Symptoms and Signs of Heroin Use

Author: NP Addiction Clinic
Published: June 28, 2022

The United States has been struggling with a substance abuse epidemic, and opioids are at the forefront with roughly 10.1 million Americans having misused opioids at least once over a 12-month period.

Heroin is a highly addictive substance derived from the opium poppy plant. Historically heroin was used for pain relief; however, it is now classed as a Schedule I substance with no legal medical use for the drug and a high potential for heroin abuse. It is recognized as one of the most addictive drugs in the world. Despite regulations from the drug enforcement administration, the number of opioid-related deaths rises each year. Knowing the signs of heroin abuse could help you in supporting a loved one with a drug abuse problem and even prevent overdose.

Heroin users can rapidly become addicted to the drug. Abusing heroin causes a range of physical and psychological signs; symptoms often progress quickly as addiction takes hold.

Heroin Abuse

Individuals who abuse heroin often do so by snorting, smoking, or injecting the drug. Injecting heroin is the most dangerous method of use as it increases the risk of overdose and the chance of contracting diseases from a dirty needle. Injecting heroin directly into your veins results in a fast, euphoric high that is soon followed by feelings of contentment, relaxation, and sleepiness. Smoking and snorting the drug produce similar effects but are slightly slower.

When heroin enters the body, it is metabolized into morphine and 6-acetyl morphine and very quickly binds to opioid receptors. This creates an intense rush of dopamine, producing the euphoric high that is so intoxicating and addictive. Some report that the faster the drug enters the body, the more intense the rush is. However, there are also reports that one can never recreate the feeling of their first heroin high, and are left chasing the euphoric rush.

Heroin is a fast-acting drug, and heroin users will generally experience the initial euphoric effects within a minute.

Risk Factors of Substance Abuse

There are certain causes and risk factors that contribute to drug use and heroin abuse and addiction:


Addiction is not a case of having poor willpower or a lack of morals; addiction can be hereditary. The chemical reactions that occur in the brain of a person with heroin addiction are very different from those happening in someone without one. According to the National Institute on Drug Abuse, approximately half of the risk factors of heroin addiction are related to genetics. Those with family members who struggle with substance abuse heroin problems are more likely to become physically dependent on addictive drugs themselves.


In recent years, there has been increasing recognition of the significance of the environment in the development of heroin addiction. A lack of parental involvement, love, and attention during formative years is associated with a higher risk of drug experimentation. It is not uncommon for children who suffer abuse or neglect to turn to drugs or alcohol to 'self-medicate', or deal with their emotions. Then, the effects of heroin can be devastating.

Dual Diagnosis

A dual diagnosis refers to the diagnosis of co-occurring disorders alongside a substance use disorder. This may include mental disorders such as anxiety, bipolar disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and depression. Co-occurring disorders and mental health issues can increase an individual's risk of addiction. Additionally, drug addiction can intensify the severity of co-occurring mental illness.

Prescription Opioid Use

The United States has been struggling with a so-called 'opioid epidemic' caused by the unregulated dispensing of prescription drugs containing opioids. Despite the fact that tight controls have now been put on these medications, those who were prescribed them by a doctor and developed a dependence or addiction may have turned to heroin as a cheaper and stronger alternative. About 80% of people who use heroin initially misused prescription opioids. Prescription opioid use is a significant risk factor for heroin addiction and should be considered if you are looking for signs that a person may be abusing heroin.

Life Changes or Loss

Events such as divorce, the loss of a loved one, trauma, or illness are not themselves significant causes for concern. But, in combination with the other risk factors or when they occur for those with a history of drug abuse or addiction, it is time to keep an eye on their behavior. If a loved one has had a recently stressful or traumatic life experience, it is especially important to consider their needs and that they may turn to substance abuse if these needs are not met, and they do not have the tools or support mechanisms to cope.

