Heroin Use and Addiction: Signs, Effects, and Dangers

Short-Term Effects

In the short term, heroin causes a quick rush of pleasure, followed by feeling very sleepy and relaxed. People may also notice that their heart rate slows down and it becomes harder to think clearly. Other common side effects include intense nausea (which may cause vomiting) and itching. These usually last for at least a few hours, during which the body’s systems slow down significantly, making it harder to make decisions or react to your surroundings.

Heroin use depresses breathing,³ which is why pulmonary edema (respiratory failure caused by too much fluid in the lungs) is the main cause of death from heroin overdose. 

Long-Term Effects

Long-term heroin use can seriously harm both physical and mental health. People who use heroin for a long time may experience brain damage, heart issues, and diseases that affect the liver and lungs. It can also cause rapid weight loss and skin sores. Research even shows that heroin use affects bone density.⁴

The mental impacts are just as concerning. Heroin changes the brain’s structure⁵ and how it functions, which can cause long-lasting imbalances in the body’s systems. This makes it harder to make decisions, manage your behavior, and handle stress. Studies show that heroin damages the brain’s white matter,⁶ affecting your ability to think and act clearly. While some people start using heroin to manage mental health symptoms, long-term heroin use eventually worsens anxiety, depression, and other co-occurring mental health conditions.⁷ 

Understanding Heroin Addiction

Heroin is notoriously addictive due to the powerful effects it has on brain chemistry. Once you become addicted, stopping can feel nearly impossible without help.

The Nature of Addiction

Heroin addiction happens quickly because of how it changes the brain’s reward system. When you use heroin, it releases a surge of dopamine, creating a strong sense of pleasure. Over time, your brain starts to rely on heroin to feel good, which causes both physical and psychological dependence. This makes it hard for people to function normally without the drug, which is why addiction isn’t a matter of willpower—it’s an overpowering compulsion.

As you continue using heroin, your body builds a tolerance, meaning you need more and more of it to feel your desired high. But once you’re physically dependent on heroin, if you stop using, your body will go into withdrawal. Eventually, you can develop a full-scale addiction, also known as heroin use disorder.⁸ This goes beyond physical dependence and turns into a chronic, relapsing disease. People with heroin addiction feel an overwhelming urge to use heroin, even if it’s hurting their health, work, or relationships. 

Heroin is highly addictive no matter how it’s taken, but methods like injection and smoking, which deliver the drug to the brain faster, only increase that risk. Once someone is caught in this cycle, getting and using heroin often becomes their main focus in life.

Withdrawal Challenges

One of the toughest parts of heroin addiction is going through withdrawal. Once you’re physically dependent on heroin, your body starts to react when it starts leaving your system. Heroin withdrawal symptoms⁹ can start within a few hours after the last dose and tend to peak within 24-48 hours:

• Nausea
• Vomiting 
• Muscle aches 
• Trouble sleeping 
• Strong cravings 
• Bone pain 
• Diahrrea 
• Cold sweats
• Jerking leg movements

Symptoms usually last for about a week, but some people may continue to feel withdrawal symptoms for much longer. These symptoms aren’t just uncomfortable—they’re painful, and they can even be dangerous. Many people return to heroin abuse simply to avoid the misery of withdrawal. That’s why it’s extremely important to detox from heroin with proper medical supervision and care. 

Overdose Risks

Heroin overdose is extremely dangerous and can be life-threatening. 

Because heroin slows breathing, respiratory failure is the most common cause of fatal heroin overdose.¹⁰ According to the WHO,

Opioids are potent respiratory depressants, and overdose is a leading cause of death among people who use them. Worldwide, an estimated 69,000 people die from opioid overdose each year.

The risk of heroin overdose is much higher due to the widespread presence of fentanyl, a synthetic opioid that’s far stronger than heroin. Fentanyl is often used to cut heroin and other substances; this dangerous drug is showing up more and more in street drugs, leading to a huge increase in fatal overdoses.

Knowing the signs of an overdose—like very slow or shallow breathing, blue lips, or unresponsiveness—can save a life. If you spot these signs, get medical help immediately. Naloxone (Narcan) can reverse the effects of opioid overdose, but it needs to be administered right away.

Learn more about Naloxone access and training here.

Treatment Options for Heroin Addiction

Heroin addiction requires comprehensive treatment to address both its physical and psychological aspects. Treatment for heroin use disorder¹¹ usually involves some combination of detox, medication-assisted treatment (MAT), and therapy.

Detox: The First Step in Heroin Recovery

Detox is the process of allowing your body to rid itself of a substance. This stage can cause withdrawal symptoms. Because “opioid withdrawal can be very uncomfortable¹² and difficult for the patient,” it’s a main driver of relapse. 

That’s why it’s important to detox under medical supervision, where addiction specialists can monitor your symptoms, help you manage withdrawals, and generally keep you as safe and comfortable as possible during the process. A controlled environment also means you won’t have access to substances. Some detox centers even offer counseling or integration with an addiction treatment program to address the psychological aspects of detox and set you up for recovery success. 

