Heroin Symptoms and Warning Signs

Medical Definition of Heroin

Heroin (diacetylmorphine), also known as diamorphine, is a synthesised opioid analgesic found in opium plants and roughly two to three times more potent. In medicine, diamorphine is used to treat severe pain, which can be related to cancer, burns or a heart attack. The name ‘heroin’ is in fact only used when referring to the illicit street form of the drug. Pure heroin comes in white powder form, with a bitter taste. Illegal heroin is mostly sold as a white or brownish powder, and is usually ‘cut’ with other types of substances, like sugar, powdered milk, starch or other drugs like quinine.

Heroin also exists in another form, known as ‘black tar’. It can be hard like coal or sticky like roofing tar, and can vary from dark brown to black in colour. Heroin is highly addictive, providing the central nervous system with feelings that can be described as euphoric, anxiolytic and analgesic. When used, heroin converts to analgesic in the body. If you are a heroin abuser, you could be unaware of the strength of the substance – or even its true contents – which could put you at risk of overdose or even death.

Heroin Abuse: Signs, Symptoms and Effects

If you, or a loved one, are abusing heroin, understanding the signs, symptoms and effects of heroin abuse will help answer a lot of your questions. As an opioid, heroin targets the opioid receptors of the brain and attaches itself to them. The result of the interaction between opioid drugs and opioid receptors in the brain is an activation of the pleasure/reward centres, temporarily flooding you with feelings of euphoria. Unfortunately, a greater amount of tolerance is developed with each use of the drug, so that in order to feel the same level of pleasure you initially experienced, your brain demands increased amounts of heroin.

Heroin is referred to as a ‘downer’, which means it quickly brings about a state of relaxation, and blocks the brain’s ability to perceive pain. If you are a heroin abuser with a long history of drug abuse, the signs and symptoms of your heroin use may be easy to conceal. However, they cannot be hidden for too long.

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Physical Symptoms

The physical symptoms of heroin abuse include: constricted pupils, a feeling of heaviness, warm flushing of skin, alternating between wakeful and drowsy state, dry mouth, mental confusion and severe itching. Other ways for you to easily identify a person indulging in the habit of heroin abuse include: nausea and vomiting, slow breathing, slow heart function, coma, possible respiratory failure and brain damage after respiratory failure.

Behavioural and Emotional Signs

When you place priority on heroin usage, your whole universe moves to revolve around this substance. This is one of the reasons why behavioural and emotional changes can be observed in your life or that of a loved one. Whilst in the grip of addiction, you may continue to place more importance on the drug over relationships and other obligations.

There are so many ways in which your behaviour will change when you abuse heroin. You may experience erratic mood swings, depression, aggressive behaviour and withdrawal from friends and social events. You may meet new friends who display some of the physical traits of a heroin user; such as track marks and, in addition, a tendency to use street slang while talking about heroin use.

Typical behavioural and emotional signs related to heroin abuse can draw your attention and that of your loved ones to a need for treatment. Some of them include:

  • Loss of interest in favourite activities and hobbies
  • Decreasing attention to hygiene and physical appearance
  • Regular comments indicating a decline in self-esteem or worsening body image
  • Loss of motivation and apathy toward future goals
  • Lying or other deceptive behaviour
  • Avoiding eye contact, or distant field of vision
  • Sudden worsening of performance in school (including expulsion) or loss of job at workplace
  • Withdrawal from friends and family, instead spending time with new friends with no previous or natural ties
  • Substantial increase in time spent sleeping
  • Increase in slurred, confused or incoherent speech
  • Repeatedly stealing or borrowing money from loved ones, or unexplained absence of valuables
  • Hostile behaviours toward loved ones, including blaming them for withdrawal or broken commitments
  • Wearing long pants or long sleeves to hide needle marks, even in very warm weather

Social and Financial

Drug abuse can totally consume your life, tearing apart your family, friendships and professional relationships. Without the correct help and intervention,you may end up feeling isolated, leading to an even deeper addiction. The effects of heroin abuse go beyond you, as they also have an impact on your home and family life, marriage, education, employment, health and well-being, as well as your finances.

