What Are the Effects of Heroin?
A derivative of morphine, heroin is a very powerful painkiller. This is because heroin mimics endorphins, the natural painkilling substances produced by the body. As heroin binds rapidly with endorphin receptors, the painkilling effect is extended and magnified, and produces a pleasurable sensation called a “rush.”1
Heroin users also report that taking heroin gives them not only a warm feeling, but a very distinct sense of well-being as well. The euphoric effects heroin produces make it highly addictive. Heroin, however, is also one of the world’s most dangerous illicit drugs. Highly addictive, heroin wreaks havoc on the human body and mind, and has claimed many lives around the world.2
Short Term Effects of Heroin Use
Generally, the effects of using heroin set in rapidly, but it all depends on the method of delivery. Snorting or smoking heroin typically requires 10 to 15 minutes for the drug’s full effects to be felt. Injecting heroin is a much faster method of ingesting heroin. It takes 5 to 8 minutes for an intramuscular heroin injection to set in, while it takes all of 7 to 8 seconds for an intravenous injection to take effect. For most first time users, nausea and vomiting are common.3
For those smoking or shooting heroin, a short period of intense pleasure called a “rush” sets in, followed by a sense of contentment and a state of physical relaxation, both of which are indicators of a heroin high. This “high” usually lasts three to four hours. Aside from the usual euphoria that accompanies heroin use, the user also alternates between alertness and drowsiness.4
Heroin effects include a certain degree of dryness in the person’s mouth. Users’ skin appears flushed and feels warm, while the pupils in their eyes become very small. Heroin also slows their breathing down, and their muscles feel weak. In this state, any problems or issues the user has in their life seem to melt away.3
As the immediate effects of heroin slowly dissipate, the user might start feeling irritable. Depression from heroin use is also quite common. For many users, the only way to get rid of these non-pleasurable sensations and regain the “high” is to start doing heroin again. It doesn’t take much for a heroin user to become a full blown heroin addict, especially when the user develops a tolerance to the drug and starts to take more in order to get that same high.5
Long Term Effects of Heroin Use
Heroin addiction has a steep price. There are so many long-term physical effects of heroin use. For one, constant heroin use causes the brain to reduce or even stop producing its own endorphins. When this is the case, the user’s body becomes barely capable of managing small amounts of pain or discomfort. This inability is especially magnified in the early stages of heroin withdrawal, making early recovery or heroin detox a particularly difficult exercise. Once heroin detoxification is done, the brain usually starts producing endorphins again. However, the damaging side effects of heroin on the brain could take years to recover from.6
It could also lead to liver disease, heart ailments, blood pressure issues, pulmonary problems, weight loss and collapsed veins. The risk of infection is also very high, especially those who inject heroin with shared needles. A number of people who have AIDS and hepatitis C contracted their diseases this way.7
The long term mental health effects of heroin use are also significant. It is very common for heroin addicts to find it hard to concentrate, learn anything new, or even organize a clear thought. Personal relationships also take a beating due to heroin, as heroin users tend to become apathetic and unmindful of the consequences of their addiction to heroin. Heroin may also have significant behavioral effects, as the drug may trigger irresponsible and self-destructive behavior in constant users, sometimes causing them to resort to criminal acts to get their next heroin fix.8
How Heroin Affects Different Genders & Age Groups
Heroin addiction and abuse can have long-term psychological and physical effects on individuals of any age or gender. However, there are certain groups that may be particularly vulnerable.9
Teenagers and adolescents constitute a high-risk group in terms of heroin abuse and addiction. This is due to the particular characteristics of their age and different vulnerability factors.10
From early teenage years to mid-to-late 20s, the human brain develops somewhat unevenly, with the areas of the brain that control emotion (amygdala), physical activity (cerebellum), and motivation (nucleus accumbens) developing first.11 The part of the brain that regulates impulse control, judgement, and reasoned thought, i.e. the prefrontal cortex, develops later. Because of this, teens may be more driven by short-term rewards and emotion, leading to potential unpredictable and risky behaviors.12
The science of adolescent brain development shows that teenagers seem to be more responsive to new influences and experiences, whether negative or positive. This means that heroin abuse during the teenage years may create an increased risk for immediate and lasting harmful effects.12
Research reveals that heroin abuse among women may lead to issues related to fertility, hormones, menstrual cycles, pregnancy, breastfeeding, and menopause.13 A study also suggests that substance abuse may also result in critical long-term reduction in brain volume and changes affecting their decision making emotional capabilities, even after periods of abstinence.14
Women who abuse heroin during pregnancy may experience spontaneous miscarriages, give birth prematurely, or give birth to infants with low weight.15 Additionally, heroin use during pregnancy may also result in the neonatal abstinence syndrome (NAS).
