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Know the Signs of Heroin Use

You may also find drug paraphernalia, such as burnt spoons, small plastic bags with white powder in them, tiny glass pipes, rubber tubing, cut straws, or syringes.

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Various Signs of Heroin Use

Heroin affects people in different ways, depending on the amount taken, the quality and content of the batch, the person’s individual characteristics, and if heroin is taken alone or in combination with other drugs.

If your loved one is using heroin, you’ll likely notice some of these signs of use:

Drug Paraphernalia

Heroin is commonly smoked, snorted, or injected. Specific items are needed to use heroin, particularly if someone is smoking or injecting it.

Cut straws are used to snort heroin. Aluminum foil, aluminum cans, and glass pipes might be used to smoke heroin. Rubbing tubing, syringes, and burnt spoons are all used to inject heroin.

You may also notice lots of products used to cover up the smell of smoke or other odors, such as air fresheners, incense, or perfume.

Physical Signs of Heroin Use

If someone is on heroin, there are telltale physical signs. Here are some of them:

  • Nodding off or overall sleepiness
  • Pinpoint pupils
  • Runny nose
  • Slurred speech
  • Excessive sweating
  • Flushed or red skin
  • Heavy eyelids
  • Coughing (if heroin is smoked)
  • Poor coordination

With long-term use, additional physical signs will become apparent, such as these:

  • Weight loss
  • Dental issues, such as tooth decay
  • Track marks or bruises on the arms and hands from injecting the drug
  • Nosebleeds from snorting heroin
  • Scabs from skin picking
  • Flu-like symptoms when withdrawing from heroin

Heroin and other opioids slow digestion. The person may talk about intestinal issues, particularly constipation.

Behavioral Signs of Heroin Use

If a person is using heroin, changes in behavior are inevitable. These include the following:

  • Extreme mood swings
  • Lying about whereabouts and activities
  • Hanging out with new groups of friends
  • Financial problems
  • Swings in energy levels
  • Poor performance at school or work
  • Missing social engagements
  • Shirking responsibilities
  • Poor personal hygiene
  • Relationship troubles
  • Giving up activities and hobbies that used to be important
  • Isolation

Psychological Symptoms of Heroin Addiction

People who abuse heroin also experience psychological changes, and they can be visible to outsiders.

These signs could indicate heroin addiction:

  • Unexplained changes in personality or attitude 
  • Unexplained anxiety or paranoia 
  • Fearful behavior

Drug abuse is often associated with stigma. People may believe that heroin users are lazy, at fault for their drug use, and not worthy of help. Some heroin users internalize this stigma, and they react by denying the problem or trying to hide it. Feelings of guilt, shame, and fear can take hold. 

Duration of Heroin Use

The signs of heroin use are directly related to how long the person has been using the drug.

Early Signs of Use

In the early stages of heroin use, the person may not display many signs, but these will compound over time. Initially, you may only notice signs of the person being high, such as pinpoint pupils, flushed skin, and excessive sweating.

As they use heroin for longer, it will take more of a toll on their physical appearance, and their behaviors will change more. Virtually every area of their life will begin to suffer.

Short-Term Heroin Effects

Heroin effects last three to five hours. They may include initial feelings of pleasure and relief from pain. There may also be signs of confusion, clumsiness, and drowsiness. Speech may be slurred or slow.

At this time, people sometimes feel drowsy. The heart rate slows down. Breathing slows down. The mouth may feel dry, and pupils appear tiny. There is a reduced appetite and possible vomiting, along with a reduced sex drive.

When the drug effect wears off, people typically feel depressed. This often triggers the craving to take the drug to feel good again.

Long-Term Effects

Using heroin regularly will eventually cause further problems.

Some of the physical effects include damage to the heart, brain, liver, and lungs. Vein damage from injection sites can become apparent in the form of track marks.

Many people experience dental issues, constipation, and no sex drive. Constipation is common. Regular heroin use can cause feelings of intense sadness when not on the drug.

With regular use, people experience increasing financial problems. Heroin is highly addictive so to get the same effect, it is necessary to use higher doses over time. This dependency costs more and more money. At the same time, it’s harder to hold a job, so people often steal to finance their heroin habit.

Heroin Overdose Signs

If you are around someone who has taken heroin, it is important to recognize the signs of an overdose. An overdose is a medical emergency, and the person’s survival depends on prompt action from bystanders.

These are heroin overdose symptoms:

  • Bluish lips and fingernails 
  • Slow, shallow breathing 
  • Cold or clammy skin 
  • Low body temperature 
  • Convulsions or seizures. 
  • Hallucinations or extreme mental confusion 
  • Unresponsiveness
  • Gurgling sounds while breathing

It is important to realize that overdose is a medical emergency. If you cannot wake the person up, call 911 immediately.

Naloxone temporarily reverses the effects of an opioid overdose. First responders such as paramedics, police officers, ambulance drivers, and emergency workers usually carry naloxone. If you suspect your loved one is abusing heroin or any other opioid, it’s a good idea to keep naloxone on hand.

