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Symptoms and Signs of Heroin Use & Addiction

Heroin is a highly addictive, illicitly manufactured opioid drug. In 2020, heroin was used by an estimated 900,000 people in the U.S. within the prior 12 months.1 In that same year, around 691,000 people ages 12 and older in the U.S. had a heroin-related substance use disorder.1

If you or your loved one is struggling with heroin use or addiction, this page will help you learn more about what heroin is as well as signs someone is using heroin. You can also learn more about what to do if you or your loved one is dealing with heroin use and find the best treatment program for your situation.


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Heroin Use and Abuse

Heroin is an opioid drug manufactured from morphine, a naturally occurring opiate alkaloid substance extracted from the opium poppy plant.2 Heroin is commonly encountered in one of 2 forms: as a powder, which can be brown or white; or a gummy substance sometimes known as black tar heroin.2 The street supply of heroin is commonly mixed with other drugs or cut with substances such as starches or sugar.3

Heroin can be used via several routes of administration. People will sometimes snort heroin or smoke it. Frequently, people using heroin will dissolve the drug into solution for needle use.3 Some people who inject heroin mix it with cocaine, which is a practice sometimes referred to as speedballing.2

When people use heroin, it quickly binds to and activates certain opioid receptors in the brain, resulting in alterations in pain perception, physiological changes such as drowsiness and slowed breathing, and an accompanying sense of reward.2 People who use heroin may experience a reinforcing, euphoric rush from the drug.3

Heroin and the Prescription Opioid Epidemic

It is not really possible to talk about current rates of heroin use without mentioning the potential impact of the prescription opioid epidemic. Factors such as misinformation about their addictive potential, and the resultant over-prescribing practices of pharmaceutical opioids—such as hydrocodone and oxycodone—contributed to widespread diversion and dangerous non-medical misuse. This in turn helped fuel an epidemic of prescription opioid addiction and overdose.

Prescription opioid use is a risk factor for heroin use as the misuse of prescription opioids may lead to heroin use.2 For people who have used heroin, many have reported that they first misused prescription opioids (although the percentage of people who move to heroin is small).2

As efforts have been made to limit the number of opioid painkiller prescriptions, the supply of heroin has increased. Reports indicate that people may have begun to transition from prescription opioid use to heroin use because of the latter being cheaper and more readily available, in addition to providing a subjectively better high.4


Potential Signs of Heroin Addiction

Some people who use heroin go on to develop a heroin addiction, which may be diagnosed as an opioid use disorder (OUD)—one of several subtypes of substance use disorders. A substance use disorder (SUD) is a pattern of compulsive use of a substance despite the substance use causing serious consequences to a person.5

The signs and symptoms of heroin use and addiction may vary somewhat from one person to the next. However, while there may be some variability, there are some characteristic physical and behavioral changes that doctors and other treatment professionals may look for to make an official diagnosis of opioid addiction.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is used by psychiatrists and other healthcare professionals to diagnose mental health issues, outlines the aforementioned signs, symptoms, and behavioral changes that may be used to make an OUD diagnosis. Some potential signs of heroin addiction can include:

  • Taking more heroin than they originally intended to
  • Making unsuccessful attempts to stop using heroin or cut back on use
  • Using a good deal of time and resources to get heroin, using it, and recover from using
  • Having cravings to use heroin
  • Neglecting duties at work, school, or home as a result of heroin use
  • Using heroin despite negative social or interpersonal consequences related to its use
  • Giving up things the person once valued or enjoyed and using heroin instead
  • Using heroin in high-risk situations, such as driving
  • Using heroin, even when the person knows it makes a psychological or medical issue worsen
  • Developing tolerance to heroin, which means needing more of it to get the same effects
  • Experiencing withdrawal when heroin use slows or stops

To be diagnosed with an OUD, a person needs to demonstrate at least 2 of the above criteria within a 12-month period.6 Though SUD diagnoses such as these are best made by treatment professionals, recognizing some of these criteria as warning signs of heroin addiction could be helpful in both detecting and getting help for you or someone close to you struggling with compulsive heroin use.


