Heroin addiction has been a problem in the United States for over a century, but the current epidemic of heroin abuse has led to more overdose deaths than ever before.
The latest opioid epidemic began in 1999, with the second wave in 2010 most closely associated with heroin addiction, as more people who could not get their prescription narcotics turned to this illicit narcotic. Currently, as many as 136 people die every day from an opioid overdose, often due to heroin which contains other illicit opiates like fentanyl.
Since heroin acts quickly and is metabolized out of the body just as fast, it is very easy to become addicted to this substance. Quitting without medical and social support increases the risk of relapse and associated overdose death, but getting treatment with a prescription medication and behavioral therapy in a rehabilitation program means you can safely end your addiction to heroin and maintain abstinence after completing treatment.
Is Heroin a Problem in the United States?
Opioid addiction is an epidemic in the United States, leading to chronic illness, overdoses, and death. In 2019, more than 14,000 people died from a drug overdose involving heroin, which constitutes about one-third of all opioid-related deaths.
The heroin overdose death rate in the US is seven times higher now than it was in 1999, when the current opioid crisis began. Although there were fewer deaths from heroin in 2019 than in 2018, opioid addiction and overdose still constitute a serious problem, with many people turning from prescription opioids to illegal narcotics like heroin. These people run a greater risk of overdosing due to fentanyl tainting the current drug supply.
Drug overdoses, in general in the US, increased about 5 percent between 2018 and 2019, with opioid-involved deaths increasing about 6 percent. Heroin-related overdose deaths may have decreased, but synthetic opioids, particularly fentanyl, killed 15 percent more people.
As of 2021, most heroin overdoses are due to fentanyl being mixed into, or taken instead of, heroin or illicit prescription drugs. The reduction in heroin-only overdoses might relate to an increase in access to addiction treatment, improved evidence-based treatments with Medication-Assisted Treatment (MAT), and support from insurance companies to go to a rehabilitation program. Expanded access to naloxone has also improved survival rates after a heroin overdose.
The History of Heroin
Heroin is an opioid narcotic derived from morphine, one of the first synthetic narcotics that came from opium. The drug derived from the opium poppy has been used both for medicine and intoxication for thousands of years, but morphine was a revolution in this substance’s use in the 19th century.
The pure form of morphine is 10 times stronger than opium, making it both a more effective pain reliever and a much more addictive drug. During the Civil War, soldiers took morphine to manage battle-related injuries, and they became addicted to the substance. In response, drug manufacturers attempted to find a new opioid that could relieve pain, without the addiction problem. By the end of the 19th century, drugs derived from morphine, including heroin, were believed to be the solution.
In the late 19th and early 20th centuries, heroin was widely used as a medicine to relieve pain and chronic cough. However, as more people took heroin as a regular medicine, more people developed an addiction to the drug.
By the early 1900s, heroin addiction was considered a serious epidemic in much of the world, including the United States. The Harrison Narcotics Tax Act was passed in 1914, one of the US’s first drug-related laws. Heroin is now a Schedule I substance in the US, meaning it has no medical use and is illegal.
Heroin Addiction, Overdose & Death
The US has battled a new, serious, rising epidemic of opioid abuse, addiction, and overdose since 1999. In the 1980s, narcotic painkillers were used predominantly in hospital settings, as short-term relief after surgery, or they were given to people with cancer pain.
Throughout the 1980s and 1990s, prescriptions for these drugs increased. Their use spiked after Purdue Pharmaceuticals began marketing their new narcotic, OxyContin, in 1996.
Researchers recognize three waves of this epidemic, with the first beginning in 1999, as more prescription opioid painkillers were offered to people with lower rates of pain. Unfortunately, the attempt at reducing suffering led to an increase in suffering. During the second wave, as prescriptions for narcotic painkillers were more tightly controlled, people who became addicted to prescription painkillers turned to illegal narcotics, particularly heroin.
In 2013, illicitly manufactured fentanyl appeared in the drug supply. Since it is inexpensive to make, fentanyl has replaced illicit prescription pills and heroin, causing overdose deaths in people who do not know they are taking fentanyl. Heroin overdose deaths in 2019 were five times higher than in 2010.
Opioid overdoses involving heroin, fentanyl, and other illicit narcotics are so prevalent in the US now that the issue has led to a declining life expectancy since 2014. Understanding what can cause heroin addiction, monitoring potential symptoms, and knowing where to get treatment means you can help yourself or a loved one avoid overdose.
Causes of Heroin Addiction
Heroin is a synthetic opioid that quickly binds to receptors in the brain, leading to lower pain, sedation and sleepiness, relaxation, and a sense of euphoria or intense happiness. However, the body also processes heroin quickly, so these feelings disappear soon after they appear.
This can lead to a cycle of taking lots of doses of heroin throughout the day, which increases the risk of side effects, addiction, and overdose. Spikes in euphoria, followed by a sudden “come down” from its effects, increase the risk of quickly becoming addicted to a drug like heroin.
The body also rapidly develops a tolerance to heroin, so soon after beginning a cycle of heroin abuse, the original size dose will no longer suffice. You will feel like you need to take more of the drug to achieve the original pleasing effects or to avoid withdrawal symptoms or a crash. You will also become dependent on the presence of the drug to feel normal, so you may develop intense cravings for heroin as it begins to leave your system.
