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Signs and Symptoms of Heroin Use

The signs and symptoms of heroin use may not always be easy to detect. However, people who use heroin, either occasionally or chronically, often display characteristic physical and behavioral indications of abuse.

If you suspect someone you know is using heroin, you can look for the heroin usage signs listed below. These may suggest they are at risk of developing or have already developed a problem that requires professional treatment. Recognizing the early onset of heroin abuse is the first step toward recovery and a drug-free life.

How Do You Help a Person Struggling with Heroin Abuse?

People struggling with heroin abuse seldom reach out for help on their own. They may be in denial or ashamed.1 Therefore, family members and friends may have to take the first step and talk to the person about the issue. Staging an early intervention could prevent heroin abuse from escalating into addiction and reduce treatment duration and enhance its effectiveness.2

Heroin use can proceed to addiction as the person begins to lose control over their use. They may compulsively seek out the drug and regularly use it even if their use is causing problems for them personally or professionally.

A part of the problem is that individuals who use heroin are at risk of building tolerance to the drug, which means they need to use more and more heroin to feel the same high that they did when they started using. They may also develop dependence — their body becomes accustomed to having a certain amount of heroin in their system, and they will go through withdrawal if they reduce their dose or try to stop using.

Withdrawal which occurs during the detoxification stage can be extremely uncomfortable, and many people keep using heroin to avoid withdrawal. To be able to prevent this chain of events, it is important to be aware of the earliest visible signs and symptoms of heroin use and address the issue as soon as possible.

Early signs of heroin use

What Are the Signs of Heroin Use?

Heroin use can have many effects on a user’s appearance and behavior.3 Although every person is different, the following are some of the most common visible signs and symptoms of heroin use and intoxication:4

  • Loss or increase in appetite
  • Weight loss or weight gain
  • Constipation
  • Intense flu-like symptoms (runny nose, nausea, vomiting, sweating, clammy skin, shaky hands, feet or head, large pupils)
  • Small, constricted pupils
  • Decreased respiratory rate
  • Drowsiness, non-responsiveness, confusion, apathy, memory issues, and lack of attention to surroundings
  • Sleeping intermittently, arousability
  • Frequent and intense mood changes: euphoria, depressed mood, moodiness, irritability, nervousness, giddiness
  • Lack of coordination
  • Slurred speech
  • Track marks
  • Wearing long-sleeves or hiding arms

Some of these symptoms are symptoms of heroin withdrawal which the person may not be able to hide. Unlike injection, snorting and smoking heroin do not involve the last two symptoms listed above.

Other visible warning signs of heroin use include supplies and equipment:5

  • Small bags with powdery or sticky, tar-like residue
  • Syringes
  • Burnt or missing spoons and/or bottle caps
  • Missing shoelaces or belts (items used as tourniquets prior to injection)

Behavioral signs that may indicate heroin use

As heroin abuse progresses and starts to get out of control, changes in behavior tend to become more prominent.3 Behavioral changes that could be a sign that a person has started using heroin and may have developed or is at risk of developing addiction include changes in attitude, interests and/or personality, sudden drop in academic or work performance, avoidance and isolation, secretive behavior, and tendency to steal.

Signs of heroin use when the effect is wearing off

The person may complain of or be unable to hide the following symptoms:3

  • Feeling nervous
  • Irritability
  • Feeling itchy
  • Pain in bones and muscles
  • Getting chills
  • Inability to sleep
  • Throwing up

Getting Help for Heroin Abuse

Once you have identified that someone is using heroin, the next step is to talk to them openly and honestly about their problem and your desire to help. Family and friends can play a critical role in motivating individuals with an emerging heroin problem to seek recovery. If your loved one expresses an interest in getting help, you can search for a rehab program together. Addiction professionals at these programs can examine the person, make a diagnosis, and recommend a course of treatment.

Drug rehabs that specialize in heroin addiction treatment address all consequences of heroin use through detox, counseling, and aftercare. This comprehensive approach is the most effective way to help a person start on a path to recovery. If the person refuses help, you can try an intervention.6

An intervention is when family members meet with someone who is abusing drugs to help them see how their drug use is affecting other people. The aim is to get the heroin user to enter rehab and get help. A professional interventionist can help organize the meeting and make it more effective. They can help decide who should be at the meeting and suggest options for what type of treatment would be best. They can also help coordinate situations where you believe the person may become violent.6

You can also try to get the person to speak to a doctor or drug counselor, as some people will be more willing to speak to a professional than their family and friends about the issue.7 You can search for more information on our site that will help you find the right facility for your loved one or call our toll-free number anytime.

