How Addictive Is Heroin, and What Other Risks Does It Pose?
The Drug Enforcement Administration (DEA) classifies heroin as a highly addictive illegal opiate drug with no accepted medicinal use in the United States.
Heroin is derived from morphine, which comes from the opium poppy plant. The manner in which it interacts with opioid receptors in the brain and causes a surge of pleasure makes it extremely desirable to repeat use again and again.
Repeated use of heroin leads to drug tolerance, which means you will need to take more of it to feel the same high. When you take heroin regularly, especially in higher and higher doses, your brain becomes dependent on the drug. You can feel physically ill and struggle with physical and emotional withdrawal symptoms and extreme cravings when you stop taking it. This can make it hard to stop, and drug use can become compulsive.
In 2016, the National Survey on Drug Use and Health (NSDUH) reported that over 600,000 American adults battled heroin addiction.
Heroin is a powerful opiate, and even one use can cause fatal overdose. Regular use of heroin increases the potential for negative health, emotional, and behavioral problems as well as the risk for drug dependence, withdrawal symptoms, and addiction.
Heroin Addiction Potential
The American Society of Addiction Medicine (ASAM) reports that close a quarter of all people who use heroin will struggle with opioid addiction.
Heroin is so addictive because of the way it floods the brain with dopamine as it fills opioid receptors and prevents dopamine from being reabsorbed.
Dopamine is a neurotransmitter that tells you to feel happy. Normally, things like pleasant smells, foods, or events can cause small spikes in dopamine levels. The extreme amount of dopamine that fills the brain when heroin is involved causes an intense rush — a euphoric high.
Heroin is potent, powerful, and also fast-acting. The U.S. National Library of Medicine (NLM) reports that all of the typical ways that heroin is abused — snorting, injecting, or smoking it — send the drug quickly into the bloodstream and brain.
A heroin high can also wear off pretty fast. A person is likely to feel drowsy, sluggish, and mentally “clouded” for several hours after taking heroin.
The National Institute on Drug Abuse (NIDA) warns that heroin is considered extremely addictive, and regular use causes a tolerance to build up rapidly. When this happens, it will take more heroin to feel the same effects. With higher doses of heroin, taken in increasing frequency, drug dependence more quickly forms.
As the brain gets used to heroin controlling its chemical makeup, it can struggle to keep itself balanced on its own. When heroin is not active in the bloodstream, significant withdrawal symptoms can set in.
Physical withdrawal symptoms, intense cravings, and significant mood swings can make it immensely desirable to take more heroin. Drug use can quickly become compulsive and difficult to control.
Addiction is a brain disease involving an inability to control drug use or stop without help. Heroin addiction occurs with regular use of the drug.
Addiction risks go up if you:
- Have a family history of addiction.
- Suffer from a co-occurring mental health or medical disorder.
- Take other drugs.
- Use heroin in high doses on a regular basis.
Misuse of prescription opioid drugs can increase the odds for heroin abuse and addiction. NIDA published a study indicating that people who abused prescription painkillers were almost 20 times more likely to try heroin than people who didn’t.
Between 2010 and 2017, overdoses involving heroin quadrupled in the United States. In 2017, over 15,000 people died from a heroin-related overdose, per the Centers for Disease Control and Prevention (CDC).
Since heroin is illegal, it is unregulated and can be cut or laced with any number of toxins or additives. Fentanyl, an even more potent synthetic opioid, is increasingly being discovered in heroin overdoses and the heroin supply. It can be almost impossible to know how pure, and therefore how potent, a dose of heroin is and what else the sample may contain.
Escalating dosage as a result of drug tolerance also elevates the risk for fatal overdose.
A heroin overdose is indicated by the following:
- Shallow, slow breaths or difficulty breathing
- Constricted pupils
- Skin that is cold and clammy and may appear bluish
- Slow pulse and reduced blood pressure
- Extreme drowsiness and a potential loss of consciousness
- Mental cloudiness or confusion and possible unresponsiveness
- Slack, limp, and weak muscles
Coma, brain damage, and death are all possible consequences of a heroin overdose. Medical intervention is necessary when one is suspected.
