Heroin: Uses, Effects, and Addiction

What is Heroin?

Heroin is a highly addictive opioid drug that’s illicitly manufactured from morphine, a natural opiate alkaloid derived from the opium poppy plant.^1,2 Heroin was first developed for pharmaceutical use in the 1800s, when it was thought to provide potent pain relief minus euphoria and the risk of dependence. However, along with analgesia, heroin effects actually include euphoria, drowsiness, and mental clouding, and it is associated with both dependence and addiction.³

Like other opioids, heroin attaches to and activates opioid receptors throughout the brain to modify pain signals. In turn, this activation is associated with an increase in dopamine activity in the brain, which can considerably reinforce its use and prompt people to repeat the experience.⁴

By the 1900s, heroin became a significant substance of misuse, prompting officials to ban its use.³ Today, heroin is a schedule I controlled substance, which signifies that it has no currently accepted medical use and a high potential for misuse.⁵

In terms of prevalence, data from the 2022 National Survey on Drug Use and Health (NSDUH)  indicates that among those 12 and older, 0.4% (1 million people) used heroin in the last year, a stat that’s down slightly compared to 2021 figures.^6,7 However, data for that same age group and time period shows that 0.3% (900,000 people) had a heroin use disorder (which officially falls under the definition for an opioid use disorder).⁶

What Does Heroin Look Like?

Heroin is typically sold as a white or brownish powder (often derived from poppy plants grown in Mexico, South America, and Southeast and Southwest Asia) or a sticky black substance often called “black tar heroin” (typically originating in Mexico).^5,8

Like some other drugs of misuse, heroin is often adulterated with other substances.⁵ So aside from morphine derived from the opium poppy, what is heroin made of?

Many forms of heroin are cut with other substances such as powdered milk, sugar, starch, or quinine as well as dangerous and highly potent substances such as fentanyl.⁵ These other substances may slightly alter its typical appearance.

How is Heroin Used?

Since heroin has no therapeutic or legal use, any use is actually considered misuse. When it comes to misuse, then, methods include injecting, smoking, and snorting.⁸ According to insights from the 2022 NSDUH, among those 12 and older, the most prevalent methods of use reported during the last year comprised: snorting (741,000), injecting (438,000), and smoking (381,000).⁹

Of note, heroin is often used alongside alcohol and/or other drugs, which in turn increases the risk of overdose. In fact, according to insights from the Centers for Disease Control and Prevention (CDC), almost all heroin users also use at least one other drug.¹

While heroin can be mixed with various substances, it’s increasingly found combined or cut with unknown amounts of fentanyl, which is considerably more potent than heroin. In such polysubstance situations, the adverse health impact of heroin can be especially unpredictable.¹⁰

What are the Short- and Long-Term Effects of Heroin?

When it comes to heroin effects, people often feel a surge of euphoria shortly after heroin use. Other adverse effects include:¹²

• Drowsiness.
• Mental clouding.
• Heavy feeling in the arms and legs.
• Dry mouth.
• Nausea and vomiting.
• Skin flushing.
• Severe itching.
• Respiratory depression.

Effects associated with the chronic use of heroin and its methods of use include:¹³

• Progressive hormonal imbalances.
• Some white matter brain changes, which can affect decision-making skills, behavior regulation, and stress response.
• The development of profound tolerance, dependence, and an associated withdrawal syndrome.

Additional medical complications of chronic use include:¹⁴

• Insomnia.
• Constipation.
• Lung complications (e.g., tuberculosis, pneumonia), resulting from a decline in health and frequently slowed breathing.
• Co-occurring mental health issues (e.g., depression).
• Sexual dysfunction for men, and irregular menstrual cycles for women.
• Collapsed veins, localized abscesses, and more generalized infections associated with frequent and/or nonsterile injections.
• Injury to delicate nasal tissues linked to repeated snorting.
• Additive-related blockages of blood vessels and foreign-body-related immune reactions.

Additional Heroin Risks

Those who inject drugs such as heroin are also at risk of developing various injection-related health conditions and of contracting HIV and hepatitis B and C as well as a host of other blood-borne viruses. Transmission via contact with blood or other bodily fluids can occur when individuals share needles and related injection equipment.¹⁵

Heroin use is also associated with neonatal opioid withdrawal syndrome, which can develop as a result of heroin use during pregnancy.¹⁶

Can Someone Overdose on Heroin?

Yes, heroin overdose is certainly possible and potentially deadly.

