What Are the Signs of Heroin Use and Abuse?

Drug-addict-with-syringe-lying-64002394Heroin abuse is on the rise in the United States, with usage increasing across all demographics across the country. The Centers for Disease Control and Prevention (CDC) reports that twice as many people between the ages of 18 and 25 are abusing heroin today as opposed to 10 years ago. The Monitoring the Future survey, as published by the National Institute on Drug Abuse(NIDA), estimated that nearly 1 percent of high school seniors abused heroin at some point in their lifetime as of 2014.

Prescription pain relievers may be a gateway to heroin abuse, and 45 percent of all heroin users are also addicted to opioid prescription drugs, according to the CDC. As the price and availability of prescription opioids make these drugs more out of reach, heroin may be seen as a viable substitute. An estimated 23 percent of heroin abusers will become dependent on the opioid drug, NIDA estimates.

Addiction to heroin can increase potential health problems and the risk for a life-threatening overdose. Heroin overdose deaths have been increasing exponentially, and in 2013, approximately 8,257 deaths were attributed to heroin overdose, which is almost three times the number of fatalities related to the drug in 2010, the Washington Post reports. Overdose deaths are one of the leading causes of preventable death in this country, as drug overdoses were the number one cause of injury death in 2013, the American Society of Addiction Medicine (ASAM) publishes. Understanding how to recognize heroin use may help in stemming the rising tide of heroin overdose and addiction.

Physical Signs of Heroin Abuse

When someone is using heroin, there are some physical signs to be aware of, such as:

  • Constricted or pinpoint pupils
  • Dry mouth
  • Runny nose
  • Blurred vision
  • Slurred speech
  • Delayed reaction time
  • Impaired motor coordination
  • Constipation
  • Drowsiness
  • Clammy skin
  • Lack of pain sensations
  • Heaviness in limbs
  • Increased euphoria

Heroin is considered an illegal drug with no accepted medicinal uses in the United States. The Drug Enforcement Administration (DEA) classifies the opioid as a Schedule I controlled substance with a high abuse and addiction potential. Heroin suppresses some of the functions of the central nervous system, like breathing, blood pressure, temperature, and heart rate. In addition, it leads to a flood of dopamine in the brain that causes the pleasant high associated with the drug.

Heroin is considered a short-acting opioid and can take effect almost immediately after ingestion. Its effects may be similarly short-lived, and a person may “come down” within as little as a few minutes, per the National Highway Traffic Safety Administration (NHTSA). This may prompt someone abusing heroin to take repeated doses in one day.

When heroin wears off, an individual may be irritable; have trouble sleeping; be restless, anxious, and depressed; and feel physically ill, experiencing headaches, muscle aches, chills, nausea, or diarrhea.

Behavioral Changes Associated with Heroin Abuse and Addiction

Heroin makes changes in the chemical makeup of the brain in regions responsible for decision-making, willpower, mood regulation, and reward processing. Over time, these changes may become more pronounced as the brain stops functioning normally without heroin. Physical and emotional dependence may develop.

There are also numerous emotional or behavioral changes that may be noticeable when someone is abusing heroin, like:

  • Mood swings, from euphoric when using to depressed when not
  • Hostility or violent outbursts
  • Seemingly erratic behavior
  • Changes in appetite or weight fluctuations (generally weight loss and loss of appetite)
  • Strange sleeping patterns, ranging from restless and wide awake to drowsy and needing more sleep
  • Financial troubles as money may be spent on drug habit
  • Lack of motivation
  • Little desire to engage in outside activities or events
  • Social withdrawal
  • Secrecy or denial of drug use
  • School or work performance drops
  • Trouble concentrating and making decisions
  • Short-term memory lapses
  • Limited awareness of surroundings or attention to others

Addiction is considered to be present when people spend most of their time engaging in thoughts surrounding heroin, how to get more, using it, and recovering from its use. When people can no longer control their heroin use, use more of the drug than intended, or continue using it despite physical, emotional, or personal consequences, it may indicate an addiction.

Heroin is abused with another drug nine times out of 10, the CDC reports. Other drugs may have additional side effects and signs of abuse. Using multiple drugs together increase the odds for a life-threatening overdose.

Other signs of addiction may include:


  • Inability to stop using heroin
  • Using the drug in physically hazardous situations
  • Engaging in risky behaviors (sexual encounters, impaired driving, etc.)
  • Being consistently unreliable
  • Unpredictable mood swings
  • Tolerance to the drug indicated by the need to take more with each dose
  • Withdrawal symptoms when heroin is removed (flulike symptoms as well as anxiety, irritability, insomnia, depression, and restlessness)
  • Possible run-ins with the law or the criminal justice system
  • Cravings for heroin

Signs of Snorting, Smoking, or Injecting Heroin

Heroin is a white, brown, or blackish powder that is abused by heating and injecting itsnorting it, or smoking it. Depending on how the drug is abused, there may be additional signs of its use.

Snorting Heroin:

  • Powder residue around nose and/or mouth
  • Nosebleeds
  • Chronic runny nose
  • Sinus or respiratory issues
  • Small baggies found in trash

Smoking Heroin:

  • Sores on or around the mouth
  • Persistent cough
  • Burns on fingers or hands
  • Evidence of pipe or other smoking apparatus

Injecting Heroin:

  • Needle or “track marks”
  • Rubber tubing or missing shoelaces (used to tie off veins)
  • IV drug paraphernalia (syringes, needles, etc.)
  • Evidence of missing or burnt spoons (they are used to heat the drug prior to injection)
  • Contraction of infectious or blood-borne disease like HIV/AIDS or hepatitis

Heroin abuse can rapidly develop into addiction. Due to the intense nature of heroin withdrawal symptoms, individuals addicted to heroin should not attempt to stop using the drug without a medical professional’s insight and supervision. Drug abuse treatment programs can foster a comprehensive recovery experience with medical detox and intensive therapy.