Heroin Addiction: Signs, Risks, Withdrawal, Detox and Treatment

Heroin addiction is a serious medical problem that can lead to deadly consequences. Fortunately, treatment is available, and recovery is possible.

Heroin is a highly addictive and illicit opioid drug that claims thousands of lives every year. The country has been in the midst of an opioid crisis for decades now, and it’s only grown worse in response to the COVID-19 pandemic (See: Is COVID-19 Fueling the Next Opioid Epidemic?).

Heroin addiction impacts people from all backgrounds and walks of life; it can affect you, your friends, your family members and your loved ones. If you want to support those you care about when they need it the most, it’s important to understand the dangers surrounding this drug and the types of life-saving treatment available.

Article at a Glance:

• Heroin is an opiate made from morphine and can be snorted, smoked or injected.
• Heroin commonly comes in powder form or as a black, sticky substance.
• Heroin is very addictive, but recovery is possible.
• Treatment for heroin addiction involves detoxification, rehabilitation and therapy.
• Anyone can become addicted to heroin, regardless of who they are.

What Is Heroin?

Heroin is an opiate, meaning it is naturally derived from the opium poppy plant. When used, heroin creates feelings of elation and pleasure (a “high”) that people become addicted to. However, heroin use and addiction can quickly lead to life-threatening consequences, such as respiratory depression and overdose.

How Is Heroin Used?

Heroin can be abused in several ways. Most commonly, it is injected, smoked, sniffed or snorted. The highest-purity heroin is typically snorted or smoked.

Paraphernalia is not required to snort or sniff heroin. However, injected heroin requires tools like a syringe, and smoked heroin needs to be heated, which often requires a spoon.

Heroin Street Names

Heroin has many street names to mask its unlawful sale and purchase. Knowing the street names could help identify whether a loved one is misusing heroin. Some of the most common street names for heroin include:

• Smack
• H
• Tar
• Dope
• Junk
• Chiba
• Chiva
• Brown Sugar
• Mud
• China White
• White
• White nurse
• White lady
• White horse
• White girl
• White boy
• White stuff
• He
• Boy
• Black Pearl
• Black tar
• Brown crystal
• Mexican brown
• Mexican mud
• Snow
• Snowball
• Skunk

What Does Heroin Look Like?

Heroin is available in multiple forms, which can make it more difficult to identify. Forms of heroin may also vary depending on the availability in your area. Two of the most common forms of heroin include a powder form and a solid, sticky form.

Powder Form

Heroin is commonly available in a white or brown powder form. The whiter it is, the purer and more potent it is compared to off-white or brown heroin. Typically, there are more impurities in brownish heroin powder. The color usually varies based on geographic location in the U.S. For example, white or off-white powdered heroin is commonly seen in the eastern part of the U.S. Some powdered heroin may also be found in the western part of the U.S., but it’s typically the brown variety.

Solid, Sticky Form

Some heroin is sold as a solid, sticky substance that is typically black in color. Known as black tar or sticky tar, this substance can be hard to the touch.

The purest forms of heroin are white, powdered and odor-free. However, the darker, impure forms of powdered heroin have a slightly pungent smell similar to vinegar. Similarly, black tar heroin also has a smell resembling vinegar. If both black tar and off-white heroin are smoked, the smell will intensify, and the vinegar scent will be even stronger.

Heroin Cut With Other Drugs

Pure heroin does exist in the drug marketplace. More often than not, however, it’s cut with other drugs and substances. In other words, drug dealers mix in different ingredients with heroin so they can sell more of the drug and make a larger profit. While this process does dilute it, it also makes consuming the drug more dangerous because it can cause a variety of effects. One newer example is purple heroin, which is a mixture of heroin and fentanyl or carfentanil.

Some substances that heroin is cut with include:

• Sugar
• Starch
• Powdered milk
• Quinine
• Fentanyl

Mixing heroin and other drugs can be dangerous. For example, mixing stimulants like cocaine with heroin can mask signs of overdose, causing people to think they should take more.

Heroin Paraphernalia

Sometimes, a person may not be aware that their loved one is struggling with heroin until they come across paraphernalia. Some of the most common things you may find if a person is struggling with heroin include:

• Needles used to inject heroin
• Tinfoil used to heat heroin
• Pipes used to smoke heroin
• Plastic pen cases or cut-up drinking straws used to snort or sniff heroin
• Small spoons used to heat heroin for injection
• Cotton balls used to remove impurities from liquid heroin
• A tie-off, such as a shoestring, used to help with heroin injection

Is Heroin Addictive?