Naloxone (Narcan) is an opioid antagonist that can reverse a heroin overdose if administered in time and in the proper dose by a trained professional.
Additional Risks of Heroin Abuse and Addiction
Heroin use causes a heavy feeling in the arms and legs, drowsiness, impaired motor control and reaction time, dry mouth, a warm “flush” to the skin, and an inability to think clearly or make sound decisions. Itching, nausea, and vomiting are further side effects of heroin use.
Heroin abuse can increase the risk for contracting an infectious disease, such as HIV/AIDS or hepatitis, from unsafe sexual contact or sharing dirty needles if the drug is injected. Sexually transmitted diseases and unplanned pregnancy can be side effects of heroin use, as the drug lowers inhibitions and makes it harder to think through the consequences of your actions. Increased risk-taking behaviors are common when under the influence of heroin.
Injection drug use can cause infections in the lining of the heart, collapsed veins, scarring or track marks, abscesses, and heart infections and problems. Snorting heroin can cause damage to the nasal membranes and sinus cavities in addition to a chronic runny nose, nosebleeds, and respiratory issues. Lung infections and diseases are potential consequences of smoking heroin regularly.
Heroin addiction and regular use can have the following complications:
- Disrupted menstruation in women and sexual dysfunction in men
- Cardiovascular and respiratory issues
- Brain damage
- Financial strain
- Unhealthy weight loss
- Skin infections and rash
- Trouble at work and/or school
- Increased risk for accident or injury
- Interpersonal relationship issues
- Decline in physical health and attention to personal hygiene
- Memory and concentration issues
- Criminal and possible legal troubles
- Difficulties at home
In short, heroin addiction can infiltrate all parts of a person’s life. It can have a significant negative impact on daily life and the ability to function normally in society.
Heroin use becomes all-consuming, in the case of addiction, and it becomes difficult for someone battling addiction to think of much else or spend time doing things other than obtaining the drug, using it, and recovering from heroin.
Dependence and Withdrawal
NIDA warns that using heroin regularly on a long-term basis can cause some brain damage that may not be reversible. Some of the white matter in the brain may deteriorate with chronic heroin abuse and be unable to completely regenerate. As a result, heroin use can cause cognitive difficulties that include compromised decision-making abilities, an inability to regulate moods and behaviors, and an incapacity to respond properly to stress.
Heroin dependence is a major side effect of regular and repeated use. The more often heroin is used, the more significant drug dependence will be. High doses and mixing heroin with other drugs or alcohol can also increase the rate of dependence more rapidly.
When heroin processes out of the body once dependence is established, withdrawal symptoms can be significant.
- Stomach pain and nausea
- Loss of appetite
- Impaired thinking processes
- Runny nose
- Muscle aches
- Tearing up
- Bone, joint, and back pain
- Drug cravings
NLM publishes that heroin withdrawal symptoms generally start within 12 hours of the last dose of heroin. Withdrawal symptoms can be intense and peak within the first two to three days after stopping heroin use and continue for a week to ten days. Mood swings, cravings, and sleep problems can last longer — up to a few weeks or months.
Since heroin withdrawal can be so significant, relapse is common. A relapse after stopping use of the drug for any length of time raises the risk for fatal overdose.
Heroin is not a drug that is easily stopped without professional help, and it shouldn’t be stopped suddenly. Dependence is best treated through medical detox, which is then followed with a comprehensive addiction treatment program.
Heroin. Drug Enforcement Administration.
Key Substance Use and Mental Health Indicators in the United States: Results from the National Survey on Drug Use and Health. (September 2017). Substance Abuse and Mental Health Services Administration.
Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine.
Heroin. (November 2018). U.S. National Library of Medicine.
What Is Heroin? (June 2018). National Institute on Drug Abuse.
Prescription Opioids and Heroin. (January 2018). National Institute on Drug Abuse.
Today’s Heroin Epidemic. (December 2018). Centers for Disease Control and Prevention.
What Are the Long-Term Effects of Heroin Use? (June 2018). National Institute on Drug Abuse.
Opiate and Opioid Withdrawal. (January 2019). U.S. National Library of Medicine.