Heroin

Medically Reviewed by Jabeen Begum, MD on June 14, 2024
Written by Camille Peri, Keri Wiginton
15 min read

Heroin is a drug that comes from a flower, the opium poppy, which usually grows in Mexico, Asia, and South America. It’s very addictive and has been illegal in the United States since 1924. It can look like a white or brown powder or a sticky black tar. It’s also called horse, smack, junk, and brown sugar, among other names.

How is heroin made?

Heroin is made in illegal drug labs, usually near places where opium poppies grow. It’s considered “semi-synthetic.” It starts out as morphine, one of the natural opiates found in the seed of the opium poppy plant, but has to go through a chemical process to become heroin.  

Drugmakers often mix heroin with other substances to make their product bulkier, cheaper, and stronger. This may include fentanyl, a powerful painkiller that’s often made and sold illegally. You can easily overdose and die on fentanyl, especially if you don’t know that it’s in the heroin you’re taking.  

Heroin may also be “cut” with:  

  • Baking soda
  • Powdered milk
  • Sugar
  • Starch
  • Over-the-counter painkillers
  • Powdered laundry detergent
  • Caffeine 
  • Quinine
  • Antihistamines (to help with the side effect of itching)

Who uses heroin?

In the U.S., use of pure heroin is highest on the West Coast and areas east of the Mississippi River. This includes cities such as San Diego and Seattle along with Boston, Baltimore, Washington, DC, Chicago, Minneapolis, and St. Louis. 

Other statistics about heroin include: 

  • About 1.1 million people, or 0.4% of the U.S. population, may use heroin each year.
  • A small percentage of kids in grades 8-12 report using heroin. 
  • Around 1 million people aged 12 or older may have a heroin use disorder. 
  • Almost 10,000 people die each year from an overdose that involves heroin. 

Black tar heroin. Like the name suggests, black tar heroin is dark and sticky. The color comes from how the drug is made. This less-refined process leaves behind impurities. Black tar heroin is sold most often in areas of the U.S. west of the Mississippi River. 

Heroin vs. morphine. They’re both opioids that can be highly addictive and misused. Though heroin comes from morphine, a legal drug used to treat severe pain and symptoms of other medical conditions, heroin is illegal and has no medical uses. 

Many people smoke or snort heroin. These methods are typically more common among people who use the drug in its pure form. Also called "chasing the dragon," smoking heroin includes heating the drug and breathing in the fumes through a tube.

Most people who use heroin, including diluted forms, inject it into their veins. That’s the most dangerous way to take it because it’s easier to overdose and you can catch a disease from a dirty needle.

Right after you take heroin, you get a rush of good feelings, relaxation, and happiness. Then, for several hours, you may feel as if the world has slowed down. You may think and walk slowly. Some people who use heroin say you feel like you're in a dream.

Heroin blocks your body from getting pain messages and slows your heart rate and breathing. If you overdose, you may stop breathing and die.

Many people start using heroin to deal with anxiety, worries, and other stressors. One study found that 75% of people who use heroin also had mental health conditions such as depression, ADHD, or bipolar disorder.

How is heroin sold? 

Usually, heroin comes in small “caps” that are just enough for one use or injection. Some dealers may sell it in grams. The drug itself may come in aluminum foil packages (called foils) or in tiny balloons.

 

The number of people in the United States who use heroin has risen steadily since 2007.

A factor that played a role in the rise of heroin is the growing abuse of prescription painkillers such as oxycodone and hydrocodone, which are also made from the poppy plant and are chemically related to heroin. People who become dependent on or misuse these drugs may start looking for a stronger, cheaper high. Heroin is both. But it's also more dangerous. There’s no way to know what you’re taking or how strong it is.

More than 1 million people have died since 1999 from a drug overdose. The U.S. opioid overdose death rate rose by 14% from 2020 to 2021. Some of these deaths happen because heroin is laced with other drugs, such as the powerful painkiller fentanyl. Fentanyl has become one of the leading contributors to overdose deaths in the U.S.

 

How long does it take heroin to kick in?

You may feel the effects within seconds of injecting or smoking heroin. The rush can take around 10 to 15 minutes if you snort it. But everyone reacts to drugs differently. 

The effects of heroin depend on things such as: 

  • Your weight and overall health
  • How often you use heroin
  • If you mix it with other drugs 
  • How much you take
  • How strong the drug is
  • How you get the drug into your body

Heroin high. Heroin is a fast-acting drug, and you may have less pain and feel a surge of happiness soon after you take it. Your brain may feel fuzzy. Some people feel detached from their surroundings and often go in and out of wakefulness, what’s often called being “on the nod.” 

