Heroin Addiction: Causes, Symptoms & Treatment

More than 500,000 people in the United States are dependent on heroin. [1] 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 heroin without medical and social support increases the risk of relapse and associated overdose death. But getting treatment with prescription medication and behavioral therapy in a rehabilitation program means you can safely end your addiction to heroin and maintain abstinence after completing treatment.

What Is Heroin?

Heroin is an opioid narcotic derived from morphine. Dealers sell heroin in multiple forms, and it can be used through insufflation (snorting), ingestion, or injection. All forms of heroin, and all methods of using the drug, are incredibly dangerous. 

Common street names for heroin include:

• China white
• White lady
• Brown crystal
• Black pearl
• Joy powder

Heroin users are often adept at using slang since they must buy the drug from dealers to use it. 

Heroin is a Schedule I substance in the United States, meaning it has no legitimate medical use and is illegal to make, use, or sell.[2]

The History of Heroin 

The history of heroin is important to understand, as this ancient drug continues to cause problems today. [3]

Heroin derives from morphine, which is 10 times stronger than opium and an effective pain reliever. During the Civil War, soldiers took morphine to manage battle-related injuries and 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 19^th century, drugs derived from morphine, including heroin, were believed to be the solution.

In the late 19^th and early 20^th centuries, heroin was widely used to relieve pain and chronic cough. However, as more people took heroin as a regular medicine, more 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. 

Common Forms of Heroin 

Heroin is sold in multiple forms. The version someone buys often dictates how the drug is used. 

Heroin is sold in the following forms:[4]

• White powder: Pure versions of heroin can be snorted or smoked. But even heroin that seems untainted can be cut with sugars, starch, or powdered milk. 
• Brown powder: Less-processed forms of heroin take on a brown tinge from sap and impurities. This type of heroin can be snorted, smoked, or mixed with fluids and injected. 
• Black tar: This type of heroin is sticky and solid. Heroin users living west of the Mississippi often encounter this form of the drug. The color comes from crude processing methods that leave impurities behind. Users dissolve the substance, mix it with fluid, and inject it. 

Key Facts About Heroin Addiction

• The societal cost of heroin abuse in the United States is an estimated $51.2 billion. That number includes the cost of both treatment and incarceration of heroin users. [5]
• Heroin manufacture is unregulated. Often, dealers spike heroin with other drugs, including fentanyl (a much stronger opioid). In a study of heroin injectors, about 53% detected fentanyl in their heroin half, most, or all of the time. [6]
• Repeated heroin use changes both the physical structure and the physiology of the brain. Those alterations can impact decision-making ability, along with the capacity to regulate behavior. [7]
• An estimated 1 million Americans have a heroin use disorder. [8]

Causes of Heroin Addiction

Heroin is a powerful drug that changes the brain with every dose you take. Using heroin even one time is incredibly dangerous. But people who use the drug more than once run the real risk of developing an opioid use disorder (OUD). Several factors can cause this issue. 

The main causes of heroin addiction include the following:

• Biology: Your genes dictate how many opioid receptors exist within your brain. The more you have, the stronger your high and the bigger your addiction risk. 
• Environment: Early use of heroin is associated with a stronger addiction risk. Living in a neighborhood where heroin is common can make early experimentation easy.
• Social: Spending time with people who buy, sell, or use heroin can make maintaining a supply easy and can lead to repeated drug use. 
• Psychological: Underlying mental health issues, such as depression or anxiety, can lead to a quick addiction progression. 

Heroin’s Effect on the Body: Why Is It So Addictive?

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.[9]

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. Due to this, it does not take long to get addicted to 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 prior 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 don’t know what else might be laced into the drug, like fentanyl, which can cause serious problems, including fatal overdose.

Health Impact of Heroin Addiction 

People who abuse heroin face very real health risks. They can be separated into short-term problems and long-lasting complications. 

Short-Term Impact 

People who use heroin report a rush, or a sense of immediate pleasure. People may also experience the following negative side effects:[10]

• Dry mouth
• Heavy-feeling extremities
• Nausea
• Vomiting
• Itchiness 

Heroin can also slow breathing to dangerous levels. Heart rate can slow too. Take too much heroin, and these side effects can lead to death. 

Long-Term Impact

With repeated use, heroin causes physical dependence. You’ll feel sick between doses, and if you try to quit, you can experience difficult side effects, including the following:[11]

• Bone pain 
• Insomnia
• Diarrhea
• Restlessness 

Long-term heroin abuse can also lead to the following:[11]

• 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 snorted
• 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, such as talcum powder or fentanyl, you never know exactly what you are taking. This increases the risk of blood clots, damage to veins, harm to internal organs, and fatal overdose.

Signs of Heroin Abuse: What to Look Out For 

Some people are comfortable discussing heroin abuse with their friends and families. Others attempt to keep their drug use hidden. You can spot symptoms of use and abuse if you know what to watch for. 

Signs of abuse can include the following:

• Puncture injuries (or track marks) on the arms and legs
• Decreased attention to personal hygiene 
• Lack of motivation
• Slurred speech
• Possession of burned spoons, needles, syringes, or glass pipes
• Hyperactivity followed by fatigue
• Irregular sleep patterns or increased sleeping

Remember that anyone can develop an addiction to heroin. The drug is powerful and can change brain cells. Using the drug can lead to an addiction in almost anyone. 