An overdose may occur when someone takes enough of a drug or drug combination to produce a life-threatening reaction or death. When someone overdoses on opioids such as heroin, their breathing typically slows dramatically or stops, which can limit the amount of oxygen that reaches the brain and other tissues (a condition known as anoxia). Opioid-related respiratory arrest can lead to anoxic brain injury, coma, and death.⁴

Fortunately, data from the CDC shows a positive trend in terms of heroin overdoses. From 2020 to 2021, the rate of heroin overdose deaths decreased by nearly 32%. However, while this decrease may partially be the result of fewer people initiating heroin use, other factors may also be involved, such as increased availability of naloxone*, a shift from a heroin-based market to a fentanyl-based market, and increased treatment availability.¹

*Naloxone—including brands such as Narcan and Kloxxado—temporarily blocks the effects of opioids and can restore normal breathing within 2 to 3 minutes. However, given its brief effects, medical attention is still necessary.⁴

How Can a Heroin Overdose be Treated?

If you suspect someone is experiencing an overdose, the Centers for Disease Control and Prevention (CDC) provides the following guidance:¹¹

• Call 911 immediately.
• Administer naloxone if available.
• Attempt to keep the individual awake and breathing.
• Position the individual on their side to prevent them from choking on vomit.
• Stay with the person until emergency responders arrive.

Heroin Addiction, Withdrawal, and Detox

When someone who has developed a physiological dependence on heroin suddenly stops using it or significantly decreases use, they may experience a set of symptoms known as withdrawal.¹⁷ Peaking in severity within 24 to 48 hours after the drug was last taken, symptoms of heroin withdrawal can include:¹³

• Insomnia.
• Restlessness.
• Muscle and bone pain.
• Uncontrollable leg movements.
• Sweating, chills, and goosebumps.
• Diarrhea and vomiting.

Although opioid withdrawal is rarely immediately life-threatening, it’s certainly unpleasant, and fear of symptoms may prompt people to continue heroin use.¹⁸ However, medically assisted detox (as described below) can ensure patients are as safe and as comfortable as possible during this challenging period of early recovery.

Chronic use of opioids such as heroin may be accompanied by functional changes in the brain that can reinforce compulsive misuse. Eventually, this use can result in the development of opioid addiction or, in diagnostic terms, an opioid use disorder.¹⁷

So at what point does heroin misuse become an addiction?

Doctors and other addiction treatment professionals may diagnose a heroin addiction as what’s known as an opioid use disorder. To make such a diagnosis, they will typically employ the following diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):¹⁹

• Using heroin or other opioids for longer periods of time or in larger amounts than intended.
• Being unable to cut down or stop using opioids such as heroin.
• Spending a lot of time obtaining, using, and recovering from the effects of heroin or other opioids.
• Experiencing cravings, or intense desires or urges to use heroin or other opioids.
• Failing to fulfill obligations at home, work, or school due to substance use.
• Continuing opioid use despite having interpersonal or social problems that are caused or worsened by such use.
• Giving up social, recreational, or occupational activities due to opioid use.
• Using heroin or other opioids in risky or dangerous situations.
• Continuing opioid use despite having a physical or mental problem that is probably due to substance use.
• Developing tolerance or needing more of the substance to achieve previous effects.
• Suffering from withdrawal, meaning that unpleasant symptoms occur when the individual stops using heroin or other opioids.

Heroin Addiction Treatment

Rehab for opioid use disorders such as heroin addiction is tailored to the unique needs of each individual. Though treatment may vary, common levels of care for heroin treatment include:²⁰

• Detox. At the start of treatment, detox helps to keep patients safe and as comfortable as possible during withdrawal. Depending on individual needs, professional opioid detox with medical withdrawal management can take place in both outpatient and inpatient settings.
• Inpatient treatment. Inpatient care, during which patients live in a rehab facility, involves 24/7 care and monitoring. This type of treatment comprises highly structured days filled with therapy, supervision, counseling, psychoeducation, and more.
• Outpatient treatment. Outpatient programs vary in intensity and include traditional outpatient rehab as well as partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and telehealth services.
• Aftercare programs. To set patients up for success following inpatient and/or outpatient rehab, aftercare programs include sober living facilities, ongoing therapy, 12-Step programs, and more.

As part of a treatment program, various behavioral therapies and individual, group, and family counselling are employed based on individual needs. Among them, cognitive-behavioral therapy (CBT) is often used to treat opioid and other substance use disorders. Additionally, medications may also be integrated into treatment. Examples include: methadone, buprenorphine, and naltrexone.²¹

If you or someone you love is struggling with addiction, American Addiction Centers can help.  Providing all levels of care via evidence-based treatment programs in a variety of U.S. locations, AAC treats a host of substance use disorders including those involving opioids such as heroin.

Take the first step toward recovery today by speaking with an admissions navigator at or by verifying your insurance benefits online. Available 24/7 for a free and confidential conversation, AAC staff can discuss payment options and treatment particulars.

It’s never too late to change, and the best day to start your recovery is always today.