Heroin Addiction: Signs and Side Effects of Heroin Abuse

Heroin is an illicit opioid made from morphine, sometimes referred to by its chemical name, diacetylmorphine or diamorphine. The potency and contents of heroin vary greatly, which is part of the reason it can lead to addiction and have detrimental health effects.

Sometimes, it’s mixed with other opioids or fentanyl, which can increase the risk of overdose. There are several routes of use, such as smoking, snorting and injecting heroin. Faster routes, such as injections, are typically associated with higher risks of addiction.

Street names for heroin include:

• Dope
• Smack
• Horse
• H
• Brown sugar
• China white
• Black tar heroin

This comprehensive guide covers the ins and outs of heroin addiction, including why heroin can be addictive, the side effects of heroin abuse and how heroin addiction is diagnosed.

Heroin is known to lead to addiction in some people due to the way it affects the brain. Because heroin is made from morphine, it’s quickly converted to morphine in the body and activates the opioid receptors in your brain. When these receptors are activated, you may feel sensations such as euphoria, pain relief and deep relaxation.

Certain neurotransmitters, such as dopamine, also increase when you use heroin. Dopamine is part of your brain’s reward system, and this fast, intense reward can reinforce repeated heroin use and drive binge patterns.

With repeated use of heroin, the body starts to build up a tolerance to the substance. As your tolerance increases over time, you’ll need higher doses to feel the same effects. Taking higher doses can increase your risk of overdose and cause additional harm to your body.

Many people who use heroin may also find that certain triggers become tied to cravings for the drug. Stress, withdrawal discomfort, social environments and emotional escape can trigger people to use heroin to cope.

It can become increasingly difficult to quit using heroin over time, especially with repeated cycles of intoxication. The same goes for withdrawal, as it can cause a negative feedback loop.

Heroin abuse and heroin addiction are often used interchangeably, but they’re different. Key differences set them apart, although they aren’t entirely unrelated. Because heroin is an illicit drug, any heroin use is considered abuse. In other words, using heroin in ways that increase harm, such as frequent use, escalating doses, risky routes of use and continued use despite consequences, constitute abuse.

Heroin addiction is compulsive use. With addiction, people often experience psychological dependence, loss of control, cravings and continued use despite serious harm. In many cases, heroin abuse can increase the risk of heroin addiction.

Someone may start by using heroin occasionally but quickly shift to regular use and feel completely out of control. For some, this shift is due to using the drug to cope with stress, numb emotions or avoid withdrawal symptoms.

Heroin misuse can cause physical and psychological dependence. As your body adapts to regular opioid exposure, it can become physically dependent on heroin.

Essentially, the body learns to function with the presence of heroin and may start to rely on it. When drug use stops or drops, withdrawal symptoms occur as a response to the lack of opioids.

When you start to become psychologically dependent on heroin, you may notice cravings and compulsions to use the drug. People who are psychologically dependent may need heroin to feel normal, calm, emotionally steady or just to get through the day.

Dependence on heroin isn’t the same as addiction, but it’s certainly a cause for concern. Both physical and psychological dependence can signal a progressing problem that may eventually lead to addiction.

Signs of heroin addiction can help you identify a potential problem in yourself or others you may be concerned about. There are several physical, psychological and behavioral signs of heroin addiction. Some signs are easier to identify than others, especially when looking for signs in someone else.

Physical signs of heroin abuse include:

• Pinpoint pupils
• Drowsiness
• Slowed breathing
• Itching
• Nausea
• Constipation
• Nodding off

Psychological signs of heroin abuse include:

• Mood swings
• Irritability
• Anxiety
• Intense cravings

Behavioral signs of heroin abuse include:

• Behavior that’s out of character
• Secrecy
• Neglecting responsibilities
• Excessive spending
• Unsuccessful attempts to stop
• Risky behavior

Certain use patterns are also important to watch for, including escalating doses, frequent use to avoid withdrawal and mixing heroin with other substances.

People who are physically dependent on heroin often experience withdrawal symptoms between doses. Withdrawal symptoms occur when the nervous system rebounds after adapting to the effects of heroin.

Common heroin withdrawal symptoms include:

• Anxiety
• Restlessness
• Sweating
• Yawning
• Runny nose
• Watery eyes
• Muscle aches
• Joint pain
• Agitation

Late onset withdrawal symptoms include:

• Nausea
• Vomiting
• Diarrhea
• Abdominal cramps
• Chills
• Goosebumps
• Dilated pupils
• Insomnia
• Elevated blood pressure
• Tachycardia

Withdrawal from heroin can vary in intensity and duration based on the individual.

How you experience withdrawal may depend on:

• Typical dose
• Frequency of use
• Duration of use
• Polysubstance use
• Overall health

For most people, withdrawal starts 6 to 24 hours after the last dose of heroin. Symptoms tend to peak between 24 and 72 hours and can last from 5 days to a week. However, sleep disturbances, mood changes and cravings can last for several weeks.