Yes, heroin is highly addictive. Heroin works in the same way as other opioids: it increases the amount of dopamine released to the limbic reward system, a part of the brain responsible for experiencing pleasurable feelings related to eating, drinking and sex.

When a person uses heroin, large amounts of dopamine create a rush of pleasure and euphoria. After this experience, many people report feeling like they need to seek out the drug again and again. This repeated heroin use is what drives heroin dependence very quickly and contributes to heroin addiction.

Heroin is addictive, but recovery is possible. However, it can be a very difficult process, so improving the chances of recovery typically requires the assistance of a professional heroin addiction treatment program. Additionally, heroin detox and withdrawal can be extremely uncomfortable and potentially harmful to the body if not done under proper guidance, so it’s important to seek the help of experienced rehab professionals.

Can You Get Addicted to Heroin the First Use?

Heroin is a highly addictive drug that can quickly lead to dependence. While it is unlikely that you will become addicted to heroin after using it just once, that first experience can be the start of a compulsive cycle that quickly leads to addiction.

The more frequently you use heroin, the more your brain and nervous system adjust to the drug’s effects. This can lead to a number of problems, including tolerance, withdrawal and addiction.

How Can I Tell If I’m Addicted to Heroin?

When a person starts to become addicted to heroin, signs and symptoms often start to emerge. Friends, loved ones, classmates and colleagues are typically the first to notice changes in a person. These can vary, ranging from changes in behavior and attitude to giving up activities due to a compulsion to take heroin. If you are concerned that your heroin use might be leading to an addiction, taking a heroin addiction quiz can help you determine whether it’s time to seek help. 

Effects of Heroin Addiction

Heroin use and addiction can lead to a number of serious changes in a person’s life, including severe consequences. In addition to immediate effects, heroin addiction can also cause issues that make a lasting impact.

Behavioral Effects

Heroin addiction can have a significant impact on a person’s social life. Many people who use heroin lose interest in their hobbies and passions, and they may start to avoid social activities. This could be because they are using heroin instead of participating in these activities, or it could be because they have been kicked out of groups or clubs for showing up high or failing to attend meetings. A person may also:

• Become strained financially to continue their habit
• Avoid loved ones and possibly become violent around them
• Experience unexpected, seemingly erratic mood changes
• Cover their arms no matter what, even in warm or hot weather

Physical Effects

Heroin use and addiction present many physical health concerns. Users are at increased risk of diseases like HIV and hepatitis from needle sharing. Along with these complications, physical consequences include:

• Dry mouth
• Skin and face flushing
• Clouded mental functioning
• “Nodding off,” which is shifting between consciousness and semi-consciousness
• Nausea and vomiting
• Decreased sensations of pain
• Constipation
• Sweating
• Constricted pupils
• Feeling light-headed and euphoric
• Lack of coordination
• Sleeping too much or sleeping too little

Severe symptoms:

• Lower blood pressure
• Heart rate changes
• Slowed or shallow breathing
• Difficulty swallowing
• Vomiting that cannot be stopped with medication
• Headaches
• Dizziness
• Extreme sedation
• Seizures

Long-Term Health Effects

Even seemingly controlled use of heroin can lead to long-term complications and consequences:

• Infection of the heart lining and valves
• Abscesses or boils
• Collapsed veins, especially for those who use heroin intravenously
• Stomach cramping and constipation
• Liver disease
• Kidney disease
• Complications arising from lung damage, including different types of pneumonia
• Sexual dysfunction in men
• Irregular menstrual cycles in women
• Damage to the mucosal tissues in the nose and perforations in the nasal septum, which mostly occurs in those who snort heroin
• Infectious diseases, like HIV and Hepatitis B and C, from needle use
• Bacterial infections
• Arthritis and rheumatological issues
• Antisocial personality disorder
• Depression
• Addiction

Overdose Risk

The opioid epidemic has taken the United States by storm, and many people are dying from heroin overdoses every day. Between April 2022 and March 2023, more than 5,000 people died from a heroin overdose in the United States.

A heroin overdose is a medical emergency. If you believe that someone is overdosing on heroin, it is important to call 911. Then, administer naloxone if it is available. Naloxone is an opioid reversal agent that can temporarily block the effects of opioids like heroin and save someone’s life. Because naloxone can wear off, you should call 911 immediately so the overdose victim can receive medical help.

Signs of a heroin overdose include:

• Shallow or slow breathing
• Small pupils
• Weak pulse
• Bluish tint to the nails and lips
• Confusion
• Drowsiness
• Coma
• Death

Heroin Addiction and Pregnancy

Heroin use during pregnancy can have serious consequences for both the mother and the baby.

