Heroin Abuse Causes, Addiction Signs, Symptoms & Side Effects

No one experiences heroin addiction the same way as someone else. Understanding the signs, symptoms and side effects of heroin addiction is a key component toward starting the recovery journey.

Understanding Heroin Addiction

Learn about heroin addiction

Heroin (also known as “smack”) is the most commonly misused drug of the opioid class. It is a fast-acting, highly addictive drug that is naturally processed from morphine, a natural substance extracted from the seeds of certain poppy plants. While some opioids are used to treat medical conditions such as pain, heroin is an illegal drug that serves no medicinal purpose. Heroin is a “downer” and creates a state of relaxation and euphoria for the user. The effects of heroin are caused by its action on the opioid receptors; the body’s natural binding sites for endorphins (the body’s natural pain relievers). Heroin blocks signal to the brain that allows an individual to perceive pain, creating an overall feeling of well-being and euphoria.

Heroin generally comes in a white or brown powder, but may also be found in a black sticky substance known as “black tar.” When acquired on the streets, heroin usually is mixed (or “cut”) with other drugs or substances, for example, baby formula, sugar or starch. Sometimes heroin is cut with strychnine, commonly used as a pesticide, or other poisons. Since heroin users do not know the purity of the drug they are purchasing, it puts them at increased risk of overdose and death. Some common street names for heroin are: “poppy,” “white junk,” “smack,” “thunder,” and “dead on arrival.”

Heroin is usually abused by injection with a needle. Other methods of abuse include smoking, inhalation through a pipe, and snorting – direct inhalation through the nose. Injection of heroin provides the fastest and most intense high, usually occurring within seconds. When heroin is snorted or smoked the effects are usually felt after about ten to fifteen minutes.


Heroin addiction statistics

It’s estimated that 9.2 million people use heroin worldwide. In 2011, 1.6%, or 4.2 million Americans over the age of twelve have used heroin at least once in their lives. Approximately 23% of people who use heroin later become dependent upon it.

Co-Occurring Disorders

Heroin addiction and co-occurring disorders

It is common for individuals who abuse heroin to have at least one other psychiatric illness. Often times it is the presence of an unaddressed psychiatric illness that contributes to the user’s pattern of heroin abuse and addiction. Some disorders that may be present with heroin abuse and addiction include:

  • Depression
  • Antisocial personality disorder
  • Post-traumatic stress disorder
  • Conduct disorder
  • Anxiety disorders
  • Bipolar disorder
  • Schizophrenia
  • Alcohol abuse

These co-occurring disorders can often make the treatment and recovery process for heroin abusers more complicated. In order to have a successful recovery it is necessary to understand each disease and the roles that they play in the heroin abuse.

Causes and Risk Factors

Causes and risk factors for heroin addiction

While there is no specific cause that has been identified, research supports a number of possibilities. These include:

  • Genetics: Research has suggested genetics as a cause for heroin addiction. Individuals who have family members that are addicted to heroin or other substances appear to be more likely to develop a heroin addiction than those without a family history of the disorder.
  • Biological: Another theory suggests the possibility that some individuals may not produce enough natural endorphins in their brain which has an effect on mood. This could lead to heroin abuse in order to cope with this chemical imbalance.
  • Environmental: Children who grow up in homes in which addiction is a large part of life learn quickly (and incorrectly) that drugs are a way to handle the stresses of life. Watching substances such as heroin abused normalizes the substance which can later lead to a life of addiction.
  • Psychological: Many people who abuse drugs have an underlying and undiagnosed mental illness, such as bipolar disorder. In order to alleviate the discomfort of the symptoms of their untreated mental illness, they instead self-medicate with drugs and alcohol.

Signs and Symptoms

Signs and symptoms of heroin addiction

There are a number of signs that may indicate the use of heroin. Immediately after heroin is injected or inhaled it crosses the blood-brain barrier, where it is converted into morphine and binds to opioid receptors. Once consumed heroin is said to create a surge of pleasurable sensation, referred to as a “rush”. The intensity of the “rush” depends on how much of the drug is taken and how fast it enters the brain. It is this immediacy with which heroin enters the brain and the resulting “rush” that makes this drug so addictive. Some symptoms that may be noticeable immediately following heroin use include:

  • Abrupt changes in behavior
  • Loss of concentration or interest
  • Small, constricted pupils
  • Suddenly nodding off
  • Periods of hyper-alertness
  • Shortness of breath

After those initial effects subsides the heroin user will generally be drowsy for several hours, their mental function will be cloudy, as heart rate and breathing slows down. In severe cases, heart rate and breathing slows to the point of death. As the disease progresses into heroin addiction and dependence, the signs and symptoms of heroin use may become more severe. Some more severe symptoms include:

Physical symptoms

  • Warm flushing of skin
  • Dry mouth
  • Heavy feeling in the extremities
  • Nausea and vomiting
  • Severe itching

Psychological symptoms

  • Rapid shift in way life is prioritized (thoughts entirely focused around drug use)
  • Loss of sense of responsibility
  • Irritability
  • Hostility
  • Depression
  • Anxiety
  • Sleep disturbances such as insomnia
  • Restlessness

Behavioral symptoms

  • Pushing loved ones away due to shame or disgust with oneself
  • Argumentative with family and friends
  • Stealing from loved ones or participation in other illegal activities to pay for drug use
  • Wearing long pants and long sleeves even in warm weather (to hide needle marks)
  • Lying or other deceptive behavior
  • Hostile behavior
  • Diminished coordination
  • Loss of interest in activities once enjoyed

The longer the substance is used the more likely it will result in heroin addiction or dependence.


Effects of heroin addiction

There are a number of side effects that result from heroin use that vary as the disease progresses. Heroin use can affect all aspects of an individual’s life. Short and long-term effects can be physical, psychological, and even effect relationships with family and friends. As heroin use continues the most detrimental long-term effect is drug addiction and dependence. Prolonged heroin use produces tolerance and physical dependence, which motivate heroin users to keep abusing this drug. Once a heroin user is addicted or dependent their whole purpose in life revolves around this drug. Some of the effects of heroin abuse may include:

  • Adverse health consequences (HIV/AIDS, collapsed veins, infections in the heart, abscesses, Hepatitis C, Tuberculosis)
  • Social problems (isolation, loss of friends and family support)
  • Sleep problems
  • Neglected appearance
  • Work or school problems (being fired or expelled from school)
  • Financial problems
  • Involuntary commitment to mental hospital
  • Suicide

The most serious side effect of heroin abuse is death resulting from an overdose or disease as a result of drug use. Heroin users are unable to know the strength of the heroin they purchase or what it is mixed with which leads to a great chance of overdose.

Withdrawl Effects

Withdrawl effects of heroin addiction

Withdrawal occurs after an individual suddenly stops using heroin after they have become physically and psychologically dependent on it. Symptoms experienced during withdrawal are characterized as being opposite of the acute agonist effects. These negative effects cause significant distress or impairment in an individual’s daily life. Some symptoms include:

  • Anxiety
  • Restlessness
  • Achy feeling
  • Irritability
  • Increased sensitivity to pain
  • Nausea or vomiting
  • Muscle aches
  • Increased sweating
  • Diarrhea
  • Cravings and drug-seeking behavior
  • Suicidal ideations

For individuals who are dependent on heroin withdrawal symptoms can occur in as little as six to twelve hours after the last dose. They are usually at their highest within one to three days and then gradually subside over a five to seven day period. However, the more chronic symptoms like anxiety, insomnia, and drug craving last for months. Due to the extreme discomfort of withdrawal symptoms individuals often times relapse.