How long does the high last?

When you inject heroin straight into your vein, you may feel a rush within seconds that lasts a few minutes or less. Heroin that’s injected under the skin or into a muscle may take longer to kick in, and the strongest effects may linger for up to an hour. 

But no matter how you get heroin into your body, you may feel some effects for around 3-5 hours.

Short-term effects of heroin

The immediate effects of heroin may include:

  • Euphoria
  • A dry mouth
  • Warm, flushed skin
  • Arms and legs that feel heavy
  • Upset stomach and vomiting
  • Itching
  • Lack of hunger
  • Pain relief
  • Small pupils
  • No interest in sex

Long-term heroin effects 

Opioids, including heroin, can change how your brain works. You may need to use more of the drug to get the same high. This is called tolerance. If you continue to use heroin often, you may become dependent and need to take the drug to avoid feeling bad when you’re not on it. 

Regular and long-term heroin use can also lead to:

  • Strong feeling of sadness
  • Collapsed veins
  • Insomnia
  • Constipation
  • Infections of your heart lining and valves
  • Skin infections like abscesses and cellulitis
  • A higher chance of getting HIV, hepatitis B, and hepatitis C
  • Liver and kidney disease
  • Trouble getting an erection
  • Mental disorders
  • Lung diseases like pneumonia and tuberculosis
  • Menstrual problems and miscarriage

Short or long-term heroin can cause medical problems that can change your brain and damage your body.

Over time, you may lose the ability to control your actions or make good decisions. You may get paranoid or have strange mood swings. If you snort heroin a lot, you may damage the lining of your nose or airways. You may destroy the tissue that separates your nasal passages (called the septum). 

If you use a needle to inject heroin, you may get: 

  • Scarred or collapsed veins

  • Bacterial infections in your blood vessels and heart valves

  • Pockets of pus caused by an infection (abscess or boil)

  • Other infections in the soft tissue under you skin

Other complications from heroin use include: 

Infections. People who use drugs do things that raise the odds of exposure to viruses that live in blood or body fluids, including sharing needles and having risky sex. And if you get sick, you may pass the infection (hepatitis B and C, HIV) to your sexual partners or kids.  

Blood vessel and organ damage. When people “cut” heroin, these extra substances can get into the bloodstream and block blood vessels. This can harm the cells that keep vital organs like your lungs, liver, kidneys, or brain working properly. Your immune system might also react to these additives, causing arthritis or other joint problems.

Low brain oxygen. Your brain may not get enough air if you take a drug that can slow your heart and breathing rate way down. This is called hypoxia and can happen if you take large doses of any opioid drug, but the chances are higher with synthetic opioids such as heroin or fentanyl. It can be fatal. 

Heroin and pregnancy

You can expose your baby to heroin if you use drugs while you’re pregnant. This raises the odds that your unborn child will become dependent on heroin and have withdrawal symptoms when they’re born. This is called neonatal abstinence syndrome (NAS). 

Signs and symptoms of heroin dependence or withdrawal in babies may include:  

  • Lots of crying
  • Fever
  • Irritability
  • Seizures
  • Trouble gaining weight
  • Body shakes
  • Diarrhea
  • Vomiting
  • Death

Prenatal care may lessen the chances your baby will have serious health problems from your heroin use. But newborns with NAS typically need medical treatment to lessen symptoms. Your doctor may give your child drugs such as morphine or methadone to ease them off heroin safely. 

Heroin interactions

It’s dangerous and unpredictable to mix heroin with other drugs, especially: 

Stimulants. Heroin is a depressant. It lowers your heart and breathing rate. Drugs like cocaine or methamphetamines speed up your central nervous system. This combo can make an overdose more likely because one drug might wear off before the other. 

Alcohol, benzodiazepines, or other opioids. These drugs can boost the sedative effect of heroin. Your heart and breathing may slow or stop if you take too many depressants. 

No matter how you take it, heroin gets to your brain quickly. Because the drug triggers the release of the feel-good chemical dopamine, you can get addicted easily. Even after you use it just one or two times, it can be hard to stop yourself from using it again. 

Heroin is very addictive. You may develop a substance use disorder if you use heroin regularly for 2-3 weeks. This means your drug use causes health problems, disabilities, and trouble at home, work, or school.

 Other signs of a heroin addiction include that you:

  • Start to use heroin daily or multiple times a day. 
  • Can’t control how much you use.
  • Want to quit but you can’t.   
  • Spend a lot of time thinking about or trying to get heroin. 
  • Have a strong urge to use heroin. 
  • Use heroin even though bad things are happening in your life due to drug use.
  • Put yourself in dangerous situations to use heroin. 
  • Are high a lot.