NAS can occur when the substance reaches the fetus through the placenta during pregnancy, which causes the baby to become dependent on heroin, too. Symptoms of NAS include fever, irritability, excessive crying, seizures, tremors, poor sleep, loose stools, slow weight gain, vomiting, diarrhea, and even death.16
Men seem to be more likely to abuse illicit drugs than women, as well as experience increased visits to emergency departments or overdose deaths. In most age groups, men tend to have higher rates of substance use or dependence than women.17 Heroin may also cause men to experience erectile dysfunction as well as decreased sexual interest in the long term.18
Older Age Population
In 2018, the Substance Abuse and Mental Health Services Administration estimated that approximately 1 million adults over the age of 65 struggled with a substance use disorder.17 Aging adults may experience more complicated persistent pain than younger adults. This may cause them to use prescription and illicit opioids for pain relief. In fact, the proportion of aging adults abusing heroin more than doubled between the years of 2013 and 2015, with many individuals switching to this cheaper opioid instead of expensive prescription drugs.19
Unfortunately, not much is known about the exact effects of drugs on the aging brain. Still, research shows that aging may lead to physical and social changes that might increase their vulnerability to substance abuse. Older adults tend to metabolize substances more slowly, which is why their brains might be more sensitive to heroin and other drugs.19
Older adults are also more likely to suffer from heart and lung problems, memory issues, and mood disorders, which can be further exacerbated by the use of an illicit substance. Additionally, the physical effects of heroin may also result in impaired judgement and coordination, which may result in falls and other kinds of accidents.19
How to Find Treatment for Heroin Addiction
Since heroin abuse and addiction have so many different dimensions and affect and disrupt such a large part of an individual’s life, treatment is essential, but complex. In order to be effective, heroin addiction treatment programs usually incorporate a number of components, each designed and directed to address a specific aspect of the heroin addiction and its consequences.20
The purpose of heroin addiction treatment is to help the person stop using the drug, maintain a drug-free lifestyle, and function productively in their family, professional settings, and society as a whole. Patients typically need repeated or long-term episodes of comprehensive and personalized care in order to achieve and maintain sobriety. This care tends to be a mixture of medication-assisted treatment, therapy, group therapy, and relapse prevention. Typical heroin addiction treatment programs include:21
- Inpatient treatment and residential programs.
- Day treatment/partial hospitalization.
- Outpatient programs.
- Opioid treatment programs.
- Provisional care.
Patients can choose between undergoing treatment at state-funded or private treatment centers. While state-funded centers are the most affordable option and may be the best choice for patients with inadequate or no insurance, they might offer less customizable care and be unable to provide the most current technologies and treatment options.
Private centers, such as American Addiction Centers, offer tailored and comprehensive treatment that aims to treat the whole person, addressing their physical wellness, social challenges, and co-occurring mental health conditions. Research has shown that treatment in general is better at providing positive results in decreasing substance use, improving personal health and social function, and reducing public health and safety risks than no treatment at all.22
Frequently Asked Questions
What Are the Side Effects of Heroin?
Long-term heroin use can have a detrimental effect on an individual’s physical and psychological well being.7
Heroin Effects on the Body
- Insomnia and other sleep disturbances.
- Lung complications.
- Scarred and/or collapsed veins.
- Bacterial infections.
- Hepatitis B and C, HIV infections and other blood-borne viruses.
- Sexual dysfunction (for both men and women).
- Spontaneous miscarriage and irregular menstrual cycles (women).
Heroin Effects on the Brain
Repeated use of heroin may bring about a number of detrimental changes on the brain, particularly to areas associated with decision-making, long-term memory, control of social behavior, and complex thought. These brain areas include the medial temporal lobe and the prefrontal cortex. The effects of heroin on the brain cumulatively lead to various behavioral changes, including:24
- Poor reasoning and problem solving.