Signs of Heroine Use

There are a range of common psychological, physical, behavioral, and social symptoms which are signs and effects of heroin addiction that may indicate that an individual is abusing or has become dependent upon the drug:

Psychological symptoms of heroin addiction:

  • Feelings of shame, guilt, and depression
  • Hopelessness and despair
  • Decline in mental health or development of mental illnesses
  • Difficulty concentrating or focusing
  • Poor judgment
  • Confusion and disorientation

Physical symptoms of heroin addiction:

  • Extreme weight loss
  • Lethargy, fatigue, or exhaustion
  • Bruising or scabbing of the skin
  • Watery eyes and runny nose
  • Flu-like symptoms that don't go away
  • Bruising or scabbing of the skin
  • Itchiness
  • Trouble sleeping
  • Kidney damage and liver disease
  • Contracting hepatitis C and HIV/AIDS or other blood-borne pathogens
  • Finding drug paraphernalia such as syringes, small glass or metal pipes, spoons, lighters, belts, or rubber tubing.

A heroin user may even leave heroin lying around. Most commonly, the heroin comes as a white or brown powder, but a sticky, black form called 'black tar heroin' can also be found.

Social and Behavioral Symptoms:

Social symptoms of heroin addiction can often be the first to be spotted. The highly addictive drug causes negative consequences in your social life and relationships can break down. This can be incredibly isolating for people who use heroin, further driving dependence on the heroin 'high' for feelings of joy that may previously have been filled through human connections and relationships. The effects of heroin and other substances can often:

  • Withdraw from family and friends
  • Become close with a new group of friends
  • Have drastic mood swings and display unprovoked outbursts of anger
  • Develop strained relationships
  • Lose a job, become unemployed, or have trouble maintaining employment
  • Wear long-sleeved tops in public to hide injection sites
  • Create financial difficulties and instability
  • Become socially isolated and lose of interest in activities that were previously important

Heroin Addiction and Withdrawal

When a person has become addicted or developed physical dependence on heroin, they will experience withdrawal symptoms when they attempt to stop taking the drug. This makes it incredibly difficult to quit and people often overdose.

Heroin withdrawal symptoms can range from mild to severe depending on the length of time a person has been abusing the drug. Heroin use causes a combination of both physical symptoms and psychological withdrawal symptoms. The National Institute on Drug Abuse (NIDA) sites list common symptoms of heroin withdrawal as:

  • Sweats
  • Nausea
  • Tremors
  • Chills
  • Muscle aches and spasms
  • Diarrhea
  • Anxiety
  • Insomnia
  • Depression
  • Rapid heart rate
  • Drug cravings

Symptoms typically last for about seven to ten days, peaking around day three to five. Heroin drug craving during the detoxification process can be strong, and many find it difficult to detox alone. There is a significant danger of heroin overdose during withdrawal as a person's tolerance to the drug decreases. Many who relapse don't take this into consideration and take the same dose that they would have before they began to detox. This is often more heroin than their body can handle and a fatal overdose can occur, after causing dangerously slowed breathing and heart rate.

Heroin Overdose

Heroin overdose deaths in the US are high, and knowing the effects and signs of an overdose could help you save the life of someone that you suspect may be addicted to heroin.

A heroin overdose is a medical emergency and you should dial 911 immediately if you suspect a person may be having an overdose. Inform the telephone operator of the fact you suspect it may be a heroin overdose and follow their instructions carefully. If their breathing has slowed dramatically or stopped, you may be asked to perform CPR. It is important to act fast as an overdose can cause permanent brain damage and even death.

Addiction Treatment

Heroin addiction treatment will always begin with detoxification, where the body rids itself of all toxins and traces of the drug. Medical detox can provide support through this process, as withdrawal symptoms can be incredibly distressing and too challenging for most people to overcome alone.

When this process is complete, you will begin addiction treatment. This will likely involve finding the root cause of your drug use, when you began abusing heroin or other drugs, and why you turned to heroin abuse. For many, it is a form of 'self-medication' for mental or physical pain. A treatment center will offer an addicted person therapy in addition to support groups and treatment for co-occurring disorders.

If you are considering treatment options for heroin use or addiction, NP Addiction is here to support you. We can help you detox safely and comfortably. We provide inpatient or outpatient addiction treatment, alongside providing therapy for co-occurring mental health issues that may have developed as a result of drug use, or been an underlying cause of the drug abuse in the first place.

If you are ready to start your recovery journey and are looking for treatment advice or information, contact us today.

Read more blog posts in this category: