Are you or someone you love using heroin? Are you worried about the effects of this powerful drug on your health, family, and finances? You may have some questions about heroin and you don’t know where to turn. Maybe you’re even seeking treatment for yourself or a loved one.

Those struggling with addiction often want some form of help. Many of them, unfortunately, aren’t sure where to turn. They feel their lives have spun so far out of control that they are beyond help. Nobody is beyond help. A simple call to our heroin hotline is a brave step in finally getting your life back on track.

Substance Overview: Heroin
Annual deaths
Side effects
collapsed veins, damage to teeth, changes in brain structure
Also known as
Smack, hell dust, China white, Mexican brown, horse, and big H

What Is Heroin?

Heroin is a highly addictive illegal drug derived from the opium poppy plant (Papaver somniferum), which is largely sourced from Central Asia and the Middle East. The milky sap of the poppy pod is refined to make morphine and other powerful painkilling medications in the opiate drug family, but it can also be used to make heroin.

Heroin was initially used as an antitussive (cough-relieving) medication by Bayer Pharmaceuticals in 1898, [1] but various forms of opiates have been extensively abused throughout history. These include smokable forms of opium, painkilling liquids and pills, and later intravenous versions of what is now known as heroin.

Currently, heroin is one of the most commonly abused illicit drugs in the world. It is available on the street as a white or brown powder or as a dark, sticky substance called black tar heroin. Street names include smack, hell dust, China white, Mexican brown, horse, and big H. People abuse heroin and other opiate drugs for their intense euphoric, relaxing, and sedating effects.

Origin and Street Value of Heroin

More than 90% of the world’s heroin supply comes from Afghanistan, which is the world’s leading producer of heroin. [2] There is immense international pressure on the Afghan government to control the size of the poppy crop, but the impoverished nation lacks the resources and mechanisms to ensure the manufacture of only legal opium for the production of prescription pain medications. Opium farming is lucrative, with a quick turnover and high returns. From Afghanistan, heroin makes its way to drug dealers and street corners all over the world.

The price of heroin on the street is determined by numerous factors, ranging from demand and supply and purity to quantity purchased.[3] There is wide geographical variation in heroin price, from $1,300 per gram in Brunei to less than $3 per gram in Afghanistan and Kenya. The average street price of heroin in the United States is $200 per gram, according to the World Drug Report by the United Nations Office on Drugs and Crime.[4]

To increase profits, dealers sometimes dilute the purity of heroin by “cutting” it with substances like baking soda, powdered sugar, talcum powder, laundry detergent, and bleach. Some of the substances used to cut heroin are poisonous and can produce deadly consequences because users have no way to ascertain the purity of the heroin they are purchasing.

In recent years, cutting or substituting heroin with the synthetic opioid fentanyl has become much more common. Fentanyl is 50 to 100 times more potent than heroin, and the introduction of fentanyl to black markets is believed to be a major contributing factor to the high rates of overdoses in recent years.

Effects of Heroin

When heroin enters the human body, it is metabolized (broken down) into morphine. The drug crosses the blood–brain barrier and attaches to opioid receptors in the brain. Opioid receptors regulate important functions and feelings like heart rate and breathing, but they also cause the release of chemicals that relieve pain and cause feelings of relaxation and pleasure.

The mu-opioid receptors have a secondary effect on dopamine levels in the brain. Dopamine is a pleasurable chemical that is largely responsible for the high that users experience when they take illicit drugs, and is closely tied to addiction. This is the reason heroin users report a “rush” or surge of intense happiness and euphoria.

The time it takes for the effects of heroin to kick in depends on the method of delivery. The fastest method of delivery is intravenous use, which is why many heroin users inject heroin into their veins. Peak blood levels of heroin occur  about 5 minutes after intravenous injection (the drug is roughly half as potent when used intranasally, i.e., snorted). [5]

Over time, increasing frequency and amount of heroin use leads to the development of physical and psychological tolerance. This means that the drug becomes less effective over time, causing users to take higher doses and greatly increasing their risk of addiction and overdose. Regular heavy users sometimes develop such high tolerances to heroin and other opiates that they are no longer able to get high from the drug and continue using just to feel normal and to avoid painful symptoms of withdrawal.

When a person becomes addicted to heroin, they will experience uncomfortable withdrawal symptoms which can include aches and pains, stomach and GI issues, chills and cold sweats, insomnia, mood swings, and drug cravings. The uncomfortable nature of heroin withdrawal is one of the reasons why quitting heroin is so difficult, and why many people relapse.

