Signs & Symptoms of Heroin Abuse

The signs, symptoms, and effects of heroin addiction can be different for every person impacted. Learning about heroin addiction is one of the first steps towards getting better.

Understanding Heroin

Learn about heroin and substance abuse

Heroin is a highly addictive opioid that has a powerful and potentially devastating impact on individuals who abuse this dangerous drug. Occasionally also referred to by slang terms such as smack, horse, and tar, heroin is a synthesized version of morphine, a substance found in the opium poppy plant. When an individual ingests heroin, which is most commonly done via smoking, snorting, or ingesting the drug, his or her body converts the heroin back into morphine. In this converted state, the drug interacts with brain receptors that are associated with feelings such as pleasure and pain, as well as involuntary processes such as breathing and heart rate.

Heroin abuse exposes individuals to significant immediate and long-term damage, including but not limited to overdose and addiction. Continued heroin abuse and the development of heroin use disorder can cause significant damage to a person’s physical, psychological, and social wellbeing.

It can be extremely difficult for a person to overcome heroin use disorder without effective professional treatment. However, various forms of therapy and medication management have been developed to help people to end their dependence upon heroin and resume their pursuit of healthier and more productive futures, free from the devastation of heroin abuse.


Heroin addiction statistics

The National Survey on Drug Use and Health (NS-DUH) reveals that heroin abuse has been on the rise among adults in the United States, especially among young adults ages 18 to 25.  About two percent of adults in the U.S. have abused heroin at least once in their lives, and about 150,000 people abuse heroin for the first time every year. According to the National Institute on Drug Abuse (NIDA), the number of people in the U.S. who met the criteria for heroin use disorder increased by more than 100 percent in a recent 10-year period, rising from 214,000 in 2002 to 467,000 in 2012. The U.S. Centers for Disease Control and Prevention (CDC) reported a 500 percent increase in heroin overdose deaths between 2001 and 2013.

Causes and Risk Factors

Causes and risk factors for heroin addiction

Abusing heroin and developing heroin use disorder may be influenced by a variety of causes and risk factors, including the following:

Genetic: Several studies, including research that involved twins and adopted children, strongly suggest a genetic component related to an individual’s risk for developing heroin use disorder. Impulsivity, which may be a heritable trait, has also been identified as a risk factor for substance use disorders including heroin use disorder.

Environmental: Having access to heroin and/or associating with individuals who abuse heroin are strong environmental risk factors for abusing this drug. Other environmental influences on the development of heroin use disorder include low socioeconomic status and exposure to high levels of stress.

Risk Factors:

  • Gender (men are more likely to abuse heroin)
  • Age (heroin abuse most commonly starts during late teens or early 20s)
  • Family or personal history of mental illness
  • Family history of substance use disorder
  • Prior substance abuse
  • Poor stress-management skills
  • Impulsivity and novelty seeking
  • Access to heroin

Signs and Symptoms

Signs and symptoms of heroin addiction

The following are some of the many signs that may indicate that a person has been abusing heroin:

Behavioral symptoms:

  • Possession of syringes, hypodermic needles, and other drug paraphernalia
  • Lying or other otherwise acting deceptively regarding whereabouts and/or activities
  • Cessation of or decreased participation in significant activities

Physical symptoms:

  • Constricted pupils
  • Itchiness
  • Slowed breathing
  • Irregular heart rate
  • Nausea and vomiting
  • Dry mouth
  • Runny nose
  • Watery eyes
  • Scabs, sores, and/or abscesses
  • Insomnia
  • Weight loss
  • Lethargy and fatigue
  • Sensation of heaviness in arms and legs

Cognitive symptoms:

  • Impaired judgment
  • Confusion and disorientation
  • Problems focusing or thinking clearly

Psychosocial symptoms:

  • Severe mood swings
  • Anxiety
  • Withdrawal from family and friends


Effects of heroin addiction

Chronic untreated heroin abuse can lead to myriad negative outcomes, both because of the specific damage caused by the heroin itself as well as the impact of decisions made or action undertaken while under the influence of this drug. The following are among the many distressing effects of continued heroin abuse:

  • Family discord
  • Strained or ruined relationships
  • Academic failure and expulsion
  • Job loss and unemployment
  • Arrest and incarceration
  • Financial ruin
  • Homelessness
  • Pneumonia and tuberculosis
  • Diseases of the kidneys and liver
  • Viral infections, including hepatitis C and HIV/AIDS
  • Suicidal thoughts and attempts

Co-Occurring Disorders

Heroin addiction and co-occurring disorders

Individuals who have developed heroin use disorder may be at increased risk for also experiencing the following co-occurring disorders:

  • Depressive disorders
  • Posttraumatic stress disorder (PTSD)
  • Other substance use disorders

Withdrawal and Overdose

Effects of heroin withdrawal and overdose

Effects of heroin withdrawal: When a person who has become dependent upon heroin attempts to stop or drastically reduce abuse of this drug, he or she can experience several unpleasant withdrawal symptoms. These symptoms, which can make it difficult for individuals to overcome heroin use disorder without professional support, can begin to occur within hours of last use. The following are among the more common heroin withdrawal symptoms:

  • Strong cravings for heroin
  • Disrupted sleep patterns
  • Anxiety
  • Agitation
  • Nausea, vomiting, and diarrhea
  • Other flu-like symptoms
  • Dysphoria
  • Anhedonia

Effects of heroin overdose: Whenever a person abuses heroin, he or she is at risk for overdose, which is a potentially fatal experience. Anyone who exhibits the following symptoms after using heroin may be in need of immediate medical attention:

  • Pinpoint pupils
  • Shallow breathing
  • Irregular breathing
  • Significant drop in blood pressure
  • Slowed heart rate
  • Abdominal cramping
  • Blue tinge around mouth or fingertips
  • Muscle spasms
  • Loss of consciousness
Marks of Quality Care
  • Commission on Accreditation of Rehabilitation Facilities (CARF)
  • Glasser Quality Organization
  • Pennsylvania Department of Drug & Alcohol Programs
  • PsychArmor