If a family member has a substance use disorder, you may notice that they:

  • Miss school or start to get bad grades.
  • Don’t go to work or lose their job. 
  • Wear dirty clothes or have poor hygiene. 
  • Ask you for money. 
  • Become defensive or secretive about their behavior or personal space. 
  • Have a change in their appearance, like weight loss or gain.  

If you become addicted to heroin, you may keep taking the drug even though it doesn’t make you feel good anymore. 

Your medical team can help you find the treatment plan that works best for you. It will probably include medication and behavioral therapy. Experts say this medication-assisted treatment (MAT) is the “gold standard” of care for people who have heroin addiction.

Medications can make it easier to wean your body off heroin and reduce cravings. Buprenorphine and methadone work in a similar way to heroin, binding to cells in your brain called opioid receptors. These medicines are safer and longer-lasting than heroin. Naltrexone blocks those receptors so opioids like heroin don’t have any effect. This makes using them less enjoyable.

Cognitive behavioral therapy helps you pay attention to the things you think and do when it comes to drug use. It gives you ways to better cope with stress and other triggers. Another type of therapy called contingency management offers rewards such as vouchers or money if you can stay drug-free.

If you use heroin a lot, your body builds up a tolerance to it. But that doesn’t mean it won’t harm you. It means you need to take more and more to get the same high. Your body comes to depend on it. Then, when you suddenly quit using it, you have physical or emotional symptoms that make you want to take more drugs to feel better.  

Heroin withdrawal symptoms may include:

  • Jitters
  • Chills followed by goosebumps
  • Trouble sleeping
  • Restless legs
  • Strong drug cravings
  • Vomiting and diarrhea
  • Bone and muscle pain
  • Trouble sleeping
  • Cold flashes
  • Leg movements that you can’t control

You may also have: 

  • Anxiety or irritability
  • Fast heart rate
  • Sweating
  • Hot flashes and shivering
  • Yawning
  • Runny eyes or nose
  • Stomach cramps
  • Muscle twitches 
  • Increased pain

How long does it take to go into withdrawal from heroin? 

Symptoms may set in within a few hours after your last use and get stronger for 2-3 days. After that, you may start to feel weak, depressed, sick to your stomach, and throw up. 

Major withdrawal symptoms from heroin and other opioids usually ease within 1-2 weeks, but how long it takes you to feel better depends on how long you’ve used heroin, how much you take, and how fast you taper off the drug. 

If you’ve used heroin for a long time, some symptoms may linger for months or years after you stop.  

Can treatment help with heroin withdrawal symptoms? 

Talk to your doctor or go to a substance use clinic if you can’t stop using heroin on your own or you’re afraid of what might happen to your body and mind once you quit. Medication can help lessen your drug cravings and withdrawal symptoms. 

Heroin is a dangerous drug. A large or strong dose can slow your heart rate and breathing so much that you can’t do it on your own. If that happens, you’ll need medical help to stay alive.  

Signs of a heroin overdose may include:

  • Serious drowsiness
  • Tiny “pinpoint” pupils that don’t respond to light
  • Low blood pressure
  • Slow or irregular heartbeat
  • Cold, clammy skin
  • Loss of consciousness
  • Low body temperature
  • Not breathing

When you’re around someone who overdoses on heroin, you may notice that they:

  • Are awake but don’t respond to you 
  • Take slow, shallow breaths or stop breathing 
  • Make choking or gurgling sounds (called a death rattle)
  • Throw up
  • Lose color in their face
  • Have fingernails or lips that turn blue or purple 
  • Have a very weak pulse or no heartbeat

People who overdose on heroin may seem like they’re asleep and snoring. If you’re not sure what’s happening to your friend or family member, try to wake them up to check if they’re OK.

If you think someone is overdosing, take action right away. They need treatment within minutes.

A medication called naloxone can block the effects of opioids and reverse a heroin overdose if it’s used quickly. Paramedics often give it as a shot. But it also comes in measured doses as an auto-pen (Evzio) and a nasal spray (Narcan). In some states, you don’t need a doctor’s prescription to get Narcan. You can get it through local resources or pharmacy chains.

Anyone can carry naloxone, and many health experts think it’s something everyone should have at home.

Someone who’s overdosing may need more than one dose of naloxone or further medical care. After you give them a dose of naloxone, call 911 or get them to the ER right away.

Always call 911 or seek medical help if you think someone is overdosing. Emergency responders are there to save lives, not turn you into the police. Most states (except Kansas and Wyoming) have Good Samaritan Laws that legally protect people who get medical help for someone who is overdosing. 

