Key takeaways:

  • The National Institute on Drug Abuse reports that nearly one in four people (23%) who try heroin will become addicted
  • Last year, over 81,000 people died from a fatal drug overdose, and the vast majority of these deaths were caused by an opioid drug like heroin
  • People who overdose on heroin need immediate medical attention to prevent death from hypoxia (lack of oxygen). Certain medications like naloxone can help to reduce the effects of a heroin or opioid overdose, potentially saving lives

Heroin is one of the most addictive and harmful illicit drugs and is widely abused in the US. More people die each year from overdosing on opioids (like heroin) than any other type of drug. Treatment helps many people overcome heroin addictions and begin the process of recovery.

What is heroin?

Heroin is a powerful drug derived from the poppy seed, which is used to create opium and other prescribed painkillers like oxycontin, morphine, and Vicodin. All drugs made from processing poppy seeds (including heroin) belong to a class of drugs called opiates. These drugs are used medicinally to relieve pain but are also widely abused for their euphoric effects. [2]

Heroin can be taken in many forms but is most commonly injected into the veins through a syringe. Last year, over 81,000 people died from a fatal drug overdose, and the vast majority of these deaths were caused by an opioid drug like heroin. [1]

Recently, the black market supply of heroin is being contaminated with fentanyl, a deadly synthetic opioid that is 50-100 times more powerful than heroin. This is believed to cause the vast majority of fatal heroin overdoses and is often being sold as heroin to unsuspecting buyers. [1]

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Addiction to heroin

Heroin is a highly potent opiate depressant that affects the brain's opioid receptors and limbic reward system in a similar way to prescription opioid painkillers. Like other opioids, heroin floods the brain with endorphins, the chemical that occurs in the brain to cope with pain. The high levels of endorphins produced when taking heroin overwhelm the brain and create intense feelings of pleasure and euphoria. 

As the limbic reward system is effectively ‘hijacked’ by heroin use, it builds up a tolerance to it rapidly, meaning users feel like they have to take the drug again frequently. This drive and repeated use are what causes heroin dependence to form quickly, and what eventually leads to heroin addiction. The National Institute on Drug Abuse reports that nearly one in four people (23%) who try heroin will become addicted.

Signs and symptoms of heroin addiction

Heroin abuse or addiction will always be diagnosed by licensed mental health, addiction, or medical professionals. During a clinical assessment, these professionals will determine if someone has a heroin use disorder (the clinical term for heroin addiction) based on whether they have two or more of the following indicators: [3]

  • Hazardous heroin use

  • Social or interpersonal problems related to heroin use

  • Neglected major responsibilities to use heroin

  • Experiencing heroin withdrawal symptoms

  • Developing a tolerance

  • Using larger amounts

  • Repeated attempts to quit or control heroin use

  • Excessive time spent using heroin

  • Physical or psychological problems related to heroin use

  • Activities replaced by heroin use

  • Heroin craving

These criteria are measured on a spectrum of mild, moderate, and severe. Meeting 1-2 criteria is defined as mild, 3-5 moderate, and 6+ severe. [3]

Effects of Heroin Abuse

The initial high tends to be the most powerful, and many users will try to ‘chase’ this feeling but because tolerance develops quickly, the drug can lose its pleasurable effects rapidly. Many people up their dose in an attempt to chase this initial high, but this greatly increases the risk for addiction and accidental overdose. 

The initial effects of heroin appear harmless, even those experiencing dizziness and tiredness describe the sensation as enjoyable. It also has no immediate comedown or hangover, meaning it may appeal to new heroin users. Still, heroin is highly addictive and can quickly lead to addiction

Once addicted, the user is unable to feel normal without the drug and can quickly spiral into a pattern of problem use that begins to impact their physical and mental health, relationships, and ability to function.

Heroin Overdose

The most dangerous risk associated with heroin use is that of fatal overdose, which is often accidental in nature. Because users may receive heroin that is of varying purity and because of the increasing use of fentanyl being sold as heroin, the risk of overdose is high. [4] People who overdose on heroin need immediate medical attention to prevent death from hypoxia (lack of oxygen). Certain medications like naloxone can help to reduce the effects of a heroin or opioid overdose, potentially saving lives.

The signs of overdose on heroin or other opioids are:

  • Shallow breathing

  • Small pinpoint pupils

  • Extreme drowsiness

  • Loss of consciousness

  • Slow or weak pulse

  • Bluish lips or nails

  • Dizziness or confusion

Frequently asked questions about heroin

Here are some answers to some of the most commonly asked questions about heroin:

Where does heroin come from?

Heroin is extracted from the seed pod of certain varieties of poppy plants grown in different areas in South America and the Middle East. It is mostly synthesized and brought into the US from Mexico and South America. 

What does heroin look like?

Not all heroin looks the same. It comes in multiple varieties, including white or brown powders or a sticky substance known as ‘black tar heroin’.

How is heroin used?

Heroin can be abused in several different ways, including snorting, smoking, and injecting. All methods of using heroin are dangerous and can lead to a fatal overdose.

What does heroin feel like?

Most heroin users describe the high from taking the drug as feeling a rush of pleasure and euphoria. 

Is heroin the same as prescription painkillers?

Most painkillers, such as OxyContin or Vicodin, are classified as opioids as they are opiate-like synthetic substances that cause the same reaction in the brain as heroin. This makes these drugs similar in their effects, and also means they carry an equally high risk for abuse and addiction. Most people who abuse heroin started out abusing prescription painkillers.

What is its legal status in the United States?

Heroin is a Schedule I substance under the Controlled Substances Act meaning that it has a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.

What happens when you mix cocaine and heroin?

Mixing cocaine and heroin is often referred to as speedballing, as the former is a CNS stimulant and the latter an opioid depressant. The myth is that when taken in conjunction with each other, the cocaine stimulant produces an immediate high and the depressant in heroin offers a relaxed feel immediately after.

Is it safe to mix heroin with other drugs?

No. Like all forms of substance abuse, taking heroin in conjunction with other drugs, or poly-drug use, is extremely dangerous and can increase the risk of addiction and overdose. 

Are fentanyl and heroin the same?

No. Fentanyl is a synthetic (manmade) drug similar to heroin but is 50-100 times more powerful. Because it’s easier and cheaper to make, it is often sold as heroin, or mixed with heroin and sold to unknowing buyers. The increased use of fentanyl in other drugs like heroin is linked to a rise in overdose cases. [1, 2]

Help overcoming heroin addiction

Heroin is a highly potent and addictive drug. Those suffering from a heroin use disorder often find it extremely hard to overcome without help. Fortunately, there are heroin addiction treatment and rehab centers up and down the country that offer medical and psychological support to those suffering from addiction. If you or someone you know is suffering from heroin addiction, talking to a licensed professional can help you determine treatment options, and which may be the best for you.