Heroin abuse can cause an array of short-term and long-term side effects. Long-term effects are most likely to occur with repeated substance abuse over an extended period of time.

The side effects you experience shortly after heroin use are considered short-term side effects. These effects tend to fade over time.

Short-term side effects of heroin include:

• Feelings of euphoria
• Heavy sedation
• Impaired judgment
• Slowed breathing
• Low blood pressure
• Nausea
• Constipation
• Warm skin flushing
• Dry mention
• Itching

With long-term use, there’s a greater risk of long-term side effects. These side effects can have a lasting impact on your health and lead to bigger issues down the road.

Long-term side effects of heroin include:

• Collapsed veins and injection injuries
• Nasal damage from snorting
• Lung irritation from smoking
• Abscesses
• Endocarditis
• Increased risk of HIV, hepatitis B and hepatitis C with needle sharing
• Sexual dysfunction
• Irregular menstrual cycles
• Insomnia

The effects of heroin on the brain can also impact your mental health. Even cognitive function may also be affected by long-term heroin abuse.

Mental and cognitive side effects include:

• White matter deterioration
• Impaired decision-making abilities
• Decreased ability to regulate behavior/responses to stress
• Confusion
• Mood instability
• Depression symptoms
• Slowed thinking

One of the most damaging long-term side effects of heroin use is the risk of overdose. A heroin overdose is a medical emergency that requires immediate attention. If you suspect an overdose, call 911 right away.

Heroin overdose side effects include:

• Severe respiratory depression
• Unconsciousness
• Blue lips or fingertips
• Coma
• Permanent brain damage
• Death

Heroin is a Schedule I drug, meaning it has a high potential for abuse and addiction. For that reason, anyone who uses heroin may be at risk for developing heroin use disorder, although some people may have an increased risk due to certain factors.

Exposure and access to opioids can increase your risk of heroin addiction. For example, people who have a history of prescription opioid misuse, a higher opioid tolerance or have progressed from other opioids to heroin may be more likely to become addicted.

Many people with these mental health disorders may use heroin to self-medicate and cope with symptoms:

• Anxiety
• Depression
• History of trauma
• Chronic stress

You may also be at higher risk for heroin addiction based on social factors. Unstable housing, high-risk peer networks, limited support and community drug availability can encourage use that later leads to addiction.

Behaviors surrounding heroin are another risk factor. Using opioids to cope with stressors, polysubstance use and impulsivity may lead to habitual use.

In some environments, heroin use may be normalized or easy to access, which can encourage abuse. Financial instability can also increase risk, as heroin is much cheaper than other opioids on the street.

Heroin addiction is a chronic condition that requires professional diagnosis and treatment. If you suspect you or a loved one is facing heroin addiction, seek a proper medical evaluation.

Because heroin is an opioid, heroin addiction falls under the category of opioid use disorder (OUD). To diagnose OUD, your doctor will ask questions about your heroin use. Some of these questions may come from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which offers guidelines to identify patterns of use that indicate addiction.

The following criteria have been quoted directly from the DSM-5:

1. “Opioids are often taken in larger amounts or over a longer period of time than
   • intended.
2. There’s a persistent desire or unsuccessful efforts to reduce or control opioid
   • use.
3. A great deal of time is spent trying to obtain the opioid, use the
   • opioid or recover from its effects.
4. Craving, or a strong desire to use opioids.
5. Recurrent opioid use results in failure to fulfill major role obligations at work,
   • school or home.
6. Continued opioid use despite having persistent or recurrent social or
   • interpersonal problems caused or exacerbated by the effects of opioids.
7. Important social, occupational or recreational activities are given up or reduced
   • because of opioid use.
8. Recurrent opioid use in situations in which it is physically hazardous
9. Continued use despite knowledge of having a persistent or recurrent physical or
   • psychological problem likely caused or exacerbated by opioids.
10. Tolerance, as defined by either of the following:
    • (a) a need for markedly increased amounts of opioids to achieve intoxication or
    • desired effect
    • (b) markedly diminished effect with continued use of the same amount of an opioid
11. Withdrawal, as manifested by either of the following:
    • (a) the characteristic opioid withdrawal syndrome
    • (b) the same (or a closely related) substance is taken to relieve or avoid
    • withdrawal symptoms”

In addition to pattern use assessment, you can expect to receive a mental health screening. Your risk of overdose and infectious disease may also be evaluated.

After the assessment, your doctor may be able to determine the severity of your addiction. From there, they may recommend certain treatment methods.

Heroin is a dangerously addictive opioid that can have a detrimental effect on the body, mind and overall well-being. Opioid addiction can happen to anyone exposed to opioids and is not a personal failure or something to be ashamed of.

Withdrawal symptoms, escalating use, risky use and overdose scares are all warning signs that intervention may be needed. If you notice these red flags, consider reaching out for professional support.

Help.org is a free, confidential resource available to help you find heroin addiction treatment based on your needs, preferences and location.