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What Makes Heroin So Addictive?

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

With repeated use, heroin changes the brain, making it incredibly difficult to quit using the drug. Treatment programs can help, particularly those that involve Medication for Addiction Treatment (MAT). 

Heroin use more than doubled among people ages 18 to 25 between 2002 to 2013.[1] Some of that growth could be attributed to prescription painkiller misuse. 

People who misuse painkillers often transfer to heroin as it’s chemically similar to opioids but cheaper, easier to obtain, and more powerful. But heroin can be incredibly dangerous, in part, because it’s so addictive. 

Heroin molecules link to brain receptors in seconds, triggering an intense, memorable high. Some people spend the rest of their lives chasing that feeling, even though they may never experience it again.

What Is Heroin?

Heroin is an opioid drug derived from poppy plant seed pods.[2] Most heroin is manufactured in other countries, including China, Mexico and Columbia. It’s smuggled into this country through sophisticated pipelines and sold to dealers for on-the-street sales. 

Pure heroin is rare, as dealers often mix the substance with heavier powders (like talc) or stronger drugs (like fentanyl). Since the manufacture of this drug is unregulated, buyers can’t know the purity or strength of the doses they take. 

Heroin powder can be sniffed or snorted through the nasal passages, where it enters the bloodstream and the brain. Users can also add water to the powder, creating a heroin solution to inject into the bloodstream with a needle. 

Understanding the Heroin High 

People who use heroin describe a rush of pleasurable sensation taking hold very quickly after they use the drug.[3] Chemical changes inside the brain are responsible for those feelings.

Heroin molecules latch to opioid receptors in the brain, triggering a release of dopamine. This neurotransmitter is often called the “feel good chemical,” as brain cells release it in response to pleasurable stimuli, like good food or a favorite song on the radio. The amount of dopamine release from an injection of heroin is larger and more intense than most people have ever felt. 

When the initial rush wears off, heroin users feel relaxed, warm and sleepy. They may drift in and out of consciousness for several hours while they rest in a state that feels safe and secure.

Heroin’s high is strongest the first time someone uses heroin. Brain cells adjust their dopamine release, so the next dose won’t cause such intense changes. 

But people remember that initial high, and sometimes, they spend the rest of their lives trying to recreate it. This often leads people to take increasingly higher doses of heroin, thinking that a higher dose will finally bring the same rush that initial use did. This can eventually lead to overdose, which can be fatal. 

Why & How Is It So Addictive?

Heroin’s high is responsible for experimentation and repeated use. But opioid use disorder (OUD) is a much more complicated condition, and heroin seems capable of triggering it. 

Addiction is defined as compulsive use despite negative consequences.[4] People with addiction keep using heroin even after experiencing issues, such as these:

  • Job loss
  • Physical illness
  • Homelessness
  • Loss of child custody 

While the initial decision to use heroin is voluntary, people with addictions have experienced persistent brain changes that limit their ability to make the decision to resist drugs.[5]

Since heroin is so powerful and capable of delivering intense changes in seconds, it can do severe damage to many different parts of the brain. People who use heroin repeatedly can no longer resist the urge to use. Chronic heroin use changes the brain in such a way that it becomes extremely challenging to stop using the drug. 

How Does Heroin Impact the Brain?

Researchers say repeated heroin use changes both the physical structure and the physiology of the brain. Portions of the brain responsible for decision-making and restraint are shrunken or damaged. The result is a brain less capable of resisting the urge to use drugs.[6] 

Doctors can see some of these changes on brain scans, but a person’s behavior is often a better indicator of an addiction. People hooked on heroin may tell their doctors they want to quit, and they may even try sobriety, but they return to heroin repeatedly. 

Anyone who uses heroin repeatedly can develop these changes. And genetics and environment can make some people experience damage quicker than others do. 

Getting Help for Heroin Addiction 

Experts consider addiction a chronic condition.[7] Treatment programs can keep symptoms in remission. But brain changes caused by drug misuse can persist, and without ongoing treatment, they can entice people to slide back into heroin use. 

Medication for Addiction Treatment programs use medications like Suboxone to address brain chemical imbalances caused by drugs. People with a history of heroin use don’t feel high while using these medications as prescribed. Instead, they feel calm and focused, allowing them to work on building a sober life.

Recovery may have felt impossible while in active heroin addiction, but MAT makes it possible.[8] The patient doesn’t experience withdrawal symptoms or cravings for heroin while taking Suboxone. Instead, they feel more normal, and they are able to focus on other aspects of recovery.

Therapy is an important part of MAT programs. Researchers know that people who feel self-sufficient and capable of dealing with daily challenges are more likely to stay sober.[9] Therapy can help teach people these skills. And therapists can provide ongoing care to help people deal with new issues that arise later in sobriety.

If you’re using heroin, talk with your doctor about whether MAT programs are right for you, or reach out to us here at Bicycle Health. With the right support, you can stop using heroin and begin to build a better life in recovery.

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. Today's Heroin Epidemic. Centers for Disease Control and Prevention. July 2013. Accessed March 2023.
  2. Heroin Drug Facts. National Institute on Drug Abuse. December 2022. Accessed March 2023.
  3. What Are the Immediate (Short-Term) Effects of Heroin Use. National Institute on Drug Abuse. June 2018. Accessed March 2023.
  4. Can Using Heroin Once Make You Addicted? Drug Policy Alliance. Accessed March 2023.
  5. Understanding Drug Use and Addiction Drug Facts. National Institute on Drug Abuse. June 2018. Accessed March 2023.
  6. What Are the Long-Term Effects of Heroin Use? National Institute on Drug Abuse. June 2018. Accessed March 2023.
  7. Treatment and Recovery. National Institute on Drug Abuse. July 2020. Accessed March 2023.
  8. Linking People With Opioid Use Disorder to Medication Treatment: A Technical Package of Policy, Programs, and Practices. Centers for Disease Control and Prevention. March 2022. Accessed March 2023.
  9. Predicting Long-Term Stable Recovery From Addiction: Findings From a 33-Year Follow Up Study. Journal of Addictive Diseases. 2007. Accessed March 2023.

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