroin they are using or how much is in a dose. 

The dangers of heroin cut with fentanyl include the following:

Increased Potency

Fentanyl is so potent that even a small amount mixed with heroin can lead to a significantly more powerful product. Users who are accustomed to a certain heroin dose may unknowingly take a lethal amount of fentanyl-laced heroin due to the increased potency.

Overdose Threat

Fentanyl suppresses the central nervous system just like heroin does, which can mean almost instant respiratory depression that is fatal.[11] The margin between a therapeutic dose and a lethal dose is incredibly narrow, making overdose highly likely since users are simply guessing at how much is a “normal” dose. 

Detection Difficulties

While there are test strips on the market that can help people detect the presence of fentanyl in any given batch of heroin sold on the street, these tests are not widely available. There is also the chance that the small amount of heroin used for a test simply doesn’t contain fentanyl, while it is elsewhere in the batch.

Threat to First Responders

Fentanyl is not only dangerous for the person using the drug. It potentially poses a threat to anyone who comes into contact with it, including first responders and law enforcement who may arrive on the scene of an overdose. Contact with the skin or accidentally breathing in the drug because it is in the air could trigger an overdose in those trying to help the person in crisis. 

What to Do if Someone Is Overdosing on Heroin

In recent years, there has been an upsurge in opioid-related deaths due to an increase in the amount of fentanyl-laced heroin being sold on the street. This issue underscores the importance of better access to harm reduction programs, including opioid overdose reversal drugs like Narcan (naloxone) and treatment. Naloxone is a life-saving drug that can quickly reverse an opioid overdose if administered in time.

If you suspect that someone is overdosing on heroin, immediate action can save their life. Follow these steps:

  • Call 911.
  • Stay calm, and assess their responsiveness.
  • Check their breathing.
  • Administer naloxone (Narcan).[12]
  • Place the person onto their side.[13]
  • Stay with the person.
  • Provide information to first responders as needed.

Finding Hope With Bicycle Health

At Bicycle Health, we offer effective treatment for opioid use disorder (OUD) related to heroin use through the use of Suboxone, a medication-based therapy that significantly reduces the risk of overdose and helps to manage OUD. 

Our caring team at Bicycle Health provides personalized care and counseling, aiming to help individuals break free from heroin use and achieve long-lasting recovery. Call now to get more information.

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 overdose death rates. National Institute on Drug Abuse. Published June 30, 2023. Accessed July 27, 2023.
  2. Overdose. A.D.A.M. Medical Encyclopedia. Published January 2, 2023. Accessed July 27, 2023.
  3. Men died of overdose at 2 to 3 times greater a rate than women in the U.S. in 2020 – 2021. National Institutes of Health. Published June 14, 2023. Accessed July 27, 2023.
  4. Heroin overdose. A.D.A.M. Medical Encyclopedia. Published July 20, 2021. Accessed July 27, 2023.
  5. Heroin. Centers for Disease Control and Prevention. Published May 23, 2022. Accessed July 27, 2023.
  6. D’Orsogna MR, Böttcher L, Chou T. Fentanyl-driven acceleration of racial, gender and geographical disparities in drug overdose deaths in the United States. PLOS Global Public Health. 2023;3(3). doi:10.1371/journal.pgph.0000769
  7. Heroin. Better Health Channel. Published August 12, 2022. Accessed July 27, 2023.
  8. Schiller EY, Goyal A, Mechanic OJ. Opioid overdose. StatPearls Publishing. Published April 29, 2023. Accessed July 27, 2023.
  9. Opioid overdose symptoms. Get Smart About Drugs. Published November 30, 2021. Accessed July 27, 2023.
  10. Fentanyl facts. Centers for Disease Control and Prevention. Published June 27, 2023. Accessed July 27, 2023.
  11. Zaig S, da Silveira Scarpellini C, Montandon G. Respiratory depression and analgesia by opioid drugs in freely behaving larval zebrafish. eLife. 2021;10. doi:10.7554/eLife.63407
  12. Opioid overdose prevention toolkit. Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed July 27, 2023. 
  13. Preventing an opioid overdose. Centers for Disease Control and Prevention. Accessed July 27, 2023.

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