• Mothers who use heroin during pregnancy are more likely to experience violence, sexually transmitted diseases and criminal activity. They are also less likely to attend prenatal doctor visits.
• Heroin use can also cause serious health complications for the baby, including preterm birth, low birth weight and neonatal abstinence syndrome (NAS). NAS is a condition that occurs when a baby is born addicted to heroin and goes through withdrawal symptoms after birth.

It is important to note that birth defects are extremely rare in babies born to mothers who use prescription opioids under the supervision of a doctor. The harmful effects of heroin on the fetus are more likely due to the repeated cycle of abuse and withdrawal, as well as other high-risk activities that often accompany heroin use.

If you are pregnant and using heroin, it is important to seek help immediately. There are treatment options available that can help you get clean and sober, and keep your baby safe.

How Long Does Heroin Stay in Your System?

Heroin is a fast-acting drug that is broken down into other substances called metabolites in the body. The half-life of heroin in the blood is about three minutes, which means that it takes five half-lives for the body to completely eliminate the drug. Therefore, heroin itself will be undetectable in the blood after about 15 minutes.

However, heroin’s metabolites have longer half-lives, meaning they can be detected for much longer. Two of the main metabolites of heroin are morphine and 6-acetylmorphine (6-MAM). 6-MAM is a unique metabolite of heroin, meaning that it is only produced when heroin is metabolized in the body. Drug tests can detect 6-MAM to confirm heroin use, as opposed to the use of other opioids.

The half-life of 6-MAM is 30 minutes, so it stays in the system for around 150 minutes. This is a lot longer than the half-life of heroin itself, which means that 6-MAM can be detected in the blood for several hours after heroin use.

Related Topic: Heroin Overdose 

Withdrawal from Heroin Addiction

One of the biggest challenges of recovery is the initial heroin withdrawal period. When you stop using heroin, your body will go through a series of physical and psychological changes as it adjusts to being without the drug. These changes can be very uncomfortable and even painful, and they can make it difficult to stay motivated in your recovery.

Heroin withdrawal symptoms are described as flu-like and typically include:

• Mood changes, like agitation and anxiety
• Increased body secretions (runny nose, teary eyes and sweaty skin)
• Stomach problems (nausea, vomiting, cramping, diarrhea and loss of appetite)
• Muscle problems (aches, twitching, shivering)
• Sneezing
• Goosebumps
• Yawning

Heroin Withdrawal Duration

Heroin withdrawal can be a difficult and uncomfortable experience, but it is a necessary step in the recovery process. The symptoms of withdrawal typically start within 12 hours of the last use, peak within 24–48 hours and last for 3–5 days for most people.

The severity and duration of withdrawal can vary depending on the individual’s history of use. People who have used heroin for a long time or who have used it in high doses may experience more severe and prolonged withdrawal symptoms.

Heroin Addiction Detox

Professional heroin detox is a medically supervised process that helps people safely withdraw from heroin. It is an important part of the recovery process, but it is not the only part. To achieve long-term recovery, people also need to address the underlying reasons for their addiction and the mental devastation that it can cause.

Heroin detox is almost always an inpatient process. This means that people stay in a treatment facility during the detox process. This is because heroin withdrawal can be very uncomfortable and even dangerous, and it is important to have medical supervision.

During detox, people will receive medication to help manage their withdrawal symptoms. They will also receive counseling and support to help them cope with the emotional challenges of detox.

Heroin Addiction Treatment Options

It can be extremely difficult for people with heroin addiction to quit the drug on their own. This is because heroin affects parts of the brain that control judgment, planning and organization. It also hijacks the brain’s memory and motivational systems.

Fortunately, help for heroin addiction is available, and recovery is possible. Treatment strategies include detox and rehab, which help get the drug out of your system and support your mental and physical health while you heal. Medications that help keep you sober and therapy that helps you live a life without heroin are also important cornerstones of treatment.

How Can You Help a Heroin Addict?

The first thing you can do to help a heroin addict is actually to stop doing something: enabling. Enabling is a common behavior of loved ones of people addicted to heroin. It means giving resources that allow the person to continue their addiction. This can include financial, emotional or other resources.

Heroin addiction is dangerous and difficult to deal with on your own. Building a support system is important. This can include other family members or support groups for families of people with heroin addiction.

To help someone who is addicted to heroin, you can set boundaries and show them you won’t contribute to their addiction. You can also research treatment options, look at how to cover the costs and coordinate care before holding an intervention.

Heroin Rehab

Heroin rehab is an important step in recovery. When recovering from heroin addiction, it is important to explore why you started using the drug in the first place. Further, you will need to develop coping strategies and mechanisms to avoid falling back into heroin use.