Frequently Asked Questions

What Are Some Physical Symptoms of Heroin Use?

There are two forms of heroin available in the illicit drug market in the U.S.: white powder heroin with a higher level of purity and black tar heroin which is impure.8 White powder heroin can be used by smoking, snorting, and injection, while black tar heroin can only be injected.

Depending on form and method of administration, the person may exhibit various visible physical signs of heroin use, some of which may be caused by unintentional or intentional illicit drug adulteration:8

  • Injection marks or track marks: These are the most notorious signs of heroin use in intravenous users. Once a vein becomes sclerotic and inaccessible, users may resort to risky behaviors such as intradermal, subcutaneous, and sometimes intramuscular administration of heroin.

This is also known as “skin-popping” or the use of hot needles when carbon and soot are administered into the dermis along with the drug. Intravenous heroin users often resort to unusual injection sites that they may hide with clothes or tattoos.

  • Thrombosis from blood clotting may cause skin issues.
  • A specific rash affecting the body and the genitalia lasting up to several days is among the the visible signs of heroin use.
  • Various other skin issues and conditions, including rashes and discoloration.
  • Infectious complications: Skin and soft tissue infections are among the possible complications of intravenous drug use.Skin infections with uncommon pathogens are also possible, particularly in the case of black tar heroin which is often cut with dirt contaminated with heat-resistant spores.
  • Vascular complications can be caused by venous damage from repeated needle-sticks.

There may be a link between different heroin source-forms leading to varying physical damage.9

What Are Some Psychological and Emotional Symptoms of Heroin Abuse?

Chronic use of heroin can cause long-term changes in the brain, increasing the risk of mental health issues, as well as the risk of co-occurring mental disorders.10 Namely, heroin users may exhibit signs of psychological and emotional distress such as paranoia, depression, anxiety, aggression, and other problems as well as experience hallucinations.

Are There Any Signs of Heroin Use That Are Not Visible?

Signs of chronic heroin use are notoriously difficult to hide, especially as heroin use starts to progress into addiction.11 Persons may also have atypical reactions to heroin, especially if adulterated.12 The non-visible signs concern changes in behavior which intensify as the person sinks deeper into addiction, although these, too, are difficult to hide.

What Are Signs of Heroin Use in Adolescents?

Visible signs of heroin use in adolescents are identical to the signs of heroin use identifiable in adults. It is important for families and educators of adolescents to be aware of the risks and on the lookout for the signs of heroin use. Not only is the developing brain especially vulnerable to drug abuse, but early substance use in adolescents raises the risk of developing a lifelong substance use disorder dramatically.11

What to Do if You Notice the Signs Your Loved One Is Using Heroin?

If you suspect that a loved one is using heroin, especially if you notice the signs of heroin use lasting over a longer period of time, you should encourage them to seek help in a specialized inpatient or outpatient treatment facility. By learning to recognize the signs of using heroin, you may be able to save a person’s life and help them start recovery.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines diagnostic criteria occurring within a 12-month period for a problematic pattern of use of intoxicating substances such as heroin.13 These are taken into account during initial assessments performed in treatment facilities across the U.S.


  1. Substance Abuse and Mental Health Services Administration. (2020). TIP 42: Substance Use Disorder Treatment for People with Co-Occurring Disorders.
  2. National Institute on Drug Abuse. (2020). Principles of Effective Treatment.
  3. National Institute on Drug Abuse. (2020). What are the immediate (short-term) effects of heroin use?.
  4. Substance Abuse and Mental Health Services Administration. (2020). TIP 63: Medications for Opioid Use Disorder.
  5. National Institute on Drug Abuse. (2020). What is heroin and how is it used?.
  6. National Council on Alcoholism and Drug Dependence. (2015). Intervention – Tips and Guidelines.
  7. National Institute on Drug Abuse. (2016). What to Do If Your Adult Friend or Loved One Has a Problem with Drugs.
  8. Raiker et al., Journal of Clinical & Experimental Dermatology Research (2016). Dermatologic Signs and Symptoms of Substance Abuse.
  9. Daniel Ciccarone, Magdalena Harris, Int J Drug Policy. (2016)Fire in the vein: Heroin acidity and its proximal effect on users’ health.
  10. National Institute on Drug Abuse. (2020).Mental Health Effects.
  11. National Institute on Drug Abuse. (2020). Preventing Drug Use among Children and Adolescents.
  12. Centers for Disease Control and Prevention (CDC). (2005).Atypical reactions associated with heroin use – five states.
  13. National Institute on Drug Abuse. (2020).The Science of Drug Use and Addiction: The Basics.

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