Methods of Heroin Use

Heroin abusers use the drug in several ways. [6]It can be smoked, snorted, injected directly into a vein, and dissolved in water. A particularly dangerous practice called speed-balling involves mixing heroin with crack/cocaine. Mixing heroin with a stimulant drug causes conflicting responses in the body and brain that can increase the risk of adverse effects and overdose.

Users who smoke heroin[7] do so by heating the drug in a spoon and inhaling the vapors or smoke. A variety of paraphernalia, such as glass pipes, is available to smoke heroin. When it is smoked, heroin enters the lungs and from there it is absorbed into the body. Some users prefer smoking heroin because it is less risky than using needles for intravenous injection. Smoking heroin also carries a lower risk of overdose. However, smoking a powerful drug like heroin can lead to lung damage and various other health complications.

Snorting consists of inhaling heroin powder forcefully into the nose with a straw or rolled-up banknote or piece of paper. Heroin quickly enters the person’s bloodstream and crosses the blood–brain barrier to reach the brain. When someone snorts heroin, it takes 3–5 minutes for the drug to reach peak blood levels. Heroin users who snort the drug often suffer nosebleeds, breathing problems, loss of smell, and damage to the mucous membrane (lining) of the nasal cavity. They can also contract infections through shared equipment. Some addicts prefer snorting heroin as the method of use because it does not leave the tell-tale track marks on the skin that are a giveaway in IV heroin users. Also, snorting does not expose them to the risk of infections like HIV and hepatitis through needle use.

Shooting heroin is a method of use in which the drug is injected directly into a vein with a syringe. Users typically use a lighter and spoon to “cook” the heroin (liquefy it) before injecting the drug into a vein. Shooting puts the heroin directly into the bloodstream and produces the fastest, most intense high. The effects are felt within a few seconds of the injection. Intravenous injection of heroin puts drug users at high risk of infections like HIV and hepatitis from shared needles and unsterilized equipment. If contaminated heroin is injected into the body, it can cause serious health complications. Heroin track marks on the skin are a red flag that a person may be abusing this illegal opioid drug.

used needles and other waste

Heroin Addiction in the United States

Opium is rarely cultivated in the United States, and heroin is mostly sourced from other countries in Asia, the Middle East, and Central and South America. Still, heroin is one of the most abused opioid drugs in the United States. It is the quickest-acting, putting users at high risk of overdose and death. Every day, an estimated 128 people in the United States die from opioid overdose. [8]

Heroin is a Schedule I drug under the United States Controlled Substances Act of 1970, meaning it carries the highest risk for abuse and addiction and has no valid medical use. In some other countries, such as the United Kingdom, heroin is available by prescription as the generic drug diamorphine, which is used to treat chronic pain. [9]

Heroin abuse and addiction have been a serious problem in the United States for decades. However, there has been a surge in heroin addiction and overdose deaths in the last couple of decades. Part of the reason could be the opioid epidemic that has swept the US. In the 1990s, pharmaceutical companies assured the medical community that opioid pain relievers were safe, leading to their widespread use. By 2015, nearly 92 million people in the US were using prescription pain pills. Today, an estimated 3 million Americans have opioid use disorder.[10]

Many people who develop an addiction to heroin started out using prescription pain pills and became addicted to them. As an addiction developed, they began to need more of the medication than they could legally obtain, and many began buying opioid drugs or heroin illegally. Roughly 80% of new heroin users in the US say they initiated drug abuse with pain pill misuse. There are more than 500,000 people in the US who are addicted to heroin. Opioid overdose was declared a national emergency in 2017 in the US.

Deaths from Heroin

The reason why heroin and other similar opioids are regarded as the most dangerous drugs is because they have an extremely high rate of overdose. People who take too much heroin often suffer from respiratory depression, and many who do not get help fast enough will die.

The life-saving drug naloxone is often used to reverse opioid overdoses but must be administered shortly after the drug is taken. When help comes too late or when a person overdoses alone, they often will not receive the drug in time.

Opioids are responsible for the vast majority of drug overdose deaths. In 2018, for example, there were 67,000 drug overdose deaths in the US, with 47,000 of these involving opioids. Since 2010, overdose deaths have increased by more than 200%, with heroin and synthetic opioids largely to blame. [11]

In 2018 there around 15,000 heroin overdose deaths in the US specifically. This was down by around 4% from 2017, despite large numbers of deaths being reported in states like Tennessee and Vermont. Much of the reduction came from the Midwest.

In addition to the 15,000 deaths each year from heroin overdose, other heroin-related deaths will occur from accidents and health complications (the precise number of which are unknown).

People who use opioids are at higher risk of overdose because of the widespread substitution of illegally produced synthetic opioids like fentanyl being sold to unsuspecting buyers. These highly potent drugs make accidental overdose much more likely to occur.