- Poor planning and task flexibility.
- Impaired executive functioning.
- Worsened decision making capabilities.
- Impaired memory.
- Impaired behavioral regulation and emotional processing.
- Worsened ability to imagine future interactions and events.
What Does a Heroin High Feel Like?
A heroin high comes with characteristic feelings of euphoria and pain relief, but has a great number of adverse effects as well. This may be exceptionally unpleasant for first-time heroin users. After a hit, the individual experiences a variety of chemical changes to the brain, which give them an intense feeling of pleasure and euphoria. This short rush of positive emotions is followed by feelings of relaxation, warmth, safety, and contentment. The person may also alternate between drowsiness and alertness, have a dry mouth, flushed skin, weakness in the muscles, and slowed down breathing.4
Once the immediate heroin effects go away, the individual might start feeling depressed and/or irritable. This might lead them to take the drug again to escape the non-pleasurable effects and re-experience the euphoric feelings of the heroin high.4
The Effects of Heroin Mixing Agents
It is also important to note that heroin is frequently mixed with other substances before being sold. The short-term effects of heroin use will depend on the amount of mixing agents present, or how much the heroin was “cut” and with what substance. Some of these substances are not harmful and reduce the typical side effects of the drug, while other substances, such as fentanyl, may increase the effects of the drug and be more dangerous.25
The Effects of Tolerance
The duration and intensity of a heroin high may also vary depending on the individual’s personal background and expectations. While one person might find the effects to be highly pleasurable, another might find them unbearable. Additionally, the feelings of euphoria and pleasure may not happen after prolonged use, after the individual builds tolerance to heroin. As the pleasurable high dissipates or disappears, the individual might use the drug simply to avoid withdrawal, instead of seeking and feeling a genuine high.26
How Long Does a Heroin High Last?
After taking heroin, an individual will experience a high relatively quickly, but the feelings of euphoria and pleasure are typically fleeting, often lasting from about 45 seconds to a couple of minutes. The feelings of sluggishness and drowsiness that follow the initial high may last for several hours.27
The length of a heroin high depends on how quickly the substance enters the brain. This is why the method of use influences the duration of short-term heroin effects. For instance, injecting heroin causes the quickest reaction, followed by smoking. The reaction is the slowest when heroin is snorted.28
How Do Heroin Effects Change Depending on the Different Types?
Different types of heroin may vary in the intensity and severity of their effects, often depending on the method of use and whether they are used together with alcohol and other substances. However, they tend to share many of the same health risks. Here are some special effects associated with each type of heroin:29
- Black tar is a type of heroin that comes in the form of a sticky black substance and is typically less pure than other types of heroin. Black tar heroin is most often injected and may pose a wide range of unique health risks and side effects including venous sclerosis, tetanus, wound botulism, gas gangrene, and necrotizing fasciitis.30
- Brown heroin is most often smoked, which may help reduce the risk of infections carried by using and sharing needles. However, this does not decrease the risks of becoming addicted to heroin and might even exacerbate asthma attacks in some users. If brown heroin is injected, the individual may be at risk from soft tissue infections related to subcutaneous use (“skin popping”), cellulitis, scarring, and abscesses.
- White powder is often considered to be purer than other types of heroin, although this may not necessarily be true. In fact, heron is often cut with additive substances that may alter its color, causing it to appear white. White heroin can be consumed in a variety of ways which will affect the intensity and duration of the short-term effects.
- China white is a term used to either describe pure heroin, heroin that is cut with fentanyl, or fentanyl on its own. The use of heroin cut with fentanyl, a powerful synthetic opioid that is 50-100 more potent than morphine, is associated with an increased risk of overdose deaths. This makes it one of the most lethal heroin types amongst all of them.31
- National Institute of Drug Abuse. (2017). Impacts of Drugs on Neurotransmission.
- National Institute of Drug Abuse. (2020). Most Commonly Used Addictive Drugs.
- National Institute of Drug Abuse. (2020). What are the immediate (short-term) effects of heroin use?.
- National Institute of Drug Abuse. (2019). Heroin DrugFacts.