Sadly, it is quite common for heroin to bring about financial stress if you don’t have much money to begin with. Providing for basic needs like housing, food and clothes becomes difficult or even impossible, because the family’s resources have been drained by drug-related financial problems. Your dependents will also suffer when it is impossible for you to sufficiently meet their needs. In fact, financial issues are one of the biggest stressors in relationships. If your relationship is filled with financial stress as a result of your drug use, it can become particularly challenging.

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Top 10 Signs of Heroin Abuse

  • Cravings: You may experience intense urges or cravings for heroin as your addiction worsens
  • Physical dependence: This develops as you become used to the consistent presence and influence of heroin in your system. The physiological changes that occur with this process can leave you feeling unwell or functioning below your normal level of productivity, when there is an absence of the drug in your system.
  • Tolerance: Prolonged use over time can lead to a build up of tolerance to the drug. This means you’ll need more and more in order to achieve the feelings you crave.
  • Withdrawal symptoms: If you attempt to cease heroin usage by suddenly stopping intake or slowing weaning yourself off the drug, withdrawal symptoms may begin to manifest.
  • Poor judgment: When you’re a heroin abuser, you may be more willing than normal to engage in any activity to obtain the drug. Risky behaviours like lying, stealing, selling drugs and criminal acts may be undertaken due to poor judgment.
  • Drug seeking: You may actively engage in sourcing and buying heroin without caring about the amount of time, energy and money that is lost in the process.
  • Financial trouble: This is a major red flag of heroin abuse, as you go ‘over budget’ and even drain your bank accounts in order to raise hefty amounts to spend on the drug.
  • Neglect of responsibility: Another classic sign of heroin abuse is when you choose to buy and use the drug, instead of focusing on meeting career and personal obligations.
  • Growth of unhealthy friendships: When you engage in heroin abuse, your friends and acquaintances are likely to have similar habits.
  • Isolation: Alternatively, you may choose to isolate yourself and withdraw from your friends and family. The main reason for such behaviour could be to avoid discovery and the perceived stigma that comes with it.

Recognising Heroin usage in Family Members

If you find out that a loved one is engaging in heroin use, you should concentrate on providing them with essential moral support to guide them to complete recovery.

The best way to handle heroin use is to address the issue as soon as you identify it. You can check for behavioural changes and physical symptoms of heroin use, and look out for objects in the area they spend most of their time.

Method 1: Watching for Behavioural Changes

If your loved one is addicted to heroin or opioids, they will act differently than normal. Their drug of choice will become their main focus, and more often than not, they are completely by their need. Other behaviours that indicate heroin use can also be expected. They include:

  • Hostility when asked about their substance abuse
  • Secretive behaviour; they attempt to hide where they’re going or who they’ve been with
  • Mood swings that will be caused by their constant substance abuse
  • Altered eating and sleeping habits
  • A disinterest in their physical appearance and/or hygiene
  • A disinterest in activities that used to matter to them, including hobbies, work, and school
  • Spending more time alone or with people you don’t know

The National Library of Medicine suggests that your loved one may even start to miss school or work, due to their excessive drug abuse. Your loved one may even start to exhibit violent episodes due to their heroin use, although such drugs tend to cause moods to switch between excitable and euphoric one minute and depressed the next.

Method 2: Checking for Physical Symptoms

As their addiction to heroin use strengthens, you may notice some physical side effects that are usually present with prolonged use of an opioid over time. The most obvious of these symptoms is a refusal to eat anything. Even if forced, they might store the food in their mouth without chewing or swallowing, before waiting until you are absent or distracted to spit it out.

Showing any of these physical symptoms and refusing to see a doctor also points to substance abuse. This is because they are refusing to stop using heroin, even though the substance is causing severe problems in their day to day life. The physical symptoms you should look out for include runny nose, chills, weight loss, constipation, abdominal pain, diarrhoea, muscle and joint pain, nausea and vomiting, dry mouth and dry mucous membranes in the nose.

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Method 3: Identifying Physical Evidence of Heroin Use

Different forms of heroin are used in different ways; they can be smoked, snorted and injected. When you find heroin abuse signs and symptoms, your next step should be to look for evidence of heroin use. Your loved one may attempt to hide the apparatus being used to take the drug in their room or other places they believe you won’t think to look. The physical evidence of heroin use can include: syringes, rubber tubes, spoons with burnt edges, tiny bags or glass tubes, residue of white or brown powder, sticky substance on furniture, and brown papers with a distinctive smell.

What Does a Heroin Overdose Look Like?