Since heroin is made illegally, you do not know the actual dose for this substance. You also don’t know what else might be laced into the drug, like fentanyl, which can cause serious problems.
Signs You Might Be Addicted
These are signs of heroin intoxication:
- Dry mouth
- Heavy feeling in the limbs
- Warm, flushed skin
- Itching skin
- Cloudy or slow thinking
- Temporarily feeling intensely happy
- Feeling sleepy, even to the point of “going on the nod,” which is cycling between consciousness and unconsciousness every few seconds
- Stomach cramps and constipation
Long-term heroin abuse can lead to the following:
- Trouble sleeping
- Chronic constipation
- Intense cravings for heroin
- Scars or thick tissue buildup where the drug is injected into the veins
- Damage to the inside of the nose when it is sniffed
- Heart infection from dirty needles
- Hormonal changes, leading to sexual difficulty or changes in menstruation
- Lung problems, including trouble with deep breaths
- Mental health problems like depression or anxiety
- Liver and kidney disease
Since heroin is often cut with other substances, from talcum powder to fentanyl, you never know exactly what you are taking. This increases the risk of blood clots, damage to veins, damage to internal organs, and overdose death.
The intense cravings and painful withdrawal symptoms make simply quitting “cold turkey,” without any medical support, very difficult. Fortunately, improvements in evidence-based treatment are becoming easier to access.
Medication & Social Support to Treat Heroin Addiction
Withdrawal symptoms from any addictive substance can be difficult to manage, but opioids like heroin need medical and social support for successful addiction treatment. One of the major causes of overdoses related to heroin are relapses.
Someone attempts to quit on their own, but they relapse and take more than they normally would. With a lower physical tolerance, this means they are at greater risk of overdose. With medical oversight, Medication-Assisted Treatment (MAT), and social support from a rehabilitation program, many people safely and successfully overcome heroin addiction.
- Cold flashes or chills
- Muscle, joint, or bone pain
- Nausea and vomiting
- Increased anxiety
- Intense cravings and obsessive thoughts about the drug
Withdrawal may begin within a few hours after the last heroin dose is consumed. Major symptoms peak between one to two days after the final dose, and they taper away over the course of a week. However, some people may develop a withdrawal syndrome that lasts for months. Support from medical professionals in an evidence-based rehabilitation program can reduce the risk of developing this syndrome, since MAT eases withdrawal symptoms.
- Buprenorphine: This partial opioid agonist is typically prescribed as Suboxone, and it eases cravings without causing intoxication.
- Methadone: This opioid agonist lasts for several hours in the body, helping people who struggle with long-term opioid abuse quit the habit of taking several doses over a day.
- Naltrexone: This maintenance medication is prescribed after withdrawal is complete, to reduce the intoxicating effects of heroin in the event of a relapse.
Once withdrawal symptoms are managed with medications, you and your doctor will work to taper the dose slowly for several weeks or even months. It is normal for people who have struggled with heroin addiction for a long time to require months to ease their body off dependence on the substance.
During this time, you will also receive behavioral therapy in a rehabilitation program, led by a trained counselor. Group therapy is the most common social approach, but you may also attend individual counseling, family counseling, art therapy, animal therapy, physical and occupational therapy, and other types of support.
Since the approach to treating heroin addiction is changing to use more evidence-based medical approaches, it is hard to know exact recovery rates. However, preliminary studies suggest that individualized combinations of MAT and behavioral therapy greatly improve outcomes for most people.
Resources for People Struggling With Addiction
Treatment and social support are vital not only for the person struggling with addiction, but also for their loved ones. The US Health and Human Services Department (HHS) maintains a page dedicated to finding these resources, and the Substance Abuse and Mental Health Services Administration (SAMHSA) has a treatment locator, so you can find MAT and behavioral therapists in your location.
Heroin Overdose Data. (March 2021). Centers for Disease Control and Prevention (CDC).
What Is Fentanyl? (June 2021). National Institute on Drug Abuse (NIDA).
Understanding the Epidemic. (March 2021). Centers for Disease Control and Prevention (CDC).
Heroin, Morphine and Opiates. (June 2019). The History Channel.
Tracing the US Opioid Crisis to Its Roots. (September 2019). Nature.com.
Heroin. (March 2021). Centers for Disease Control and Prevention (CDC).
Heroin. (April 2020). Department of Justice (DOJ) and Drug Enforcement Administration (DEA) Fact Sheet.
Heroin. National Institute on Drug Abuse for Teens.
Heroin DrugFacts. (June 2021). National Institute on Drug Abuse (NIDA).
What Are the Long-Term Effects of Heroin Use? (June 2021). National Institute on Drug Abuse (NIDA).
Opioid Dependency Medications, MAT Medications. (September 2021). Substance Abuse and Mental Health Services Administration (SAMHSA).
What Are the Treatments for Heroin Use Disorder? (June 2021). National Institute on Drug Abuse (NIDA).
Predicting Long-Term Stable Recovery From Heroin Addiction: Findings From a 33-Year Follow-Up Study. (2007). Journal of Addictive Diseases.
Help and Resources: National Opioids Crisis. Health and Human Services (HHS.gov).
Find Treatment. Substance Abuse and Mental Health Services Administration (SAMHSA).