US Laws and Regulations to Reduce Heroin Use

Heroin is a Schedule I drug according to the Controlled Substances Act of 1970, making it a crime to be in possession. In recent years, growing awareness of the opioid epidemic has led to several important policy changes that help to reduce the epidemic and save lives.

Funding has been pumped into rehabilitative centers across the nation; naloxone has become more widely available to public servants, first responders, and private citizens; and regulations have been imposed on prescribers. Forty-nine states in the US now have prescription drug monitoring programs which help to reduce the over-prescribing of opioids.

The treatment of opioid use disorder has become a priority issue in communities across the US. In most cities, options are widely available for suboxone and methadone, drugs which help to prevent relapse for opioid addicts in recovery.

Stricter laws have been enacted to prevent the widespread distribution of heroin and other illicit opioid drugs. The government has sanctioned harsher penalties for drug distribution and trafficking, with 3–5 years of incarceration, or substantially more depending on quantity.

Stats on Heroin Addiction

Researchers have investigated many aspects of heroin addiction to better understand why and how it occurs. Here are some statistics on heroin use in the United States.

  • The death rate from opioid overdose increased 22-fold between 1979 and 2015 in the United States. There were 33,000 opioid overdose deaths in 2015 alone.[12]
  • In the 1960s, heroin users were predominantly young men whose first brush with opioids was heroin. In more recent times, older men and women are abusing heroin who were introduced to the drug through prescription drug abuse.[13]
  • The percentage of drug overdose deaths involving heroin increased three-fold from 8% in 2010 to 25% in 2015.[14]
  • More than 800,000 people reported using heroin and nearly 15,000 people died from a heroin overdose in the United States in 2018.
  • Up to 36 percent of heroin addicts pass through the criminal justice system each year, representing about 200,000 people.[15]
  • The socioeconomic and healthcare costs of heroin addiction in the United States are more than $51 billion annually.[16]

Causes and Risk Factors for Heroin Addiction

The exact reason why a person develops heroin addiction is not known. However, experts agree that a combination of genetic, environmental, and physical causes lead to the development of heroin abuse and addiction in some people and not others.[17] [18]

Some of the risk factors for heroin abuse include male gender, peer pressure, and easy access to heroin. Poor relationships with family, lack of self-esteem, and stressful life circumstances also increase the risk of heroin addiction. The presence of co-occurring mental health disorders is another potential risk factor for heroin abuse. People with an addiction to prescription pain pills sometimes switch to abusing heroin since it produces a stronger high and is less expensive.

Researchers have found that genetics plays a role in all types of addiction. Several genes have been identified that are involved in heroin addiction.[19]People who have family members that struggled with substance abuse have a higher risk of heroin addiction.

Heroin is a highly addictive drug, so even people without multiple risk factors can develop an addiction with regular use. Risk levels can also fluctuate depending on a person’s current circumstances. Specifically, people who are experiencing high levels of stress or struggling with symptoms of a mental health condition are more likely to become addicted to drugs. Having a chronic pain condition can also increase the likelihood of abusing opioids and becoming addicted.

Signs and Symptoms of Heroin Addiction

Each individual reacts to heroin differently and displays different signs and symptoms. This varies depending on the person’s genetic makeup, underlying health status, amount of heroin used, length of abuse, and combination with other drugs and alcohol. However, the following signs and symptoms are commonly seen in heroin users.

Early signs of addiction:

  • Prescription misuse of opioid pain killers
  • Hiding or minimizing extent of use
  • Making excuses to justify use
  • Not being able to follow limits around use
  • Feeling guilty after using
  • Using to cope with stress or difficult emotions
  • Becoming defensive when asked about use
  • Changes in behavior, mood, or appearance noticed by others
  • Withdrawal from friends, family, and normal routines and activities

Symptoms of addiction

  • Using the drug more often or in higher quantities than intended
  • Using the drug in situations where it is risky to do so (e.g., driving)
  • Giving up important activities to use the drug more
  • Experiencing frequent thoughts about or cravings for the drug
  • A loved one expressing concern about the use of the drug
  • Developing a tolerance to the drug (needing more of it)
  • Experiencing withdrawal symptoms when you stop using it
  • Experiencing negative consequences because of the drug use
  • Neglecting important responsibilities because of drug use
  • Drug use impacting on physical or mental health
  • Making multiple unsuccessful attempts to quit [20]

Health Effects of Heroin

The intended effects of heroin are euphoria, pain reduction, and alleviation of withdrawal symptoms in heroin addicts. However, heroin produces a range of unwanted health effects, the most concerning of which is slowed breathing.

Heroin is classified as a Schedule I drug by the DEA in the United States. It currently has no accepted medical use and has a high risk of abuse. The long-term health effects of heroin addiction and abuse are not only devastating but can be fatal.[21]

Short-Term Health Effects of Heroin

  • Warm, flushed skin
  • Pinpoint pupils
  • Dry mouth
  • Heavy limbs
  • Nausea and vomiting
  • Itching
  • Drowsiness
  • Mental fog
  • Slowed heartbeat
  • Slowed breathing
  • Bluish lips, fingers, and toes

Long-Term Health Effects of Heroin

  • Damage to the teeth, gums, and nasal mucosa
  • Cold flashes (goosebumps)
  • Constipation
  • Skin infections from scratching a heroin itch
  • Infections from needle use in IV heroin users
  • Heart, kidney, and liver disease
  • Changes in brain structure[22]
  • Joint problems
  • Weakness and weight loss
  • Menstrual disturbance in women
  • Sexual dysfunction in men
  • Insomnia
  • Depression
  • Collapsed veins
  • Abscess formation at injection sites

The intensity of heroin health effects depends on various factors, such as the amount of heroin used, the duration of use, the purity of the drug, the method of use, and individual tolerance. Also, adulterants used to cut heroin or contaminants introduced during the manufacturing process can lead to various health complications. Last but not least, mixing heroin with other drugs or alcohol can cause serious, potentially life-threatening health problems.

homeless man sleeping on street

Heroin Abuse by Pregnant Women

Heroin abuse during pregnancy can lead to several health problems in the mother and in her baby. Premature birth, low birth weight, birth defects, and developmental problems are common in babies born to mothers who are heroin addicts. Moreover, in mothers who use heroin while pregnant, the baby can develop neonatal abstinence syndrome (NAS) after delivery due to withdrawal from the opioid drug.

Babies who test positive for any illicit drug after birth are treated, but health care workers are also mandated to report the mother to the child protective services. This often results in the removal of the child from the mother’s custody. In some cases, it is possible for the mother to get treatment and go through the necessary process of regaining custody of the child.

Dangers of Heroin Addiction

Heroin is a highly addictive drug that has an impact on every aspect of the user’s life. Some of the dangers of heroin addiction include:

  • Domestic violence, child abuse, and neglect
  • Breakdown of relationships, potentially leading to divorce
  • Legal problems, including incarceration
  • Social isolation
  • Unemployment, loss of income, and raking up huge debts to feed the habit
  • Infectious diseases such as HIV and hepatitis
  • Health consequences, including permanent damage to vital organs
  • Death due to health complications or overdose
  • Effects on the baby in pregnant women who abuse heroin

Heroin Overdose

A heroin overdose can occur if a person uses a large quantity of heroin, either intentionally or unintentionally. A person can also overdose on heroin if the purity of the drug is higher than anticipated or more than what they are accustomed to. Some of the signs and symptoms of heroin overdose include:

  • Slow, labored breathing or cessation of breathing
  • Pinpoint pupils
  • Dry mouth
  • Discolored pallor
  • Very low blood pressure
  • Thready pulse or no pulse detectable
  • Blue lips and nails
  • Muscle spasticity
  • Disorientation
  • Delirium
  • Drowsiness
  • Convulsions
  • Coma
  • Death

A heroin overdose is a medical emergency. Call 911 or your local emergency number if you suspect a heroin overdose in a friend or family member.

Heroin overdose can be treated with a medication called naloxone. It works by attaching to the opioid receptors in the brain and blocking the effect of heroin. More than one dose of naloxone is sometimes required to restart breathing in a person who is overdosing. Family members and friends of heroin abusers should keep naloxone kits on hand for use at home. These include either a hand-held naloxone auto-injector (EVZIO) or nasal spray (NARCAN) to deliver a life-saving dose to someone who is overdosing.

Heroin Withdrawal

People who have been using heroin for a long time develop a physical dependence on the drug. If they discontinue heroin use suddenly, i.e., quit heroin cold turkey, it can lead to withdrawal symptoms. Symptoms can begin within a few hours of stopping heroin use and may include:

  • Agitation and restlessness
  • Muscle and bone pain
  • Insomnia
  • Depression and anxiety
  • Goosebumps or cold flashes
  • Nausea, vomiting, diarrhea
  • Involuntary jerking movements (sometimes called “kicking the habit”)
  • Severe cravings for heroin

To prevent complications, withdrawal from heroin should happen under medical supervision at a drug detox and rehabilitation center.

