The Risks of Injecting, Smoking, and Snorting Heroin

This will explain the different methods individuals use to ingest heroin and the effects that each has, the signs of overdose and how you can help, the warning signs that someone may be addicted to heroin, and how to get help for heroin addiction.

What Is Heroin?

Heroin is an illegal, Schedule I, highly addictive opioid drug that is derived from morphine, a substance that is found in the opium poppy plant that is grown in Southeast and Southwest Asia, Columbia, and Mexico.¹

It has been estimated that more than 900,000 people in the United States used heroin in 2020, and around 691,000 had a heroin use disorder.²

How Is Heroin Used?

Heroin is sold on the street as either a white or brown powder or as a sticky substance known as black tar.¹ People use it a few different ways. It can be smoked, injected, or snorted—all of which cause the drug to enter the brain quickly.^1,3

Regardless of the method in which heroin is ingested, it’s generally used for the rush of euphoria it produces, but other common effects include:¹

• Heavy feelings in the limbs.
• Fluctuating between states of consciousness and semiconsciousness.
• Confusion.
• Feeling flush.
• Nausea and vomiting.
• Itching.

These effects are the result of heroin acting upon the opioid receptors that are found in the brain and body.¹ These opioid receptors are involved with pain and pleasure but also control heart rate, breathing, and sleeping.¹

Injecting Heroin

While individuals may inject dissolved heroin into a muscle or under the skin, administering the drug into a vein is one of the fastest ways for the drug to reach the brain.^3,4,5 The chronic use of heroin by injection can cause several harmful effects, including:^1,3-7

• Scarred and/or collapsed veins, which can lead to swelling in the arms, hands, legs, and feet.
• Bacterial infections that affect the blood vessels, heart valves, or lining of the heart.
• Skin abscesses or boils.
• Cellulitis, an infection of the skin, and other soft-tissue infections.
• Clogged blood vessels from additives or particulate contaminants in the heroin, which can cause permanent damage to the lungs, liver, kidneys, and brain.
• Arthritis or other rheumatological problems stemming from immune responses to the additives or impurities.
• An increased risk of infections such as hepatitis B and C, HIV, and other blood-borne viruses from shared injection equipment.
• Muscle stiffness.
• Wound botulism, which is a serious illness caused by a germ that gets into a wound and makes a toxin that attacks nerves in the body.
• Respiratory complications, such as fluid in the lungs, collapsed lungs, shortness of breath, an increased risk of tuberculosis, difficulty breathing, pulmonary hypertension, and pneumonia.
• A greater chance of developing a heroin use disorder, the clinical term for heroin addiction.

Smoking Heroin

Smoking heroin, which involves heating the drug and inhaling the vapors, gained popularity in recent years since it avoids the use of needles.⁴

Some individuals smoke heroin through a glass pipe; others heat the powder using a flame under tinfoil, inhaling the resulting vapor through a straw or other tube-like structure, a method referred to as “chasing the dragon” (since the individual must chase the smoke).^8,9

Similar to injecting the drug, smoking heroin produces effects quickly. And while some consider smoking heroin to be a less risky alternative to injecting it, this method of ingestion is associated with several negative health effects, including:^3,4,10

• Respiratory problems, such as difficulty breathing, wheezing, breathlessness, emphysema, persistent cough with excess mucus, edema, a greater risk of getting pneumonia, chronic obstructive pulmonary disease (COPD), and other lung diseases.
• Spongiform leukoencephalopathy, which is characterized by progressive damage to the white matter in the brain and can lead to muscle spasms, hyperactive reflexes, and sometimes death.
• Addiction.