Having a support system and treatment can help reverse the hijacking effects heroin has on the brain and allow you to begin living a sober life. Rehab helps you accomplish all of this, with an emphasis on therapy and self-awareness.

Heroin Addiction Detox vs. Rehab

Although there is a misconception that detoxification and rehabilitation are the same, they are distinct steps in the recovery process. Detoxification — the act of getting off of heroin — is the first step in recovery. Detox is followed by rehab, which consists of talk therapy, teletherapy and ongoing support. These are all important tools that help people recover from heroin addiction.

Medication

In some cases, medications can be used to help clients stop using heroin and stay sober. As an extremely addictive opioid, heroin often gives people a euphoric high. Longer-acting opioids like methadone and buprenorphine can be used to prevent withdrawal symptoms without the risk of causing euphoria. In addition, non-opioid medications can be used during the detox and rehab process to help treat other withdrawal symptoms, such as muscle aches or diarrhea.

Behavioral Therapy

It is important to understand why you began to rely on heroin and to develop coping mechanisms to help you avoid heroin in the future. Relapse is a serious risk, and therapy helps mitigate the risk of relapse. In rehab, you may work with a therapist in one-on-one sessions or in groups to help you explore the underlying causes of your addiction.

Heroin Hotline for Immediate Help

The Recovery Village heroin addiction hotline is available to help people who are ready to make a change in their lives. They can provide support, information and referrals to treatment providers.

Call the heroin addiction hotline: 866-874-9479

If you are in a life-threatening situation, please call 911 immediately. Heroin hotlines and helplines are not equipped to handle emergency situations.

If you are not in a life-threatening situation, you can call a heroin hotline or helpline when you are ready to start your journey to recovery. Our hotline is available 24 hours a day, 7 days a week, and we can help you find the resources you need to get started.

Continue reading at Substance Abuse Treatment Programs or Verify Your Insurance Benefits 

Heroin Addiction Demographics

About 1 million Americans — roughly 0.4% of the population — had a heroin use disorder as of 2021. Heroin use impacts younger people as well: in 2020, around 0.4% of high school seniors said that they had a history of heroin use, with 0.3% stating they’d used it in the past month. A survey from The Recovery Village on past and present opioid users also found that around 25% of respondents used heroin. Further, one in three respondents started with a legitimate opioid prescription but later began abusing heroin or other prescription opioids.

The death rate from heroin dropped almost 32% from 2020 to 2021: in part, this was due to increased use of fentanyl instead of heroin, as well as from people seeking treatment for heroin addiction.

Chris’ Story: Beginning of a Heroin Addiction

Related Topic: Survey Finds New Stats & Trends in the Opioid Epidemic

Prescription Opioids and Heroin

Prescription painkillers have become a gateway drug to heroin, so anyone who has been prescribed opioid medications can be susceptible to heroin use and addiction. The risk is greatest among those who have become dependent on prescription opioids or abused them. Prescription opioid abuse often starts about two years before a person turns to heroin.

People who are unable to finance their prescription opioid addiction or whose prescriptions have been cut off may resort to heroin use. This is because heroin produces a more distinct high for less money and is readily available. Due to its availability, affordability and link to prescription opioids, heroin addiction affects people from many backgrounds.

Mixing Heroin and Alcohol

The combination of heroin and alcohol is extremely dangerous and can be fatal. Heroin and alcohol are both central nervous system depressants, which means that they slow down the body’s functions. When these two drugs are used together, the effects are additive, meaning the risk of overdose is significantly increased.

There are a number of reasons why mixing heroin and alcohol is so dangerous. First, the body absorbs alcohol faster when heroin is present. This means that it is possible to overdose on alcohol even after consuming a small amount. Second, both heroin and alcohol depress breathing. When these two drugs are used together, the risk of respiratory arrest is greatly increased. This can lead to coma or death.

In addition to the physical risks, mixing heroin and alcohol can also lead to risky behavior. For example, people who are under the influence of these two drugs may be more likely to drive or engage in other activities that put themselves and others at risk.

Find the Help You or Your Loved One Needs

If you or someone you love struggles with heroin abuse and addiction, The Recovery Village is here to help. Our multidisciplinary team of addiction experts can help you address your addiction and begin the road to a healthier, heroin-free life. Contact us today to learn more about heroin treatment programs that can work well for your needs.

Editor – Abby Doty

Abby Doty graduated from Hamline University in 2021 with a Bachelor's in English and Psychology. She has written and edited creative and literary work as well as academic pieces focused primarily on psychology and mental health. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more