If you see overdose signs, administer naloxone immediately. Tell medical personnel what you have administered when they arrive. Even though naloxone temporarily reverses overdose, further medical assistance is still needed. Once the naloxone wears off, the overdose could return.

Heroin Withdrawal

If someone is dependent on heroin, symptoms of withdrawal will appear once heroin is processed out of the body. Typical opioid withdrawal symptoms include the following:

  • Cravings for opioids
  • Fever
  • Excessive sweating
  • Shaking and twitching
  • Nausea
  • Diarrhea
  • Vomiting
  • Crying
  • Mood swings
  • Stomach cramps
  • Muscle aches
  • Hot or cold flashes
  • Goosebumps
  • Rapid heartbeat
  • Insomnia
  • Overall weakness
  • Yawning
  • Stress
  • Loss of motivation
  • Anxiety
  • Chattering teeth

Symptoms are usually at their worst in the first three days of withdrawal.

Certain medications, such as buprenorphine and methadone, are used to manage the opioid withdrawal process. Used as medication-assisted treatment (MAT), these drugs can mitigate withdrawal symptoms and help people feel comfortable during withdrawal. The FDA-approved lofexidine is also designed to reduce withdrawal symptoms.

People may be on MAT for a few months or years. Some people remain on maintenance medications indefinitely.

Self-Assessment: Identifying Personal Risk

Are you struggling with heroin? Answer the following questions honestly. The more “yes” answers you give, the stronger your chances of addiction. 

  1. Do you need more heroin to get high than you did when you started using?
  2. Does the idea of missing a dose of heroin make you feel anxious or worried?
  3. Do you use heroin first thing in the morning to avoid feeling sick?
  4. Are you worried about your heroin use?
  5. Do you find it hard to quit using or lower your heroin dose?
  6. Do you spend a lot of time getting high or recovering from heroin use?
  7. Have you ever missed important appointments or events because of heroin?

If you think you need help with a heroin use issue, take action. Entering a treatment program now could mean quitting heroin for good and avoiding some of the serious risks associated with long-term use. 

Understanding Heroin’s Neurobiological Impact 

Long-term heroin use can change the brain’s physical structure. Those alterations can make it harder for users to regulate their behaviors, especially when under stress. 

Long-term heroin use can change the body too. People who keep using the drug develop a tolerance to it, meaning they need larger doses of the drug to get high. They may also develop physical dependence, so they feel sick between doses and when they try to quit. 

Repeated heroin use is also associated with chronic relapse. People become so dependent on the drug that they’ll keep using it despite the consequences. Without help, people with this level of addiction put heroin at the center of everything they do. 

Heroin users also experience a variety of medical complications, including the following:

  • Constipation
  • Lung disease
  • Mental health disorders, including depression 
  • Sexual dysfunction 
  • Scarred or collapsed veins (if the drug is injected) 
  • Organ damage (if contaminants are injected) 
  • Hepatitis or HIV (if needles are shared)
  • Nasal tissue damage (if the drug is snorted)

Approaching Conversations About Suspected Heroin Use 

If you think someone is using heroin, you can be a source of help and healing. An open and honest discussion about what you’ve seen and what should happen next could change your loved one’s life for the better. 

Use the following approaches during your talk:

  1. Open with honesty. Tell the person about the heroin abuse signs you’ve seen. Explain that you care and you’re worried about them. 
  2. Explain how treatment works. Remind the person that plenty of people struggle with drugs. Introduce the idea of entering a treatment program and getting help. 
  3. Express your support. Tell the person how you’ll help with the next step. Maybe you can go with them to the treatment center or make the introduction phone call. 

This conversation will be sensitive, and it’s best held in private. Don’t ambush the person at work or in the middle of a crowded restaurant. Talk when you’re in private, ideally when the person is likely to be sober. 

You may repeat this conversation multiple times before the person agrees to get help. Know that each time you discuss heroin, you’re making a tiny change in the way the person might behave next time. 

How to Help Someone Who Is Using Heroin

If you think someone has overdosed on heroin, call 911 immediately and administer naloxone if you have it. Stay with the person until professional medical help arrives.

If your loved one is regularly using heroin, they need help. Talk to them about the signs you’ve observed, and find them a treatment program that can help.

Medications can be vital in recovery from heroin addiction, but therapy will be the backbone of treatment. They’ll learn coping skills that can help them to resist the temptation to relapse and build a new life in sobriety.

Most treatment programs begin with medical detox and include both individual and group therapy. The level of care will depend on the severity of the addiction, but higher levels of addiction treatment (such as inpatient treatment or partial hospitalization treatment) are generally recommended for heroin addiction.

Support is critical, so your loved one will be guided to build a strong support system in recovery. This will include family members, friends, sober peers, therapists, and others who are committed to supporting your loved one in recovery.

With the right treatment, your loved one can stop using heroin. There is hope in recovery.

Profile image for Dr. Alison Tarlow
Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More

Updated February 21, 2024
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