Medically Reviewed

Heroin Addiction Symptoms, Causes & Treatment

Heroin is a widely used, highly addictive illicit opioid drug.1 In 2020, roughly 902,000 people throughout the United States reported using heroin at least once within the past 12 months, and a staggering 691,000 people met the criteria for heroin use disorder.2

To protect yourself against the dangerous risks of heroin use, it’s important to understand what heroin is, its effects and risks, and effective treatment options available for heroin addiction.

What is Heroin?

Heroin is an illegal opioid drug made from morphine, a naturally occurring opiate extracted from opium poppy plants commonly cultivated in Southeast and Southwest Asia, Mexico, and Columbia.3,4 Depending on different manufacturing techniques, heroin may appear in various forms, such as white or brown powder, or a black sticky substance, known as black tar heroin.4

Heroin can be used in several ways, including:4

  • Snorting.
  • Smoking.
  • Injecting.

Heroin works by binding to and activating opioid receptors that exist in the brain and body.5 The downstream physiological effects of opioid receptor activation are involved with the regulation of breathing and  heart rate, and also influence how someone perceives pain and pleasure.4

At certain doses, heroin is capable of eliciting a powerful euphoria, which may put people who use it at risk for becoming addicted to it.6

Because of its powerful effects on breathing and other physiological processes, people who use heroin are also at risk of overdosing on this drug. 4 Because heroin is illicitly manufactured and inherently unregulated, drug manufacturers may cut or mix it with additional substances, which can additionally increase the risks of use. Some of these substance may could include sugar, starch, and – most dangerously – a profoundly potent synthetic opioid known as fentanyl. If someone – either knowingly or unknowingly – consumes heroin that was mixed with synthetic opioids like fentanyl, this increases their risk for overdose toxicity, respiratory arrest, coma, and death.5

In recent years, the unwitting ingestion of fentanyl by heroin and other illicit drug users has contributed to an alarming rise in fentanyl-related overdoses.7

Statistics on Heroin & Addiction

Statistics on past and current heroin use and overdose deaths include:7,8

  • Heroin-related overdose deaths rose drastically since 2010 and peaked in 2017.
  • From 2000-2013, drug poisoning rates involving heroin were highest among non-Hispanic black people, ages 45–64.
  • In 2020, more than 19% of all opioid overdose deaths included heroin.
  • Heroin overdoses decreased 7% from 2019 to 2020, but still remain prevalent.
  • Heroin is 30-40 times less potent than fentanyl, even though fentanyls are often sold under the guise of potent heroin.

Effects of Heroin Use

When heroin enters someone’s body, it’s converted to morphine and quickly binds to the opioid receptors in their brain. In turn, this creates a surge in pleasurable feelings and intense euphoria.9

Some of the desirable, immediate short-term effects of heroin—such as the pleasurable rush associated with its use—can reinforce repeated heroin use; repeated use can progress to compulsive use as a person develops an opioid addiction, or opioid use disorder.9

Heroin Overdose

Whether it’s someone’s first time using heroin, or they’re someone who has used heroin many times, as an illicit substance of often unknown purity or effective dose, the drug may always carry a risk for overdose. Consuming illicitly-manufactured opioids, such as heroin, is inherently dangerous; it’s extremely difficult to discern whether heroin could be laced with other dangerous substances, such as fentanyl.

A heroin overdose occurs when the adverse effects of the drug overwhelm the body, resulting in life-threatening symptoms such as respiratory arrest and hypoxic brain injury.

There has been an unprecedented increase in fentanyl-related overdose deaths since 2013, with several such deaths involving fentanyl-adulterated heroin or fentanyl substitutions for heroin.7 The number of heroin-related overdose deaths in the United States was 7 times higher in 2020 than in 1999.12

Certain risk factors may increase someone’s likelihood of overdosing on heroin, including:13,14,15

  • Combining heroin with other substances, such as alcohol or other drugs.
  • Using heroin after a prolonged period of abstinence, which can result in someone’s tolerance becoming substantially lower.
  • The presence of certain comorbid medical issues such as liver insufficiency or sleep apnea.
  • Heroin use in older age (e.g., 65+).

To understand more about heroin overdose, visit our page on heroin overdose signs, symptoms, and treatments.

Heroin Use Disorder & Addiction

As previously mentioned, repeated heroin use can lead to the development of opioid use disorder (OUD). According to the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), to meet the criteria for OUD, someone must experience at least 2 of the following symptoms within a 12-month time frame:16

  • Taking opioids in bigger amounts over a longer period than intended.
  • Failed attempts to cut down or control heroin use.
  • Significant time spent obtaining, using, and recovering from opioids.
  • A strong desire to use opioids, also known as craving.
  • Failure to fulfill significant responsibilities at work, home, or school.
  • Continuing to use opioids even if someone experiences relationship or social problems because of opioid use.
  • Decreased participation in significant occupational, recreational, or social activities due to opioid use.
  • Repeated use of opioids in dangerous situations, such as while driving.
  • Continued use of opioids despite exacerbated psychological or physical problems.
  • Tolerance to opioids.
  • Withdrawal symptoms when opioid use ceases.