When a heroin overdose occurs, your body shuts down because of the presence of more drugs than your body can handle. The CNS depressant effects from heroin often cause lethal respiratory depression, stopped or slowed heartbeat. It’s possible to overdose after your first use, due to a lack of knowledge about how sensitive your body is to the drug that may result in taking too much. Even if you are a long time user, heroin overdose is still possible. Tolerance is often unavoidable with chronic heroin use, and leads to the intake of huge amounts in order to find satisfaction.

Also, if you inadvertently buy a purer or more potent batch, even your regular amount could cause an overdose. Impurities or additives are sometimes mixed in with street heroin. More potent opioid drugs like fentanyl are also added in some cases. This adds another level of unpredictability and a higher danger for overdose when you use the drug.

The following are some symptoms which can be used to identify heroin overdose: shallow or no breathing, low blood pressure, weak pulse, very small pupils, discoloured tongue, dry mouth, bluish lips and nails, stomach or intestine spasms, delirium, disorientation or confusion, uncontrollable muscle movements, extreme drowsiness and coma.

Heroin Use Statistics

According to the National Centre for Health Statistics, about 63,000 deaths occurred in 2016 as a result of substance overdose. 20,000 of those were a result of the highly potent drug, fentanyl. 15,000 were due to heroin abuse and about 14,500 were the result of prescription opioids. The rest were a direct consequence of cocaine, methadone, methamphetamines and benzodiazepines.

In the case of heroin, the death rate from 1999 to 2005 was found by the NCHS to be steady, after which a 10% increase was recorded between 2005 to 2010, and 33% per year from 2010 to 2014. Since 2014, the percentage has been increasing at the steady rate of 19%.

Causes and Risk Factors for Heroin Abuse

Commonly, heroin abuse is not attributed to a single contributing factor. Instead, a combination of physical, environmental and genetic risk factors work together to cause the problem.

Physical: as a result of the release of pleasurable neurotransmitters in the brain from heroin, a deficiency in the neurotransmitters may cause you to seek out heroin or other opioid drugs in order to gain feelings of pleasure.

Environmental: If you experienced heroin abuse as a part of daily life in the environment where you were raised, you could have a greater chance of engaging in this type of behaviour too. In addition, if you started to use the drug at an earlier age, chances are you might have a higher risk for developing an addiction.

Genetic: you may be prone to addiction if someone in your family has also struggled with it. However, it’s true that not every individual who becomes a heroin abuser has a family history of it.

Therefore, the risk factors for abuse include: lack of family involvement, peer pressure, usage of highly addictive drugs like heroin, psychological or mental illness, conduct disorder in childhood.

Long-Term Health Effects of Heroin Abuse

Heroin abuse can result in a range of different negative impacts on your health and mental functioning for a long period of time. While it can be difficult to see past the instant feelings of euphoria, it is important to take into consideration the long-term health effects that extended heroin abuse can cause.

Heroin is a very powerful drug, and continued use can have very destructive effects on the body. Consistently injecting heroin can lead to collapsed veins and cause your blood vessels and heart valves to become infected, and could eventually lead to tuberculosis. Another long-term health effect of heroin abuse is arthritis.

The physical structure and physiology of the brain can become altered as a result of repeated heroin abuse. This could create long term, difficult-to-reverse imbalances in your neuronal and hormonal systems. According to studies, heroin use causes deterioration of the brain’s white matter, which may affect your ability to regulate behaviour, decision-making, and how you respond to stressful situations. In addition, significantly high degrees of tolerance and physical dependence are caused by heroin. Tolerance occurs when the same physical and mental results achieved from the substance can only come from greater doses than normal. As far as physical dependence is concerned, your body will begin to adapt to the presence of the drug, and if abruptly stopped or reduced, withdrawal symptoms could occur.

Co-Occurring Disorders in Heroin Abuse

A co-occurring disorder is diagnosed when you have a substance abuse disorder (e.g. heroin) and mental illness (OCD, PTSD, anxiety, depression, etc.). It is also known as a dual diagnosis, and generally describes any combination of mental health disorders and substance addictions. Examples of co-occurring disorders include alcoholism-depression, anorexia-cocaine dependence, post-traumatic stress disorder-heroin addiction, anxiety-prescription drug dependence, and so on.

