These are signs that someone you love has become addicted to heroin:
- Excessive tiredness
- Changes in personality and behavior
- Quitting activities they loved
- Track marks or signs of needle injections on the arms or hands
Fortunately, there are several evidence-based treatments available that include medication to slowly ease off a dependence on heroin, behavioral counseling, and even other services like job retraining or nutritional therapy, which support long-term recovery.
The Prevalence of Heroin Addiction in the US
Heroin is one of the most addictive drugs ever developed, and millions of people struggle with overcoming addiction to this opioid substance.
In the United States, 28 percent of opioid-related deaths in 2019 involved heroin. While the rate of overdose deaths related to heroin declined by 6 percent between 2018 and 2019, the rate of overdose deaths with heroin was five times higher in 2019 than it was in 2010. The scope of the problem is large, but evidence-based treatment for heroin addiction is greatly improving, so you can access the help you need.
According to data on addiction recovery, 1 in 10 Americans has resolved a substance use problem, typically with medical help to detox and change behaviors. While addiction is still a significant problem across the US, especially to heroin, there is help available to end cravings and manage triggers, so you can focus on a healthy life.
What Is Heroin?
Heroin is a substance synthesized from morphine, which is a molecule derived from the opium poppy.
Opium has been in use for thousands of years, but morphine is a relatively new drug. Since it was first manufactured, dozens of variations on morphine have been developed in an attempt to treat pain, chronic coughing, and related ailments. Unfortunately, many of these drugs have proven to be highly addictive.
Heroin was once a prescription medication, but it is now a Schedule I drug in the US, which means any heroin use is illegal. There are no longer any recognized medical uses for heroin.
Modern illicit heroin is manufactured in Southeast and Southwest Asia, as well as Mexico and Colombia. It is typically a white or brownish powder, but it can also come as black tar heroin, which is a sticky, less pure substance.
Although heroin has been a relatively inexpensive illegal drug in the US for decades, drug cartels are now mixing it with an even less expensive, and even more dangerous, opioid called fentanyl, which has proven simple and cheap to make. The presence of fentanyl in illegal opioids like heroin has rapidly increased the risk of overdosing on these drugs.
How Heroin Addiction Forms
Heroin is a fast-acting opioid that binds to receptors in the brain to trigger an intense euphoric high. It is metabolized out of the body almost as quickly, leading to a crash that can lead to physical discomfort and negative emotions. Avoiding this experience usually leads to taking another dose of heroin, to keep the high going. With this rapid cycling, a person can quickly become addicted to this drug.
The body also develops both a physical tolerance to and dependence on heroin very quickly. Tolerance means that the original dose you took will not be as effective, so you end up consuming more heroin. Dependence means that you need the presence of this narcotic bound to receptors in your brain to feel normal.
People who struggle with addiction to heroin soon find that they are taking the drug regularly not to feel good, but to avoid feeling bad. They may try to quit using heroin “cold turkey,” or suddenly and without any social or medical support. In some cases, quitting like this can work, but for most people, it leads to intense withdrawal symptoms, including cravings, which can trigger a return to heroin abuse.
When a person becomes addicted to heroin, their brain chemistry changes, but there may be physical signs of addiction too. These might include the following:
- Becoming more fatigued or sleeping more often
- Nodding off when not appropriate
- Appearing dazed or physically slower
- More shallow breathing or seeming short of breath
- Large pupils
- Track marks or signs of needle use on their arms or hands, if injecting
- Collapsed veins in those who have injected heroin for a long time
- Redness or irritation around their nose, if snorting
- Problems with personal hygiene
- Lung complications, liver disease, and kidney disease
- Injection-related infections like HIV or hepatitis
- Hormone changes, leading to sexual dysfunction and other problems
If you are struggling with addiction to heroin, you might experience these physical symptoms:
- Warm flushing sensation on the skin
- Heavy limbs
- Dry mouth
- Nausea, stomach upset, or vomiting
- Clouded mental functioning
- Being tired or nodding off frequently
- Anxiety or high stress when heroin is not in your system
Mental & Behavioral Signs
People who struggle with addiction to heroin also appear to develop different personalities. They struggle to constantly have a supply of heroin. This can make them seem distant, dismissive, or even mean. It is important to know that this person is suffering from compulsive drug-seeking behaviors, and likely has little control over themselves.
These are some of the emotional or mental signs that a loved one is struggling with addiction to heroin:
- Conflict in relationships
- Neglecting responsibilities, like work, school, or family obligations
- Disappearing more often because of more frequent heroin abuse
- Giving up activities they once loved
- Signs of greater depression or anxiety, or more frequent symptoms of a mental health condition
If you struggle with addiction to heroin, you may also experience the following:
- Frequent cravings for heroin
- Higher stress when you are unable to find the drug or when you are trying to find the drug
- Poor decision-making that puts you in physically dangerous situations, like driving while intoxicated
- Repeatedly trying to quit but being unable to
No Such Thing as ‘High-Functioning’ Addiction
People who struggle with an addiction to heroin may initially think that they have it under control.
They might think that as long as they are able to regularly take this dangerous drug at low levels, they can maintain a job or family responsibilities. This situation never lasts for long. They may develop withdrawal symptoms when they are not able to take more of the substance, and that can cause them to take higher doses to compensate. They are at very high risk of escalating use that leads to an overdose.
Withdrawal symptoms include the following:
- Restlessness and anxiety
- Bone, joint, or muscle pain
- Chills and shaking
- Uncontrollable leg movements, like restless leg syndrome
- Intense cravings that lead to compulsive behaviors
Signs of an overdose include:
- Passing out and not waking up
- Being unresponsive to touch or sound
- Cold, pale, or clammy skin
- Bluish tint to lips, fingernails, or nose
Overdoses are serious and can cause death. It is important to call 911 if you see someone overdosing.
Ultimately, there is no such thing as “high-functioning” when it comes to addiction. Escalating use means you put yourself and those around you at risk of physical and mental harm. You need to get help with an evidence-based treatment program to safely detox and change your behaviors.
Get Help to Overcome Heroin Addiction
Evidence-based treatment to overcome heroin addiction combines several forms of support, ranging from prescription medication to job training. Most programs now offer Medication-Assisted Treatment (MAT). This typically involves buprenorphine-based treatment but might involve methadone instead or naltrexone to reduce cravings after detox.
Behavioral therapy in both groups and individual sessions is also important. This therapy helps you recognize triggers for compulsive, drug-seeking behaviors, so you can reduce your risk of relapse when you complete the program.
As more people lose loved ones and financial independence due to drug addiction, more programs are also offering therapies, like occupational, physical, family, and vocational therapies, to help people get back on their feet.
Recovering from heroin addiction can take time, so it is important to stick with programs that work, including MAT, rehabilitation, and aftercare programs, like sober housing, nutritional therapy, regular exercise, and more. Support from loved ones is also essential, so ask for help from those closest to you to find the right treatment plan or motivate you to stick with it.
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What Can Be Done for a Heroin Overdose? (June 2021). National Institute on Drug Abuse (NIDA).
What Are the Treatments for Heroin Use Disorder? (June 2021). National Institute on Drug Abuse (NIDA).