Are you using heroin and trying to get clean? Is someone you love in the grips of heroin abuse? You may be worried about the effects this powerful drug is having on your health, family, and finances. And you may have many questions about heroin abuse and its treatment. Maybe you’re even ready to start treatment for yourself or a loved one but don’t know how to go about it.

This scenario is not uncommon. Many people struggling with addiction want help, but unfortunately, aren’t sure where to turn. They feel their lives have spun so far out of control that they are beyond help. The truth is that 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
9,173 in 2021
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 illicit drug derived from the opium poppy plant (Papaver somniferum), which is native to Central Asia and the Middle East. The milky sap of the poppy pod is refined to make morphine and other powerful prescription painkillers called opioid analgesics. It can also be used to make the illegal drug heroin.

Various forms of opiates have been used and abused throughout history. These include smokable forms of opium, liquids and pills for pain management, and intravenous (injectable) versions including what is now known as heroin. Interestingly, heroin was initially used as an antitussive (cough-relieving) medication by Bayer Pharmaceuticals in 1898. [1] 

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 for heroin 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 of Heroin

More than 90% of the world’s heroin supply comes from Afghanistan, making it the world’s leading producer of this dangerous drug. From here, heroin makes its way to drug dealers and street corners all over the world.

Fortunately, there has been a dramatic decline in the opium poppy supply coming out of Afghanistan after a ban on its cultivation was announced in April 2022. A decline in opium cultivation has been noted across Afghanistan, including some areas where opium poppy had been grown for years. The area used for opium poppy cultivation has declined by 95% to just 10,800 ha in 2023. This has led to a reduced supply of opium and export quality heroin coming out of Afghanistan after the 2023 harvest. Opium production saw a 95% decline from 6,200 tons in 2022 to 333 tons in 2023. The 2023 opium harvest was converted into 24-38 tons of export quality heroin (50 – 70% purity), compared to 350-580 tons in 2022. [2]

This ban follows immense international pressure on Afghanistan to control the size of the poppy crop. However, it has put rural populations, who were dependent on opium cultivation as a source of income, at economic risk. Opium farming is lucrative, with a quick turnover and high returns. The impoverished nation has struggled to put together resources and mechanisms to limit manufacturing to legal opium for the production of prescription pain medications. 

Street Value of Heroin

The price of heroin on the street is determined by numerous factors, including demand and supply, purity, and the quantity purchased. [3] There is also a wide geographical variation in the street prices of heroin, ranging from $1,300 per gram in Brunei to less than $3 per gram in Afghanistan and Kenya. The average price of heroin in the United States is $35,500 per kilogram in 2021 according to the World Drug Report by the United Nations Office on Drugs and Crime. [4]

To increase profits, dealers sometimes dilute pure 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 result in deadly consequences because users often have no way to test 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. The addition of fentanyl to street drugs is believed to be a major contributing factor to the high rates of drug overdose deaths 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. These receptors regulate important functions such as heart rate and breathing. 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 natural brain chemical that is largely responsible for the “high” or euphoria that drug users experience when they take illicit drugs. The release of large amounts of dopamine is closely tied to addiction. It is the reason heroin users report a “rush” or surge of intense happiness and euphoria. It is also the reason behind drug cravings and drug seeking behaviors.

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

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

Withdrawal symptoms develop in people with a physical dependence on heroin. Their brain and body is unable to function without the drug, resulting in withdrawal symptoms such as aches and pains, stomach and GI issues, chills and cold sweats, insomnia, mood swings, and drug cravings. These uncomfortable symptoms of heroin withdrawal is one of the main reasons why quitting heroin is so challenging, and why so many heroin users 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. This practice of mixing heroin with a stimulant drug causes conflicting responses in the body and brain that can increase the risk of adverse effects including a fatal overdose.

Users who smoke heroin do so by heating the drug in a spoon and inhaling the vapors or smoke. [7] A variety of paraphernalia, such as glass pipes, are available to smoke heroin. When the drug is smoked, heroin enters the lungs and from there is absorbed into the body. Some users prefer this method of using 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. With this method of use, heroin quickly enters the 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 (inner 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 such as 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. Shooting puts 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 a high risk of infections such as 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 illegal drugs.

used needles and other waste

Heroin Addiction in the United States

Opium is rarely cultivated in the United States. Heroin is mostly shipped to the US 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. In 2021, over 9,000 drug overdose deaths involving heroin were reported in the US. [8]

Heroin is a Schedule I drug under the United States Controlled Substances Act of 1970. This means 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. Drug overdose deaths involving heroin rose from 1,960 in 1999 to 15,482 in 2017. However, fortunately, deaths related to heroin overdoses have started trending down recently to 13,165 deaths in 2020 and 9,173 deaths in 2021. 

As mentioned, heroin is an illegal opioid drug. Prescription opioids such as OxyContin and Vicodin and the synthetic opioid fentanyl are also widely abused. Part of the reason behind the opioid epidemic in the US is that in the 1990s pharmaceutical companies assured the medical community that prescription opioid pain relievers were safe, leading to their widespread use. By 2015, nearly 92 million people in the US were using these powerful prescription pain pills. Today, an estimated 3 million Americans have opioid use disorder.[ efn_note] In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.  Azadfard M, Huecker MR, Leaming JM. Opioid Addiction. Available online. Accessed on March 19, 2024. [/efn_note]

Many people who develop an addiction to heroin say they started out misusing prescription pain pills and became addicted to them. As the addiction developed, they began to need more of the medication than they could legally obtain. To feed the habit, they began buying opioid drugs including heroin illegally. Roughly 80% of new heroin users in the US say they initiated drug abuse with pain pill misuse. In 2022, over 6.5 million people reported using heroin at least once in their lifetime, 1 million reported using heroin in the past 12 months, and 700,000 within the past month. [10]

Deaths from Heroin

The reason why heroin and other similar opioids are regarded as some of the most dangerous illegal drugs on the streets is because they have an extremely high rate of overdose. People who take too much heroin can develop life-threatening respiratory depression. Many who do not get help fast enough die.