Heroin abuse can co-occur alongside a number of mental illnesses. Some that co-occur with heroin addiction include: alcoholism, anxiety disorders, schizophrenia, depressive disorders, bipolar disorder, eating disorders, personality disorders and post-traumatic stress disorder.

For instance, a co-occurring disorder of heroin abuse and depression occurs because of the potent nature of the drug. When you use heroin, it causes a ‘high’ in the short-term, but consistent use can have severe, negative effects on the parts of your brain responsible for making pleasure signals. A form of brain damage may have occurred that leads to depression, hindering your ability to feel happy without the presence of heroin.

Effects of Heroin Withdrawal

Your body develops a dependence on heroin after you have taken it consistently for weeks or months. This means your central nervous system has become used to the presence of heroin in your system and your body will be unable to function properly or be normal without it. If you’re unable to take heroin or have decided to stop your drug habit, you will experience withdrawal.

Withdrawal begins a few hours after heroin has left your system, around the time you would normally take another dose. During withdrawal, you can expect heroin to affect both your physical and mental health. The side effects from withdrawal are usually physically and mentally exhausting, as well as painful. You can usually expect to experience abdominal cramps, constipation, cold sweats/chills, sweating, fever, nausea/vomiting, dilated pupils, diarrhoea, depression, excessive yawning, cravings, body pain, restlessness and disturbed sleep.

Heroin Addiction Treatment

There are a range of highly effective treatments available for heroin addiction. These include pharmacological and behavioural treatment. Heroin addiction treatment also involves the use of therapy, support groups and lifestyle changes. These are available for you at both inpatient and outpatient addiction treatment clinics. The main aim of heroin addiction treatment is to restore a sense of normalcy to behaviour and function of the brain.

Results of successful heroin addiction treatment can usually be seen in increased employment rates, reduced criminal behaviour and a lower risk of HIV and other dangerous diseases. Even though both behavioural and pharmacological treatments for heroin addiction provide positive results when used alone, studies show that for certain individuals, a combination of both treatment types is the most effective approach.

Your personal experience during heroin addiction treatment mainly depends on certain factors, such as how much of the substance you‘ve been using, and how long you’ve been using it. In addition, recovery depends on how well you can understand and cope with a range of challenges, including the underlying psychological problems that may have caused, or been caused by, your addiction.

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Medication and Behavioural Therapy for Heroin Abuse Treatment

The most effective heroin treatment medications work through the same opioid receptors as heroin, but are a lot safer and less likely to result in the harmful behaviours of addiction. Such medications are divided into three categories:

  • Agonists – which trigger opioid receptors
  • Partial agonists – also trigger opioid receptors, but to a lesser degree
  • Antagonists – which block the receptors and intercept the pleasurable effects of opioids

When you are undergoing heroin addiction treatment, the medication that is used will depend on a number of factors, including your specific medical needs. Effective medications include Methadone, Naltrexone and Buprenorphine.

Behavioural therapies are effectively used in outpatient and residential settings to treat heroin addiction. When applied in combination with medications, forms of behavioural therapy such as contingency management and cognitive-behavioural therapy (CBT) are very effective methods. Contingency management makes use of a voucher-based system in which you as the patient can earn ‘points’ based on negative drug tests, which you can then exchange for items you need, to help encourage healthy living. Cognitive behavioural therapy is designed to help you modify your behaviours and expectations related to drug use. It also helps to increase your skills in coping with different life stressors.

When to See a Doctor

When dealing with heroin abuse, you should see a doctor in any of the following situations:

  • If you wish to receive treatment for heroin abuse or dependence
  • Complications from heroin abuse which need medical evaluation
  • If you notice severe pain, abnormal vital signs or any serious or sudden onset of problems
  • If your loved one has an alteration of consciousness, he or she should be taken to see a doctor immediately, because they might be a danger to themselves or others

If you’re unwilling to go alone, you can enlist the help of a close family member to accompany you to a doctor’s appointment to discuss the issue. In order to ensure an appropriate diagnosis of heroin abuse or dependence, your doctor will ask what symptoms prompted you to seek help, and find out the length and amount of substance abuse you have experienced.

When to Seek Emergency Help

Emergency help is essential, especially when overdose or severe withdrawal symptoms occur. If you need help managing withdrawal symptoms in an emergency room, it means you have become physically dependent, to the point that trying to quit has led to what could be a life-threatening situation. Don’t be ashamed. Seek help immediately.