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) is an effective approach for heroin addiction.¹³ Medications are typically used in treatment to: 

• Replace heroin with a prescription opioid that can then be managed by a prescribing doctor
• Block the effects of heroin and reduce the intense cravings that often lead to relapse

NIDA describes these categories of medications:

Medications developed to treat opioid use disorders¹⁴ work through the same opioid receptors as the addictive drug, but are safer and less likely to produce the harmful behaviors that characterize a substance use disorder. Three types of medications include: (1) agonists, which activate opioid receptors; (2) partial agonists, which also activate opioid receptors but produce a smaller response; and (3) antagonists, which block the receptor and interfere with the rewarding effects of opioids. A particular medication is used based on a patient’s specific medical needs and other factors. 

The medications most commonly used in MAT are: 

• Methadone and buprenorphine, prescription opioid medications that are taken daily over the course of several months or years to reduce the cravings and drug-seeking behaviors associated with heroin
• Naltrexone, a non-narcotic medication that blocks the effects of heroin so you don’t get pleasure from using

All of these medications are approved by the FDA. However, MAT carries its own set of risks, as the medications used in opioid replacement therapy are themselves opioids and are therefore addictive. This is mitigated by controlling the methods and environment in which they’re taken. For example, someone might visit a clinic every day to receive methadone administered by a treatment professional.

Counseling and Therapy

While medication-assisted treatment helps with the physical side of addiction, counseling and therapy are just as important for its emotional and mental aspects. Addiction treatment usually involves a combination of individual and group therapy to help you process what arises on your journey, learn healthy coping skills, and build a strong support network. Therapy gives you a safe place to talk about your feelings, helping you identify what led to your addiction and learn how to work through challenges differently in the future. 

Harm-Reduction Strategies for Heroin Users

For those who aren’t yet ready to completely quit using heroin, harm reduction strategies can help minimize the risks.

What Is Harm Reduction?

Harm reduction focuses on making drug use safer, even if someone isn’t ready or able to quit yet. The goal is to reduce the risks and harmful effects of using drugs, like preventing overdoses or infections, without stopping use completely. Based on a principle of “any positive change”¹⁵ and originally created as an alternative to incarceration in communities of color, harm reduction is about meeting people where they are and helping them stay as safe as possible. 

Practical Approaches to Minimize Risks

Harm reduction practices include safe injection sites, needle exchange programs, and overdose prevention education. 

• Safe injection sites provide a clean and supervised environment for people to inject heroin, reducing the risk of infection and overdose. 
• Needle exchange programs allow people who inject heroin to obtain sterile needles, decreasing the transmission of infectious diseases like hepatitis and HIV. 
• Overdose prevention education teaches people how to recognize and respond to an overdose, including how to administer naloxone.

Recognizing Signs of Heroin Use

Recognizing the signs of heroin use can be the first step toward helping someone get the treatment they need.

Behavioral Signs

People who are using heroin often show noticeable changes in how they act. They might pull away from friends and family, stop doing things they used to love doing, or ignore important responsibilities. You might notice them taking more risks or even doing things that are illegal. It’s also common for people using heroin to become secretive, not wanting to talk about where they’ve been or why they’re acting differently.

Physical Signs

There are some clear physical signs that someone is using heroin. They might lose weight, have visible marks on their arms from injections, and often seem sleepy or have slurred speech. You might also notice skin infections, poor hygiene, and signs that they’re not eating well.

What to Do if You Suspect Someone Is Using Heroin

If you’re worried that someone you love is using heroin, approach them with kindness and understanding. Try not to be judgmental or overly confrontational, as this can make them defensive. Instead, let your loved one know you’re there for them, encourage them to get professional help, and have resources available. Share information about treatment options and harm reduction so they know support is there when they’re ready.

Learn more about staging an intervention here.

Recovering From Heroin Addiction

It may not feel like it now, but recovery from heroin addiction is entirely possible, and there are plenty of resources available to help you do so. Recognizing the signs of heroin addiction and getting professional help as soon as possible can increase your chances of successfully getting sober and preventing relapse.

Comprehensive addiction treatment programs that include detox, medication-assisted treatment, talk therapy, and social support offer a path to a new, substance-free life. If you’re ready to take your first step toward recovery, search for heroin addiction treatment centers and reach out to a support specialist today.

Frequently Asked Questions About Heroin Use and Addiction

What are the first signs of heroin use?

Early signs of heroin use include changes in sleep patterns, irritability, sudden weight loss, and physical marks from injection, such as track marks on the arms or legs.

How long does heroin withdrawal last?

Heroin withdrawal symptoms can begin within hours of the last use and typically last up to a week, but how severe they are, and how long they last, can vary from person to person.

Can heroin addiction be treated successfully?

Yes, heroin addiction can be successfully treated with a combination of medication-assisted treatment, therapy, and long-term support. Recovery requires ongoing care and a commitment to working through challenges, but it’s entirely possible.

How can I help someone addicted to heroin?

If you know someone struggling with heroin addiction, avoid enabling behaviors and instead offer them your support and encouragement to get professional help. Have resources ready, such as information on harm reduction strategies and treatment programs for when they’re ready to get sober.