Comparing Heroin Abuse Symptoms by Type

Physical	Mental	Behavioral
Slow breathing	Decreased ability to problem solve	Changes in heating patterns
Slow heart rate	Disorientation	Lack of personal hygiene
Flushed skin	Lack of self-control	Neglecting responsibilities
Slurred speech	Distractibility	Possession of paraphernalia

Symptoms of Heroin Withdrawal 

With repeated use, your brain and body depend on heroin. The intense cravings and painful withdrawal symptoms make simply quitting cold turkey, without any medical support, very difficult.

Physical Symptoms

People who quit heroin suddenly can develop significant physical symptoms, such as cold flashes, muscle pain, diarrhea, nausea, vomiting, and twitching in the legs and feet. These symptoms can be debilitating, and without treatment, they can be life-threatening. Severe dehydration from vomiting and diarrhea can lead to organ failure. [1]

Mental Symptoms

Anxiety and restlessness are common in people who quit heroin use suddenly. These symptoms are accompanied by a deep and persistent craving for more heroin. Thoughts can become obsessive and impossible to ignore. [1]

Behavioral Symptoms 

People moving through withdrawal may return to heroin abuse. The physical symptoms combined with strong cravings for the drug can make people feel like heroin use is inevitable. 

Heroin Compared to Other Drugs

Fentanyl & Its Impact on Heroin Addiction 

Fentanyl is a synthetic opioid, so it’s in the same medication class as heroin. But fentanyl is about 50 times stronger than heroin. [12] The drugs people buy from dealers may look, taste, and smell like heroin, but they may contain fentanyl instead. 

Experts say more than 150 people die every day from overdoses of synthetic opioids like fentanyl. [12] Many people load up needles with the amount of drug that seems right to them. But if that dose contains fentanyl, it could be far too much. 

Why do dealers include fentanyl in heroin? It’s easier to smuggle into the country. Even small amounts result in big profits, so dealers don’t need to push big packages past the authorities. And since it’s very addictive, dealers can include fentanyl with other drugs and ensure their customers develop an addiction much more quickly. 

Treatment for Heroin Withdrawal & Detox

Heroin withdrawal is extremely painful and often leads to relapse. Someone attempts to quit independently but relapses. A lower physical tolerance caused by brain cells healing during withdrawal means a greater risk of overdose. 

With medical heroin detox, medication-assisted treatment (MAT), and social support from a heroin rehabilitation program, many people safely and successfully overcome heroin addiction.

Inpatient Rehab

Inpatient rehabilitation is safer than quitting cold turkey. Medical teams can provide supervision and medications to help the brain adjust. 

In an inpatient program, you move out of your home and into the facility. Some people use this program to help them detox from drugs. Others stay in the program longer until their sobriety skills are strong enough to allow them to live at home without relapsing. 

Medication-Assisted Treatment 

Medication can ease withdrawal symptoms and reduce drug cravings. Medications used in MAT programs include the following:

• Buprenorphine: This partial opioid agonist is typically prescribed as Suboxone, and it eases cravings without causing intoxication.
• Methadone: This opioid agonist lasts several hours in the body, helping people who struggle with long-term opioid abuse to quit misusing opioids.
• Naltrexone: This maintenance medication is prescribed after withdrawal is complete to reduce the intoxicating effects of heroin in the event of a relapse.
• Suboxone. Suboxone contains both buprenorphine and naloxone. This combination reduces addiction symptoms and offers abuse protection. 

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.

Behavioral Therapy

You will also receive behavioral therapy from a trained counselor in a rehabilitation program. Group therapy is the most common social approach, but you may also attend individual counseling, family counseling, art therapy, animal-assisted therapy, physical and occupational therapy, and other types of support.

Studies suggest that individualized combinations of MAT and behavioral therapy greatly improve outcomes for most people.[13]

Preventing Relapse

Addiction is a chronic condition. People can and do gain control over their symptoms. But relapse risks are real, and people must develop strategies to cope with them. 

The following steps can help people lower their relapse risks:

• Use your medications. If the doctor recommends MAT, keep taking the drugs as prescribed. Don’t skip doses or stop taking them until your doctor tells you to. 
• Keep your appointments. Therapy is an important part of recovery for many people. Keep your therapy appointments and work through your concerns and risks with your doctor. 
• Join support groups. Many people appreciate meeting others in recovery through support group meetings. Find a group you enjoy and join meetings when the urge to use starts. 
• Stay away from triggers. Your therapist can help you identify the people, places, and things that make you crave drugs. Once you’ve identified them, stay away from them. 

Frequently Asked Questions About Heroin

We’ve compiled some of the most common questions about heroin. 

What does heroin look like?

Heroin can look like a white powder, a brown powder, or a sticky substance that looks a little like tar. 

What does heroin smell like?

Heroin smell varies depending on the type you use. White powder can smell pungent or acidic. Black-tar versions often smell like vinegar. 

What does heroin feel like?

People who use heroin often report a rush of good feelings, followed by profound sedation and the sense of drifting in and out of sleep.

How long does heroin stay in your system?

Heroin moves out of the body very quickly. Most people don’t feel the impact of the drug after an hour or two. 

How long does heroin addiction treatment usually last?

Heroin addiction treatment programs should last a minimum of 90 days. Most people need much longer treatment times to get better. Longer treatment teams are linked with better chances of sustained recovery.

Is heroin a stimulant or a depressant?

Heroin is a depressant. The drug slows breathing and heart rates, putting users into a relaxed and dream-like state. 

Should you quit heroin cold turkey?

It’s not wise to quit heroin cold turkey. Physical and mental health symptoms can lead to relapse. Medical supervision and the use of medication-assisted treatment are recommended.

What percentage of heroin addicts recover?

It’s hard to know how many people truly recover from opioid addiction. Experts say about half of people relapse, but sometimes, they relapse once and never do so again.