Snorting Heroin

Snorting heroin brings on a rapid onset of effects, which is one reason individuals may choose this method.⁴ Additionally, some favor this route of administration because of ease of use or to avoid the stigmas associated with injection use.^3,4 Mistakenly considered a less risky method of ingestion, snorting heroin can cause harmful effects, which may include:^1,3,4,7

• An increased risk of developing hepatitis C with shared snorting paraphernalia.
• Fungal infections or death of the tissues in the sinuses.
• Nasal tissue damage.
• A perforated septum, which means there is a hole or fissure in the bony cartilaginous wall between the nasal cavities.
• Soft palate (the muscular part that sits at the back of the roof of the mouth) injury.

Signs of a Heroin Overdose

A heroin overdose is dangerous and can be deadly.^1,3 In 2020, approximately 13,165 individuals died from an overdose involving heroin.³ However, recognizing the signs of a heroin overdose and getting medical attention and treatment quickly can potentially save a person’s life.

Heroin overdose warning signs can include:^1,3,5,11

• Pale, clammy, or blue skin.
• Constricted, or pinpoint pupils.
• Extreme drowsiness or unconsciousness.
• Shallow, slow, or stopped breathing.
• Making gurgling or choking sounds.
• Limpness in the limbs and body.

Signs That Someone Is Using Heroin

It is important to note that only a healthcare professional can officially diagnose someone with an opioid use disorder (OUD) or any kind of substance use disorder. However, knowing the warning signs can help you figure out if you or a loved one might have a problem with heroin.

The criteria that clinicians use when diagnosing an OUD includes experiencing 2 or more of the following symptoms in a 1-year period:⁷

• Taking heroin in larger amounts or for a longer period than was intended.
• Desiring or unsuccessfully attempting to cut down or stop using heroin.
• Spending a great deal of time obtaining heroin, using it, or recovering from the effects of it.
• Experiencing cravings to use heroin.
• Failing to fulfill major role obligations at home, school, or work because of recurrent heroin use.
• Having persistent or recurring personal problems either caused by or worsened by heroin use.
• Giving up important social, recreational, or occupational activities due to heroin use.
• Using heroin in situations where it is physically hazardous.
• Continuing to use heroin despite knowing that an ongoing or recurring physical or psychological problem is either caused by or worsened by heroin use.
• Developing tolerance, meaning either needing increasing amounts of heroin to get the desired effects or taking the same amount of heroin and having notably diminished effects.
• Experiencing withdrawal, meaning signs of physical withdrawal surface when heroin use is cut back or stopped.

When to Seek Help for Heroin Addiction

It is never too late to get help. Treatment for heroin addiction typically includes a combination of behavioral therapy and medications for addiction treatment. While effective treatment is individualized to fit a person’s unique needs, options include:¹²

• Detox. Medically managed detoxification means healthcare professionals monitor the individual and provide a series of interventions to help get the heroin out of their body. For most, detox alone is not enough for sustained recovery but is the first step in a more comprehensive treatment plan.
• Inpatient treatment. Inpatient care requires individuals to live at the facility for treatment. Services include round-the-clock monitoring, individual and group therapy, counseling, education, and other structured activities to help individuals understand the emotions, thoughts, and behaviors that led to their heroin misuse and learn strategies to identify triggers, manage stressors, and avoid relapse.
• Outpatient treatment. Outpatient programs look similar to inpatient programs but vary in the number of hours individuals spend in therapy, counseling, and education sessions. Additionally, instead of remaining at the facility for the duration of treatment, individuals return home or to a sober living environment at the end of each day.
• Aftercare. Ongoing care continues after formal treatment ends and may involve mutual-help meetings, private counseling, and a discharge plan designed to help you remain sober.

Regardless of the setting, treatment involves various behavioral therapies designed to enhance motivation and change an individual’s thoughts about their heroin (or other substance) use.¹²

Additionally, opioid use disorders utilize medications that help manage withdrawal symptoms and reduce cravings during detox and beyond. These medications include methadone, buprenorphine, and naltrexone—all of which can help a person stabilize and reduce heroin use.¹²

It is possible to recover from heroin addiction and to live a healthy, substance-free life. Take the first step. Reach out, .