Other Signs of Heroin Use

The associated adverse side effects or symptoms of heroin use are not always visible to others, and the person using heroin may be the only one who is aware of them.

Though some of the acute or short-term drug effects include more readily recognizable signs such as altered mental status and fluctuations in and out of consciousness, some less obvious symptoms that may be experienced by the individual include:2

  • Heaviness of the extremities (arms and legs).
  • Warmth/flushing of the skin.
  • Skin itching.
  • Dry mouth.
  • Stomach upset.

More chronic heroin use sometimes leads to longer-term health effects, including:2

  • Chronic sleep disturbances.
  • Vascular inflammation after injection use.
  • Localized skin inflammation, infection, abscesses.
  • Endocarditis (heart infection).
  • Chronic constipation.
  • Sexual problems in men.
  • Irregular menstrual cycles in women.

One of the major risks of repeated heroin use would be the development of physiological dependence and the onset of an associated withdrawal syndrome should heroin use slow or stop.2

Heroin Withdrawal Symptoms

Symptoms of withdrawal include:2

  • Insomnia.
  • Restlessness or agitation.
  • Nausea and/or vomiting.
  • Diarrhea.
  • Muscle or bone pain.
  • Cravings.
  • Chills and goosebumps.
  • Muscle twitches.

Paraphernalia

While it is not always possible to see the signs of heroin abuse from a person’s behavior or physical state, you may be able to find drug paraphernalia. A person may stash their paraphernalia in a gym bag, purse, case, or backpack. You may find it hidden in drawers or under the bed. Some common types of heroin paraphernalia can include:7

  • Needles.
  • Spoons.
  • Tinfoil.
  • Plastic pen cases or cut up straws (for either snorting or smoking/inhaling).

What to Do If Someone Is Showing Signs of Heroin Use

If you believe that your loved one is showing any or all of the signs of heroin use and addiction, it is time to reach out for help. There is hope for recovery if a person can get into treatment. However, trying to find the right rehab for heroin addiction treatment may be confusing, and you may wonder what to do now and what your next steps are.

There are numerous approaches to addiction treatment. Some of these are:8-11

  • Inpatient programming, which provides 24/7 oversight and care to help you begin your recovery.
  • Outpatient programming, which can consist of several levels of services, ranging from a few hours per week up to 20 hours per week while the patient lives at home.
  • Behavioral therapies, such as cognitive-behavioral or motivational enhancement therapy, can help you learn new skills to avoid drug use and relapse after opioid addiction treatment.
  • Care for co-occurring disorders, which are mental health disorders that occur along with an SUD, is important for recovery. Some programs offer this specialized, integrated treatment that addresses both conditions at the same time.
  • Medication-assisted treatment, or MAT, is an important tool in helping people overcome heroin addiction. Medications such as buprenorphine or methadone are used to ease withdrawal symptoms, control cravings, and help people avoid relapse.

Sources

  1. National Institute on Drug Abuse. (2020). Heroin research report. What is the scope of heroin misuse in the United States?
  2. National Institute on Drug Abuse. (2021). Heroin DrugFacts.
  3. United States Drug Enforcement Administration. (2020). Drug fact sheet: heroin.
  4. National Institute on Drug Abuse. (2018). Prescription opioids and heroin research report: Heroin use is driven by its low cost and high availability.
  5. National Institute on Drug Abuse. (2020). Drug misuse and addiction.
  6. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  7. Drug Enforcement Agency. (2022). How to identify drug paraphernalia.
  8. National Institute on Drug Abuse. (2020). Types of treatment programs.
  9. National Institute on Drug Abuse. (2020). Behavioral therapies.
  10. National Institute on Drug Abuse. (2021). What are treatments for comorbid substance use disorder and mental health conditions?
  11. Substance Abuse and Mental Health Services Administration. (2021). Medication-assisted treatment (MAT).

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