Certain factors can increase someone’s risk of developing an OUD, and they include:17

Route-Specific Risks of Heroin Use

If someone uses unsterile needles for intravenous or other injectable routes of heroin use, this can put them at risk for contracting certain blood-born illnesses or developing serious health conditions, such as:20

  • Hepatitis B and C.
  • HIV, or human immunodeficiency virus.
  • Endocarditis, which is a bacterial infection in the heart.

Because heroin is a rapidly acting opioid, it is highly addictive no matter how someone ingests it. However, certain routes of administration, such as injecting or smoking, are associated with additionally reinforcing or rewarding effects of use, and may therefore increase someone’s risk for developing an addiction to heroin.

Heroin Use Disorder & Addiction

As previously mentioned, repeated heroin use can lead to the development of opioid use disorder (OUD). According to the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), to meet the criteria for OUD, someone must experience at least 2 of the following symptoms within a 12-month time frame:21

  • Taking opioids in bigger amounts over a longer period than intended.
  • Failed attempts to cut down or control heroin use.
  • Significant time spent obtaining, using, and recovering from opioids.
  • A strong desire to use opioids, also known as craving.
  • Failure to fulfill significant responsibilities at work, home, or school.
  • Continuing to use opioids even if someone experiences relationship or social problems because of opioid use.
  • Decreased participation in significant occupational, recreational, or social activities due to opioid use.
  • Repeated use of opioids in dangerous situations, such as while driving.
  • Continued use of opioids despite exacerbated psychological or physical problems.
  • Tolerance to opioids.
  • Withdrawal symptoms when opioid use ceases.

Certain factors can increase someone’s risk of developing an OUD, and they include:22

  • A past history of problematic substance use.
  • Untreated mental health or psychiatric disorders.
  • Family or social environments that support and encourage substance use.
  • Use starting at a relatively younger age.

Effective treatment modalities for heroin use disorder exist and can also be tailored to meet someone’s recovery needs. These effective treatments may include:14,24

  • Medications, such as methadone, naltrexone, and buprenorphine, which are also associated with a reduced risk for overdose death.
  • Behavioral therapies, such as cognitive-behavioral therapy (CBT) and contingency management (CM).

The goal of substance abuse treatment is to help someone recover from addiction and decrease their compulsive drug seeking and drug use patterns.25 In addition, treatment helps patients improve their quality of life through:25

  • Teaching healthy coping skills, including relapse prevention.
  • Improving communication skills, relationships, parenting skills, and family functioning.
  • Helping someone strengthen and build social support systems.
  • Learning how to live a healthy lifestyle without illicit drug use.

Treatment may be covered by your insurance. You can verify your insurance coverage by calling the number on the back of your insurance card or contacting the treatment center directly. You don’t have to continue to live in the grips of heroin addiction. Get the help you need today.

  1. National Drug Intelligence Center. (2022). Heroin Fast Facts.
  2. National Institute on Drug Abuse. (2018). Heroin research report: What is the scope of heroin use in the United States?
  3. National Institute on Drug Abuse. (2018). Heroin.
  4. National Institute on Drug Abuse. (2021). Heroin DrugFacts: What is heroin?
  5. National Institute on Drug Abuse. (N.A.). Drugs on the Street.
  6. U.S. Drug Enforcement Administration. (n.d.). Heroin. 
  7. Ciccarone, D. (2022). The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current Opinion in Psychiatry, 34(4), p.344-355.
  8. Centers for Disease Control and Prevention. (2022). Heroin. 
  9. National Institute on Drug Abuse. (2018). Heroin research report: What are the immediate (short-term) effects of heroin use?
  10. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment: A treatment improvement protocol TIP 45.
  11. National Institute on Drug Abuse. (2021). Fentanyl Drug Facts.
  12. Centers for Disease Control and Prevention. (2022). Heroin overdose data.
  13. Centers for Disease Control and Prevention. (N.A.). Preventing an Opioid Overdose.
  14. SAHMSA. (2021). TIP 63: Medications for Opioid Use Disorder.
  15. U.S. Department of Labor. (2020). Risk Factors for Opioid Misuse, Addiction, and Overdose.
  16. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 
  17. Webster, L. (2017). Risk factors for opioid-use disorder and overdose. Anesthesia & Analgesia, 125(5), p.1741-1748.
  18. Kosten, T. R., & George, T. P. (2002). The neurobiology of opioid dependence: implications for treatment. Science & practice perspectives, 1(1), 13–20. 
  19. National Institute on Drug Abuse. (2018). Heroin research report: What are the long-term effects of heroin use?
  20. Centers for Disease Control and Prevention. (2021). Infectious diseases, opioids and injection drug use.
  21. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders.
  22. Webster, L. (2017). Risk factors for opioid-use disorder and overdose. Anesthesia & Analgesia, 125(5), p.1741-1748.
  23. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition)-Types of treatment programs.
  24. National Institute on Drug Abuse. (2018). Heroin research report: What are the treatments for heroin use disorder?
  25. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition)- What is drug addiction treatment? 
Last Updated on September 12, 2022
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