- Substance Abuse and Mental Health Services Administration. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet]. Chapter 2, The Neurobiology of Substance Use, Misuse, and Addiction. Washington (DC): US Department of Health and Human Services
- National Institute of Drug Abuse. (2020). What are the long-term effects of heroin use?.
- National Institute of Drug Abuse. (2020). Why does heroin use create special risk for contracting HIV/AIDS and hepatitis B and C?.
- National Institute of Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction.
- National Academies of Sciences, Engineering, and Medicine (2017). Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Trends in Opioid Use, Harms, and Treatment. Washington (DC): National Academies Press.
- Alcohol Research: Current Reviews Editorial Staff. (2018). NIH’s Adolescent Brain Cognitive Development (ABCD) Study. Alcohol research: Current Reviews, 39(1), 97.
- Arain, M., Haque, M., Johal, L., Mathur, P., Nel, W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the Adolescent Brain. Neuropsychiatric Disease and Treatment, 9, 449–461.
- Winters, K. C., & Arria, A. (2011). Adolescent Brain Development and Drugs. The Prevention Researcher, 18(2), 21–24.
- National Institute of Drug Abuse. (2020). Substance Use in Women DrugFacts.
- Regner, M. F., Dalwani M., Yamamoto D., Perry R.I., Sakai J. T., Honce J. M. , & Tanabe J. (2015). Sex Differences in Gray Matter Changes and Brain-Behavior Relationships in Patients with Stimulant Dependence. Radiology 277:3, 801-812.
- National Institute of Drug Abuse. (2020). How does heroin use affect pregnant women?.
- Kraft, W. K., Dysart, K., Greenspan, J. S., Gibson, E., Kaltenbach, K., & Ehrlich, M. E. (2011). Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome. Addiction (Abingdon, England), 106(3), 574–580.
- Substance Abuse and Mental Health Services Administration. (2020). Results From the 2018 National Survey on Drug Use & Health: Detailed Tables. Rockville (MD): Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.
- Cioe, P. A., Friedmann, P. D., & Stein, M. D. (2010). Erectile dysfunction in opioid users: lack of association with serum testosterone. Journal of Addictive Diseases, 29(4), 455–460.
- National Institute of Drug Abuse. (2020). Substance Use in Older Adults DrugFacts.
- National Institute of Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide, 3rd Edition.
- National Institute of Drug Abuse. (2020). Types of Treatment Programs.
- McLellan, A. T., Woody, G. E., & Metzger, D. (1996). Evaluating the effectiveness of addiction treatments: Reasonable expectations, appropriate comparisons. Milbank Quarterly, 74(1), 51–85.
- National Institute of Drug Abuse. (2020). What are the medical complications of chronic heroin use?.
- Fishbein, D. H., Krupitsky, E., Flannery, B. A., Langevin, D. J., Bobashev, G., Verbitskaya, E… Tsoy, M. (2007). Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use. Drug and Alcohol Dependence, 90(1), 25–38.
- National Center for Biotechnology Information (2021). PubChem Compound Summary for CID 5462328, Heroin.
- Seip-Cammack, K. M., Reed, B., Zhang, Y., Ho, A., & Kreek, M. J. (2013). Tolerance and sensitization to chronic escalating dose heroin following extended withdrawal in Fischer rats: possible role of mu-opioid receptors. Psychopharmacology, 225(1), 127–140.
- South Carolina Department of Alcohol and Other Drug Abuse Services. (2001). Fact Sheet Heroin.
- Scott N. P. & Alex K. H. (2011) Comparing Injection and Non-Injection Routes of Administration for Heroin, Methamphetamine, and Cocaine Users in the United States. Journal of Addictive Diseases, 30:3, 248-257.
- Ciccarone D. (2009). Heroin in brown, black and white: structural factors and medical consequences in the US heroin market. The International Journal on Drug Policy, 20(3), 277–282.
- Mars, S. G., Bourgois, P., Karandinos, G., Montero, F., & Ciccarone, D. (2016). The Textures of Heroin: User Perspectives on “Black Tar” and Powder Heroin in Two U.S. Cities. Journal of Psychoactive Drugs, 48(4), 270–278.
- National Institute of Drug Abuse. (2019). Fentanyl DrugFacts.
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