Illegal drug use is always risky. But if you’re going to take heroin, there are steps you can take to lessen the chances of serious health consequences, including overdose or death. 

Here are some heroin harm reduction strategies: 

  • Use one substance at a time. Mixing drugs raises your odds of overdose, especially if you take heroin with other depressants such as fentanyl, other opioids, alcohol, and benzodiazepines. 
  • Carry naloxone with you. This fast-acting drug can reverse an overdose, but you may not be able to give it to yourself. Make sure your close friends and family know how to use naloxone. Ask them to keep some handy just in case they need to give you a shot.  
  • Don’t take drugs by yourself. Always use heroin in a safe place. Have a trusted person with you who can call for medical help if you need it. 
  • Don’t drive. It’s not safe to operate any kind of machine when you’re high.  
  • Use and dispose of needles safely. See if there’s a syringe services program (SSP) in your area. SSPs or other needle exchanges offer access to sterile syringes and other injection gear. They also help you safely get rid of used needles. 
  • Take a small amount first. Take a little bit of heroin to see what happens before you take more. 
  • Find child care. You may not be able to take care of yourself or your kids when you use opioids or other drugs. Make sure your children are somewhere safe before you take heroin. 

Visit your local health department to learn more about heroin harm reduction strategies. You may also find support through: 

  • Community treatment centers or clinics
  • Churches
  • Public transportation hubs
  • Unhoused shelters
  • College and university health services
  • Social services offices
  • Mental health clinics
  • Urgent care centers

The website of the National Harm Reduction Coalition may be another good resource.  

Yes. Heroin is grouped with other Schedule I drugs under the Controlled Substances Act. That’s a classification the U.S. government uses for drugs that are easy to abuse, have no medical purpose, and aren’t considered safe even if a doctor were to give it to you.  

Does heroin show up on a drug test?

Common drug tests screen for opioid drugs. While a urine test may not detect heroin specifically, morphine will show up in your pee for at least 2-4 days after your last heroin use. (Morphine is what the liver turns heroin into as your body breaks it down.) 

Some drug screenings are more sensitive than others and may check for the presence of 6-MAM. This is a metabolite, or a byproduct of the drug breakdown process, that only shows up after you take heroin. A urine test can detect it for about 8 hours after your last heroin use. 

How long does heroin stay in your system?

The liver starts to break down (or metabolize) heroin within minutes. If someone took your blood, they could only detect the pure form of the drug for about 5 minutes. But heroin metabolites may stick around in your urine or hair for 2-4 days or longer. 

Your body breaks down heroin quickly. But many things affect exactly how long the drug will stay in your system, including: 

  • How often you use heroin
  • How much heroin you take
  • Your weight and body size
  • Your age
  • How much body fat you have
  • Your metabolism rate
  • How well your liver and kidneys work
  • How much water you have in your body

Heroin may stay in your system longer if you use it every day for a long time compared to someone who only uses it once or every now and then.  

A person on heroin may not look like they’re "on drugs." They may just seem sleepy. People who are addicted almost always deny that they’re using.

If you think a friend or family member is using heroin, don't wait and hope things will get better. Act right away. The sooner a person gets help, the better.

You can treat heroin addiction. Contact the National Council on Alcoholism and Drug Dependence to find services near you. Or call the Substance Abuse and Mental Health Services Administration hotline at 800-662-HELP (4357).

Heroin is a highly addictive and illegal opioid drug. It may give you a rush of good feelings when you use it, but you can overdose if you take too much of it.  If your heart rate and breathing slow too much, you may die. 

Naloxone (Narcan) is a fast-acting medication that can block the effects of heroin and reverse an overdose. Carry it with you if you use heroin or misuse other opioid drugs. 

Talk to your doctor or visit FindTreatment.gov if you can’t quit using heroin on your own. Medication and other substance use treatments can help ease drug cravings and withdrawal symptoms that come with ongoing heroin use. 

What is the meaning of the word heroin? 

The name probably comes from the German word “heroisch.” In English, that means heroic. Historians think the doctor who first trademarked and sold heroin as a medicine in the early 1900s may have wanted people to link it with “feelings of grandeur” because he marketed the drug as a stimulant.  

What are the risk factors of drug abuse?

Though anyone can develop a substance use disorder, genes and environment play a big role in who’ll get one. Other strong risk factors for drug misuse include mistreatment as a child, family history of substance misuse, and a personal history of mental illness or drug use. 

The type of drug you take also raises the odds you’ll misuse it. Certain drugs are easier to get addicted to, including heroin and other opioids.