Whether you’re a new or a long time user, any moment of heroin use could be a crisis point,as it is possible to overdose from even the first time. Seeking treatment for addiction before it reaches a dangerous point is a better idea than waiting for a life-and-death situation to force you into the emergency room.

In the event of a suspected overdose, the first thing to do is call the relevant authorities to get immediate medical assistance. Also, remember to follow the basic first aid steps before the professionals arrive.

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Staging an Intervention

If your loved one is dealing with heroin abuse and talking to them about rehab isn’t successful, an intervention might be best option. Here are some steps to help you stage a successful intervention:

Find an intervention specialist : Confronting an addict alone might only complicate issues. They may be in denial about their problem or refuse help. An intervention professional can help to break their cycle of denial and ensure that the lines of communication stay open as much as possible during the intervention.

Form your intervention group : There are no rules about who should be in an intervention group. The specialist can help to create a strategy and work with your group to address the specific needs of the addict. Your intervention group can include a spouse or partner, parents, siblings, co-workers and close friends.

Rehearse and prepare : The intervention specialist will then provide simple training in addiction and recovery to participating members. Knowledge from such training will equip you to convince the person that they need help. Prepare written stories about how the addiction has affected you and rehearse them before the intervention.

Decide on a time and place : Generally, interventions should be held in a familiar and non-threatening space. This helps the addicted person to feel at ease during the intervention. Also, you should try to choose a time when your loved one will be sober and more open to your intervention.

Be prepared for anything : You cannot possibly predict or control how your loved one will react in the face of an intervention. Intervention specialists are equipped with the experience to calm hostile environments and increase the chance of an effective intervention. Also, contact the authorities immediately if your loved one’s reaction presents danger to the intervention party.

Preventing a Relapse

Relapse occurs to many people as they try to achieve complete recovery from heroin abuse. It should never be seen as a failure or symptom of weakness. If you do not have a deep understanding of addiction, it may be difficult to see why relapses occur. Heroin relapse is not a sign that you have to start again at the beginning of your recovery, but it can be seen as a pointer that additional support is required. Luckily, if you are preparing to leave treatment, there are aftercare planning services that can help to prevent a relapse. Some other tools and techniques are available that can help you stay true to your new and healthy lifestyle:

  • Avoid places and situations that you know may trigger temptation.
  • Steer clear of people who do not support your choice to remain sober, and instead seek out new connections that include individuals who care about your health and well-being.
  • Create a daily schedule and stick to it.
  • If you had no access to an aftercare plan after leaving heroin abuse treatment, you can take time out to research suitable options in your community for continued care.
  • Engage in all aspects of your aftercare plan, and don’t wait to begin accessing these services.
  • Seek out support from trusted friends and family who can provide a listening ear in times of temptation.
  • Join a recovery support group in your community so that you can share your experiences with other individuals who have had similar experiences.
  • Practice the coping skills that work for you, and take time to learn new ones.
  • If you feel that you require additional treatment for heroin abuse, seek out the level of care you need to commit to a drug-free life.

It’s helpful to note that while no particular aftercare treatment plan will work for every single individual, the techniques like those listed above have proven effective at reducing the chances of heroin relapse after treatment.

At Addiction Helper, our staff of highly experienced and compassionate professionals make relapse prevention planning essential for all our patients. If you or your loved one would like more information about heroin abuse treatment and sustained recovery at Addiction Helper, we hope that you will contact us at your earliest convenience.


What is Heroin Abuse?

Heroin abuse refers to an extreme desire to obtain and use heroin, in increasing amounts.

What is Heroin Addiction?

Heroin addiction describes a physical and psychological dependence on heroin in order to function. The life of a heroin addict revolves around the use of the drug. They’ll do anything in order to get it.

Who does Heroin Addiction Affect?

The effects of heroin addiction are not restricted to the physicaland mental consequences suffered by the addict, as their family and friends are also affected.

What are the Risks and Effects of Heroin Abuse?

Heroin abuse can lead to the destruction of both physical and mental health. It can also result in a series of serious social and legal ramifications for the abuser.

Are Signs and Symptoms of Heroin Abuse Deadly?

Heroin abuse creates a feeling of euphoria and reduced pain perception, but it can also lead to severe respiratory depression, coma and even death.

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