Heroin is derived from the poppy plant and is distributed as either a white powder or a black, sticky substance (“black tar heroin”).

For various reasons, drug dealers “cut” or dilute the pure heroin with other substances like sugar, starch or even baby powder or strychnine.

The actual dose of the heroin that is injected, smoked or snorted can vary greatly because of this cutting process.

Short Term Effects of Heroinheroin addiction

Heroin is a rapidly acting, highly addictive opioid . While heroin can reduce pain and is related to morphine, there is no medical purpose for heroin in modern medicine.

This illegal substance is abused for the intense feeling of euphoria that results from its use.

Once heroin enters the bloodstream it moves rapidly to opioid receptors in the brain. These receptors are (over) stimulated causing a “rush” or “high.”

Abusers will also experience flushing skin, itchiness, and dry mouth. After the initial high, but still during intoxication, abusers will be sleepy for a long period of time (“heroin hump”; slouched over, sleepy, but awake).

Short Term Damage

Heroin is cut with random substances to varying doses—the user never really knows what he or she is getting until it is used. Therefore any number of problems and toxicities can occur. These range from overdose of the opioid itself or complications from the diluting substance.

Injected heroin causes a number of needle-related problems.

  • Serious infections such as HIV and Hepatitis C are commonly passed through heroin needles.
  • Bacterial infections, such as MRSA, lead to abscesses and endocarditis (destructive infection of the heart valves).
  • Small, undissolved bits injected into the blood can cause a virtually immediate heart attack or stroke.

 Long Term Damage

Heroin is highly addictive, which means the abuser will seek out and use the drug despite obvious, harmful consequences.

As with any opioid, tolerance develops over time—the longer the period of abuse, the more heroin one needs to consume in order to achieve the same “high.”

Heroin lowers a person’s pain threshold. Normal aches and pains become almost unbearable.  At a certain level of tolerance, abusers need high levels of opioids just to avoid pain—the “highs” are not very high at all.

In fact, some abusers partially “detox” from heroin so that they can regain that same high that they once enjoyed.

The constant pursuit of more concentrated heroin increases the risk of overdose. Since heroin is illegal, abusers risk prosecution from using the drug, but also the various illegal activities that are often required to fund heroin use.

There are many ways to abuse heroin, but many users start by snorting or smoking heroin rather than injecting it.

Informal discussions with heroin addicts that start this way cite that snorting or smoking seemed less dangerous or “not as bad” as injecting the drug. However, as tolerance develops, many smokers and snorters switch to injection because they seek the stronger high.

Injection drug users ruin their veins over time. The veins become scarred and collapse making subsequent use more difficult. When an intravenous drug user cannot find a suitable vein, the will turn to “skin popping.” In this route of administration, heroin is placed under the skin so that it can absorb into the bloodstream. The skin breaks down, leading to horrible infections and abscesses.


Overdose on opioids can be fatal. These drugs depress the region in the brainstem that controls breathing.

Very high doses of opioids can essentially shut off the automatic drive to breathe that we all take for granted.

Heroin overdose can be immediately reversed with a drug called naloxone (opioid antagonist) if the overdose is recognized in time.

Symptoms and Signs of Abuse

Someone that is actively intoxicated with heroin will appear drowsy, detached, or sleeping. They will be breathing very slowly. If the person injects heroin, they may leave the needle in or very near the site of injection after administration.

It is much more likely to discover a heroin abuser during a period of withdrawal. They will irritable, restless, and appear sick (“dope sick”). In severe dependence, most daily activities will be devoted to getting more heroin (or the money to buy the heroin).

Heroin use requires paraphernalia. Abusers may leave behind “straws” used to snort the substance. Spoons or vessels with burn marks may be a sign that the item was used to dissolve the heroin (heating with a lighter). Heroin users that inject require needles, syringes, items to dissolve the drug, and possibly tourniquets (like rubber tubing).

“Track marks” are the tell-tale sign of IV drug abuse. Abusers may be able to hide these injection sores for some time under clothes or in the folds of the skin, but as veins are destroyed, these skin lesions will become apparent to even the casual observer.

Adverse Interactions

Drugs that depress the central nervous system can be lethal when taken with heroin. Alcohol, barbiturates, benzodiazepines, and even antihistamines can further slow the user’s breathing and possibly stop it, leading to death.


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