The life-saving drug naloxone can be used in an emergency to reverse the effects of heroin and other opioids. Naloxone must be administered shortly after the opioid drug is taken. It is available as an auto-injector and nasal spray by prescription. In 2023, the U.S. FDA approved an over-the-counter naloxone nasal spray to increase access to this lifesaving medication. 

Opioids were responsible for 3 out of 4 drug overdose deaths in the US in 2021. More than 80,000 people lost their lives to opioid overdoses. The synthetic opioid fentanyl is the most common culprit and was involved in more than 70,000 overdose deaths in 2021. [11]

It is worth noting that in addition to drug overdose deaths related to heroin, additional deaths occur from accidents and health complications, the precise number of which is unknown.

In recent years, people who abuse street drugs are at a higher risk of overdose because of illegally produced synthetic opioids such as fentanyl being sold to unsuspecting buyers. These highly potent drugs make an accidental overdose much more likely to occur.

US Laws and Regulations to Reduce Heroin Use

Heroin is a Schedule I drug under the Controlled Substances Act of 1970. It is a crime to be in possession of heroin. In recent years, growing awareness about the opioid epidemic has led to several important policy changes that are designed to control the epidemic and save lives.

Funding has been pumped into rehabilitative centers across the nation; naloxone has become more widely available to 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 over-prescription of opioid painkillers.

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 in opioid drug users who are in recovery.

Stricter laws have been enacted to prevent the widespread distribution of heroin and other opioid drugs. The government has sanctioned harsher penalties for drug distribution and trafficking, with 3–5 years of incarceration, or substantially more, depending on the 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 overdoses increased 22-fold between 1979 and 2015 in the United States. The problem unfortunately continued to get worse post-2015. There were 33,000 opioid overdose deaths in 2015. In 2021, drug overdose deaths involving opioids were over 80,000. [12]
  • In the 1960s, heroin users were predominantly young men for whom heroin was the first brush with opioids. In more recent times, older men and women are abusing heroin after being introduced to opioids through prescription drug abuse. [13]
  • More than 1 million people reported using heroin in the past year and over 700,000 reported using heroin in the past month in 2022. [14]
  • 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 were more than $51 billion annually in 2015. [16]

Causes and Risk Factors for Heroin Addiction

The exact reason why some people develop an addiction and others do not is not known. However, experts agree that a combination of genetic, environmental, and physical causes lead to 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 may be involved in heroin addiction. [19] People who have family members who have struggled with substance abuse have a higher risk of heroin addiction.

Heroin is a highly addictive drug, so even people who do not have known 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, the amount of heroin used, the duration of abuse, and whether heroin was used in combination with other drugs or alcohol. However, the following signs and symptoms are commonly seen in heroin users.

Early signs of addiction:

  • Misuse of prescription 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 drugs 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 to get the same effects as before)
  • Experiencing withdrawal symptoms when attempting to stop using it
  • Experiencing negative consequences because of the drug use
  • Neglecting important responsibilities because of drug use
  • Suffering physical and mental health issues as a consequence of drug use 
  • 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 carries a high risk of abuse. The long-term health effects of heroin abuse and addiction 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 severity of health consequences caused by heroin abuse depends on various factors, such as the amount of heroin used, the duration of use, the purity of the drug, the method of use, individual tolerance, and the person’s underlying health status. 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 expectant mother and 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 during pregnancy, the baby can develop a condition called neonatal abstinence syndrome (NAS) after birth due to withdrawal from the opioid drug.

Babies who test positive for any illicit drug after birth are treated for their health problems, 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 impacts every aspect of a drug 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.

A heroin overdose can be treated with a rescue medication called naloxone. Naloxone works by attaching to the opioid receptors in the brain and blocking the effect of heroin and other opioid drugs. 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 are available as either a hand-held naloxone auto-injector (EVZIO) or nasal spray (NARCAN) to deliver a life-saving dose to someone who is overdosing. Since 2023, the U.S. FDA has made an over-the-counter 4-mg naloxone nasal spray available that can be purchased without a doctor’s prescription.

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 pain 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 always be undertaken 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. These programs are designed to match the needs of individual clients. Medically supervised detox from heroin helps recovering drug users to come off heroin 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 cravings for heroin. Naltrexone is another medicine that blocks the effects of opioid drugs like heroin and is effective in addiction treatment.

Medication assisted treatment can be incredibly useful in helping recovering heroin users establish and maintain sobriety. However, these medications should always be used under the recommendation and supervision of a healthcare provider. The best practice is to combine medication with therapy for comprehensive addiction treatment.

Psychotherapy and counseling for heroin addiction include behavioral therapies like cognitive-behavioral therapy (CBT) and contingency management. These 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 distressing symptoms arising from 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 can help to ensure lasting recovery because it teaches you more effective methods of coping long-term.

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 our 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 a heroin hotline. They make excuses and keep putting it off. Some folks are 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. Our advisors who answer the heroin addiction hotline calls 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 to help you battle heroin addiction. By calling our hotline you can learn how to find and use detox centers, methadone clinics, and substance abuse treatment. Our advisors will be happy to 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. Our 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 19, 2024

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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