Heroin Addiction Treatment

Heroin addiction is a challenging problem to overcome. It is arguably one of the most difficult things a person will accomplish in their lifetime. But it is not an insurmountable problem. If you (or a loved one) are struggling with heroin abuse, it is possible to get your life back on track with heroin addiction treatment at a professional drug rehab center.

Top drug rehab facilities in the United States offer individualized heroin rehab programs to recovering addicts to match their individual needs. Medically supervised detox from heroin can help in coming off the drug safely and as comfortably as possible.

Medication-assisted treatment for heroin abuse has shown promising results. Medicines such as buprenorphine (suboxone) and methadone are used to reduce withdrawal symptoms and reduce cravings for heroin. Naltrexone is another medicine that blocks the effects of opioid drugs like heroin and is effective in addiction treatment.

Sometimes, these medications can be incredibly useful in helping users establish and maintain their sobriety. These medications should always only be used under the recommendation and supervision of a doctor or prescriber, and best practice is to combine medication with therapy or other addiction treatment.

Psychotherapy and counseling for heroin addiction include behavioral therapies like cognitive-behavioral therapy (CBT) and contingency management. These heroin addiction treatments help recovering addicts to modify their drug-seeking behaviors and learn new skills to manage triggers and stressors. Contingency management provides small motivations like cash rewards or vouchers for staying drug-free.

Heroin abuse is sometimes the result of attempts to self-medicate and reduce unpleasant symptoms of mental health conditions. For this reason, it is common for people struggling with heroin addiction to have a co-occurring mental health disorder. The most common psychological conditions that occur along with heroin addiction include anxiety and depression, bipolar disorder, schizophrenia, OCD (obsessive-compulsive disorder), PTSD (post-traumatic stress disorder), and other substance use disorders.

To ensure lasting recovery from heroin abuse, it is critical to treat heroin addiction and any co-existing mental health conditions simultaneously. Addressing the root causes of addiction will help to ensure lasting recovery, and will teach people more effective methods of coping.

When to Call a Heroin Hotline for Addiction

Since heroin is such a dangerous drug, the sooner you call a heroin addiction help hotline, the better. While it might not be easy for some people to ask for help, it could be the difference between getting your life back together or completely destroying it.

You don’t need to wait until your life becomes unmanageable to call a hotline. In fact, early interventions could save you or a loved one from serious problems in the future. If you notice any of these typical signs of addiction, you should consider calling.

  • Changes in behavior or sleeping patterns
  • Presence of drug paraphernalia
  • Withdrawing from family and friends
  • Avoiding responsibilities like school or work
  • Using language associated with heroin use like “”smack” or “big H”
  • Engaging in illegal or high-risk behaviors, sometimes to obtain the drug
  • Difficulties with mental functioning

Any of these signs could point to a problem with heroin or other drugs.

What to Expect When Calling a Heroin Helpline

Finally deciding to get help is a brave step that can positively change the course of your (or a loved one’s) life. Still, some people may hesitate to call. They make excuses and keep putting it off. Some might be embarrassed about their situation and think they will be judged. Others have gotten to a point where they can’t imagine an enjoyable life without the drug.

Addiction is a complex mental health disease. The people answering a heroin addiction hotline know this. They are not there to judge you or make you feel bad. In fact, they are ready to listen to your story, struggles, and worries. They provide comfort during a very turbulent time in your life.

In addition, they connect you with essential resources helping to battle heroin addiction. By calling, you learn how to find and use detox centers, methadone clinics, and substance abuse treatment. They answer any questions or concerns you have about finally getting treatment.

And don’t worry, no question is silly. No subject is taboo. Speak your mind and, if needed, let your emotions flow. After all, you’ve probably bottled up a lot of fears and feelings while using drugs. The heroin help hotline has assisted countless others in similar situations. They have the experience to help you.

You don’t need to battle addiction alone. A heroin hotline ensures that someone will always be nearby to give you help and comfort when you need it most. Make today the day you finally start changing your life for the better.

Last updated: March 9, 2023

Hailey Shafir, M.Ed., LCMHCS, LCAS, CCS

Hailey Shafir is a licensed addiction specialist and mental health counselor. She graduated from North Carolina State University with a master of education in clinical mental health counseling in 2012, and has developed deep expertise in the areas of mental health, behavioral addictions and substance abuse. She is passionate about using this knowledge to raise awareness, provide clear and accurate information, and to improve the quality of treatment for these disorders.

Hailey is an LCMHCS (license number: S9539) under the North Carolina Board of Mental Health Counselors, and an LCAS (ID: LCAS-21333) and CSS (ID: CCS-20721) under the North Carolina Addictions Specialist Professional Practice Board.


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