Heroin Addiction, Treatment & Recovery

Start defeating your heroin addiction. Help is easier to find than you might think.

You are one phone call away from discovering entirely new options for your future. Very soon, you could be on your way to regaining control, feeling free, recovering your relationships, and restoring your sense of purpose and meaning. All of that is possible with the support of caring experts who know how to help addicts stop using heroin. Rehab truly works for many people like you.

So learn more about heroin abuse symptoms, why the drug is so addictive, and where to get treatment.

What Is Heroin?

Heroin is derived from the seed pods of poppy plants. First processed into morphine, the addictive milky sap of the poppy is then further processed into heroin. It is considered to be an analgesic or painkiller. Heroin, in its purest form, is a white powder that can be used by injection, snorting, or smoking. Typically, the heroin used is impure, however. It is mixed by dealers with additives such as caffeine, flour, chalk, talcum powder, sucrose, starch, powdered milk, antihistamines, sugar, quinine, or strychnine (University of Rochester Medical Center, 2014). Heroin has a range of colors and can be found in white, brown, gray, and black (Stop Heroin, 2008-2014).

With inconsistencies in ingredients and strength determined by illegal providers, poisoning and overdose are consistent risks.

Heroin and the Law

Heroin is considered a Schedule I drug in the U.S. and Canada. This means that there is "no currently accepted medical use and a high potential for abuse" (U.S. Department of Justice, 2014). Drugs in Schedule I are considered dangerous and able to cause psychological and physical harm (Government of Canada Justice Laws, 2014). Consequently, heroin users have to obtain heroin illegally "from a market that is highly priced and violent and where crime is frequent" (Riley, 1998).

Additionally, heroin is not governed by any agency that would control the quality of its ingredients. This causes further danger to the user. It is estimated that street heroin is three- to 99-percent pure (Johns Hopkins University, 2014). With inconsistencies in ingredients and strength determined by illegal providers, poisoning and overdose are consistent risks.

How Does Heroin Work? How Is It Used?

A significant attraction of heroin is its rapid and euphoric effect. Plus, addicts often discover multiple ways to use heroin. It can be injected, smoked, or snorted (NIDA, 2014):

  • Injection

    Injecting heroin into a vein produces the most rapid effect of the drug. Other forms of injection have more rapid effects than smoking or snorting as well. For injections, a heroin user must dissolve the drug. Typically, this is done with water and heat. It is then injected into a vein, a muscle, or under the skin (skin-popping).

  • Smoking and snorting

    Heroin can be smoked and snorted. For smoking, it is commonly heated on aluminum foil and smoked with a small, straight pipe directly from the foil. Heroin can also be snorted as a powder or put into a water solution in a nasal mister bottle (Stop Heroin, 2008-2014).

Intoxication typically lasts for several hours during which bodily processes like heart rate and breathing are slowed down.

Heroin Intoxication

The "high" of heroin use sets in at different rates depending upon the method of use. For example, an injection of heroin into the vein has an almost immediate effect (seven to eight seconds) versus an injection into a muscle (five to eight minutes). Smoking or snorting heroin takes longer—about 10 to 15 minutes (Heroin.net, n.d.).

The initial effect of intoxication is described by users as a "rush." This is an intense feeling of pleasure that floods the body. It is commonly accompanied by nausea and vomiting. Intoxication typically lasts for several hours during which bodily processes like heart rate and breathing are slowed down. During this time, a user can be observed "nodding" or in a state of drowsiness. Typically, there are periods of waking when intoxicated.

The physical signs of heroin use and intoxication can include:

  • Small pupils
  • Drowsiness
  • Warm and flushed skin
  • Poor response due to drowsiness and poor mental functioning
  • Disorientation
  • Wakefulness alternating with drowsiness, appearing heavily sedated
  • The body appearing limp, asleep, heavy, or droopy
  • Shallow breathing
  • Itching
  • Complaints of dry mouth
  • Poor coordination (NIDA, 2014)

Heroin Withdrawal

Withdrawal from heroin is a difficult experience. It is considered a medical condition whose consequences can range from discomfort to death (LeVert, 2006). While still in active addiction, users experience what is known as being "dope sick" when they have gone too long between doses. This is early withdrawal that usually leads to more use to feel better. The withdrawal symptoms of a heroin addict range from early and milder to acute and most severe. Withdrawal symptoms at the most severe have been likened to a serious bout of the flu that is debilitating while it lasts. Heroin withdrawal itself is not considered life-threatening; however, there can be fatal complications, and medical supervision is highly recommended for complete withdrawal.

