Updated on February 16, 2024.
Opioid painkillers played a role in more than 75 percent of the 106,699 United States drug overdose deaths in 2021, according to the Centers for Disease Control and Prevention. While the vast majority of deaths involved fentanyl and other synthetic (lab-made) opioids, heroin use was also part of many fatal overdoses.
For a number of reasons, including the stigma that comes with addiction, it’s difficult to know how many people use heroin. One 2021 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), estimated that more than 1 million people in the U.S. aged 12 or older had taken the drug in the 12 months prior.
But what is heroin, exactly, and how does it affect the body? How do people become addicted? Most importantly, what can be done to help?
What is heroin?
Heroin belongs to a class of drugs called opioids. They are derived from or related to substances in poppy plants and include methadone, morphine, oxycodone, hydrocodone, and fentanyl. Though these medications can be used as powerful painkillers by healthcare providers (HCPs), heroin has no medical uses in the U.S., where it has been considered illegal since 1924.
Heroin is synthesized from morphine and comes in the form of a white or brown powder or as a black sticky substance. It can be injected through a vein, smoked, or snorted.
Highs and lows of heroin
Like other opioids, heroin blocks out pain. It also makes a user feel high, initially in the form of an intense euphoria that can last several minutes. Following that peak, users typically feel relaxed, drowsy and “out of it” for three to five hours.
With regular use, a dependence can develop. If a user doesn’t quickly gain access to more heroin, they will crash, or go into withdrawal. In the more immediate or acute phase, withdrawal can involve throwing up, diarrhea, muscle pain, cold flashes, fever, sweating, high blood pressure, and a quickened pulse. Later, longer-term symptoms can include fatigue, depression, anxiety, short-term memory problems, and an intense craving for the drug (to avoid these symptoms).
Heroin tolerance can grow over time, as well. This means users may need greater amounts or a more powerful drug to achieve the same high. That’s partly why the use of fentanyl, a synthetic opioid that’s up to 50 times more powerful than heroin, has skyrocketed in recent years.
The most serious risk of heroin use is overdose, which is frequently fatal. When someone takes too much of the drug, blood pressure drops and they become extremely sleepy. Skin and/or lips may turn bluish, and the pupils of their eyes will shrink. Breathing slows and can eventually cease, leading to death unless treatment is administered quickly.
In the case of an overdose, call 911 right away. Or, if you have naloxone on hand and are trained in its use, it may be employed to treat the overdose before calling 911. Naloxone is medication designed to restore breathing and rapidly reverse an overdose. It’s available in all 50 states, legal to carry, and can be procured with or without a prescription.
The making of a substance use disorder
Reasons for trying heroin for the first time vary greatly. Since the drug may have the temporary effect of relieving both physical and psychological pain, many people use it to deal with unresolved feelings from past traumatic experiences, says Mark Hutchinson, a mental health counselor who specializes in addiction in Utah. “Or they started with marijuana or alcohol and found they needed more and more to get high. Heroin is a more efficient high,” he says.
Taking prescription opioids such as hydrocodone (Vicodin) and oxycodone (OxyContin, Percocet) can also be a catalyst. Some people develop addictions when using the drugs for a medical reason, such as back pain or recovery from surgery. Eventually, they may move on to stronger and more readily available opioids, such as heroin.
Prescription drug cost plays a role, too. “Oxycontin is expensive, plus it’s in a locked safe in the pharmacy, and you usually have to wait to pick it up,” explains Hutchinson. “Heroin is a lot cheaper.”
That said, although misusing a prescription opioid does increase the risk of starting heroin, only a small percentage of people switch from prescription opioids to heroin, according to the National Institute on Drug Abuse (NIDA). Rather, heroin addiction often begins with heroin itself—it is more often the first opioid taken.
Heroin addiction as a medical issue
While the stigma attached to heroin use has not gone away, the public perception of addiction has changed over time. The medical community, for example, now commonly recognizes it as a medical disease—a brain disorder—versus a moral weakness.
“There are parts of the brain that are more affected by addiction, such as the hypothalamus and the amygdala, which are connected to the frontal lobe, the judgment and responsibility area of the brain,” explains Hutchinson. “When someone is addicted to anything, the amygdala and hypothalamus start to deteriorate physically.”
It becomes a feedback loop, explains Hutchinson. “When that happens, people will continue to use even though they know it’s high risk and will end badly,” he says. “It gets to the point where using doesn’t even bring pleasure, it just allows them to function.”
Heroin addiction help and recovery
If you or a loved one are using heroin, seek help as soon as possible. Addiction support groups, counseling, and psychotherapy can be key components to help with recovery. Organizations like Narcotics Anonymous and the Substance Abuse and Mental Health Services Administration (SAMSHA) national helpline (1-800-662-4357) can provide support, education, and encouragement to help you through withdrawal and prevent relapse.
There are also a variety of inpatient and outpatient programs available for those entering recovery. Operators of these programs use multiple therapeutic approaches to treat heroin addiction. These typically include behavioral therapy—cognitive behavioral therapy, in particular—and medication such as methadone or buprenorphine.
The cost and availability of treatment programs can vary greatly depending on your location. If possible, Hutchinson recommends starting heroin addiction treatment at an intensive inpatient program and then joining an outpatient program to stay clean. He says that group therapy can be particularly helpful.
“Patients bond with one another, not just because they have people who know what they’re going through, but also in sharing what’s happened in their lives to bring them to this point,” says Hutchinson. “They trust one another and want to spend time with each other.”
If you have a loved one with a heroin addiction, it’s essential to care for and support them in their efforts to get clean, says Hutchinson. It might not be easy, he adds, as addiction can lead people to harmful, hurtful behaviors, because parts of the brain aren’t functioning the way they should. But Hutchinson says the odds of recovery are much improved with support of friends and family.