Early withdrawal symptoms:

  • Runny Nose
  • Sweating
  • Yawning
  • Restlessness
  • Anxiety
  • Irritability
  • Achiness
  • Insomnia

Symptoms of acute withdrawal:

  • Dilated pupils
  • Vomiting
  • Nausea
  • Goosebumps
  • Abdominal cramping
  • Diarrhea

Complications of withdrawal can include:

  • Aspiration—vomiting breathed into the lungs
  • Dehydration from vomiting and diarrhea
  • Complications of other health issues
  • Overdose after returning to use because withdrawal lowers the amount of heroin one can tolerate (U.S. National Library of Medicine, 2011)

Why Is Heroin So Addictive?

Heroin use creates changes in how the brain functions. It does so by affecting receptors in the brain that cause euphoria and kill pain. When ingested, heroin converts back to morphine and produces the same effects as morphine in the brain.

Regular heroin use changes the functioning of the brain. One result that develops is a higher heroin tolerance, in which more of the drug is needed to achieve the same intensity of effect. Another result is dependence (commonly called "addiction"). When people are heroin-dependent, they continue to use despite the negative consequences from it. Because of the severe feelings of discomfort and distress in withdrawal, users who are dependent avoid becoming "dope sick" by using again (NIDA, 2013).

Heroin users become "flooded with extra opiates and dopamine" ("feel-good chemistry") in the brain when intoxicated. Eventually, with regular heroin use, the brain changes and stops producing its own natural "feel-good" chemicals. If this occurs, it is thought to be not fully reversible. People with this type of heroin-related brain change often need medication in order to feel normal when they are no longer using (Heroin.Net, n.d.).

Heroin effects are all a function of brain changes caused by the drug. The high occurs because of the response of brain receptors that control pain and produce pleasure. Withdrawal is the brain's way of saying it is time for more of that effect. Building a tolerance for heroin (needing more to get the desired effect) and heroin addiction overall are both a function of brain changes. Additionally, the behavior and mental and emotional struggles of a heroin addict are directly related to the effects of heroin on the brain. (Kosten & George, July 2002).

All of that plays a role in why the heroin addiction rate in America is estimated to be about one addict for every five people who use the drug (NIDA, 2014).

Heroin users have a higher risk for hepatitis and infections such as HIV, TB, and STDs.

Medical Issues

The use of non-sterile paraphernalia and the high-risk lifestyle of heroin users can cause serious medical concerns (NIDA, 2014). For example, heroin users have a higher risk for hepatitis and infections such as HIV, TB, and STDs. These risks are due to use of non-sterile needles and the general lifestyle of many heroin users. Additionally, malnutrition, poor immunity, and long-term neglect of health problems are common. As a result, heroin users can need medical attention not only for the addiction itself, but also for physical problems caused by it or neglected because of it.

The risk of death from overdose is also a major concern when it comes to heroin addiction. Statistics show that heroin overdose deaths in America grew in number by 494 percent between 2001 and 2014. That's a six-fold increase (NIDA, 2015).

An unborn baby exposed to heroin is at risk for birth defects, premature birth, and death.

Heroin and Pregnancy

Heroin use is a serious concern during pregnancy. Unborn children become addicted and can suffer a great deal of distress and damage, including premature birth, birth defects, and death. Because the mother's use exposes the baby to the heroin she uses, children are born addicted. They require hospitalization and intensive medical treatment for heroin withdrawal just after birth. An unborn baby exposed to heroin is at risk for birth defects, premature birth, and death. The newborn's withdrawal requires 24-hour medical care until detox is complete.

Symptoms of heroin withdrawal in babies include:

  • Excessive crying
  • Fever
  • Irritability
  • Seizures
  • Slow weight gain
  • Difficulty breathing
  • Trembling
  • Sweating
  • Vomiting
  • Difficulty with feeding
  • Tremors
  • Diarrhea
  • Vomiting
  • Possible death (Adapted from U.S. National Library of Medicine, 2014)

Prenatal care and a comprehensive drug treatment program for the mother can improve the health of both mother and baby. Mothers may be given medications during pregnancy like methadone, buprenorphine, and naloxone (Fund, Fischer, Welle-Strand, & al, 2013) which reduce risks and ease the withdrawal that an addicted baby will undergo just after birth (Jones, Kaltenbach, Stine, et al, 2010).

Psychiatric Issues

As many as 67 percent of opioid addicts may also have psychiatric issues (Roncero, Barral, & Rodríguez-Cintas, et al, 2016), which can greatly complicate both conditions. These combined issues are called dual diagnosis, dual disorders, or concurrent or coexisting disorders. The relationship between the two is complex, and the treatment of people with (both) is more complicated than the treatment of either condition alone. This is unfortunately a common situation… (NAMI, 2013). There are many professionals trained in treating both addiction and mental health issues at the same time. It is a best practice in medicine to have treatment for both simultaneously (Centre for Addiction and Mental Health, 2002).

Who Uses Heroin

Heroin use is a problem in the U.S. and Canada in all sectors of life—urban, suburban, and rural areas—as well as all economic groups and across the range of educational and occupational status. The reason people use heroin is an individual issue; however, there are certain people at risk for using. For example, using drugs to self-medicate emotional pain is common in all addiction. Also, people with childhood trauma are at risk for addiction as well as those with other psychological problems (Darke, 2013). There is also a significant portion of heroin abusers who have used painkillers, both with prescription and without, before starting heroin.

The Dangers of Fentanyl

Today, a lot of street heroin is mixed with fentanyl, often without the knowledge of those who buy and use it. Fentanyl is a synthetic opioid that can be up to 100 times more potent than morphine (NIDA, 2016). Because fentanyl is highly potent, users who take it have an extremely high risk of overdosing, especially if they aren't aware that it's been mixed with the heroin they're using. Many addicts stop breathing and die from such overdoses unless they receive immediate treatments of naloxone to reverse fentanyl's effects.

Heroin Addiction Treatment

Much of the treatment for heroin use is the same as for other substances: medical supervision for withdrawal and detox, psychiatric services if there is a mental health condition, individual, group and family counseling, and education and relapse prevention planning. Heroin addiction recovery is done in inpatient, residential, and outpatient settings. Many enter "step-down" settings before returning fully to the community after treatment. Such programs include halfway houses, transitional programs, and "sober living" communities. Community self-help groups such as Narcotics Anonymous provide further support.

While the core of substance treatment is similar for most drugs, heroin abuse can require an additional step—the use of medicines to correct for the brain changes caused by that abuse. Some of the drugs used to treat heroin addiction are buprenorphine, methadone, and naltrexone (NIDA, 2014). These medications work in the brain receptors that heroin affects. An addiction-certified physician can recommend which may be most appropriate.

Signs of a Heroin Addict (for Friends and Family)

Significant others in the lives of heroin addicts have a difficult struggle of fear, frustration, anger, helplessness, and grief in reaction to the tolls of heroin use on their loved ones. While the user is active in addiction, the many safety risks are naturally concerning. Even after rehab, concerns continue due to the significant risk of relapse.

Below are some heroin addiction symptoms and signs that can be helpful for significant others to know about. A heroin addict's behavior and visible clues might include:

  • Continuing contact with people who use or deal
  • Frequenting old places
  • Having changes in mood
  • Having poor grooming and appearance
  • Having poor motivation
  • Losing jobs or not seeking work
  • Having track marks from needle use (red and swollen places on the skin) and wearing long pants or long sleeves to cover them
  • Scratching or picking at skin
  • Spending long periods alone
  • Losing interest in activities
  • Having paraphernalia such as needles, syringes, burnt spoons, aluminum foil, straws, or metal pipes
  • Having small plastic bags
  • Being deceptive or lying
  • Borrowing money, stealing it, or taking valuable objects (Adapted from HowToQuitHeroin.com, 2014)

How to Help a Heroin Addict

Here are some tips to help significant others when a loved one is doing heroin:

  • Educate yourself about heroin, its use, and the addiction.
  • Keep in mind that you can do nothing to "make" an addict get better.
  • Take care of yourself and other loved ones.
  • Talk openly with your loved one about his or her addiction.
  • Remember that heroin use is a serious medical condition.
  • Discuss the addiction without shaming—as if you were discussing any other serious medical issue.
  • Expect anger, denial, avoidance, and relapse as part of any addiction.
  • Offer help to find help.
  • Be supportive of all recovery efforts.
  • Express your love and concern.
  • Communicate with compassion and concern, remaining firm but calm.
  • Remember that money or valuables will be converted into heroin.
  • Remember that any "slack" of theirs that you take up can help them use more heroin.
  • Find a support group for yourself and continue your life.

Discuss the addiction without shaming—as if you were discussing any other serious medical issue.

Get Help Overcoming Your Addiction to Heroin

With guidance from substance abuse professionals, you can learn how to beat heroin addiction. Treatment centers all over the country welcome addicts who are ready to kick their dependencies and get their lives back.


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