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The Dangers of Taking Heroin

Heroin can cause serious harm regardless of how it’s used. The most serious consequences of heroin abuse are overdose and death. But users who share needles can also contract HIV, hepatitis, and tuberculosis.

This page outlines some of the ways that using heroin can put you or someone you love at serious risk for physical and psychological side effects.

Different Ways of Using Heroin

The 3 main ways of using heroin are snorting, shooting, or smoking it. Each of these methods carry their own unique dangers, and all can lead to addiction.

Heroin is abused in different forms, including white or brownish powder and black tar heroin. White or brown heroin is commonly cut with adulterants such as sugars, starch, or powdered milk. Tar heroin gets its name because it is sticky like roofing tar. The color is darker because the crudely processed product contains more impurities.1
Variety of drugs on a table
Purer forms of heroin may be more easily smoked or snorted than the stickier, impure varieties, such as black tar. Smoking or snorting heroin may be more appealing to new users because it allows them to avoid some of the stigma associated with injection drug use. Most commonly, the more impure varieties of heroin are dissolved in water prior to being injected.1

What Makes Shooting Heroin Such a Risk?

There are a number of potentially serious health hazards associated with shooting heroin. The 2 major risks are contracting HIV/AIDS and overdose.

  • HIV/AIDS. The practice of sharing used needles among heroin users increases the risk of contracting communicable diseases such as HIV/AIDS. In fact, sharing needles has a higher likelihood of spreading AIDS than most forms of sexual intercourse.2 It is estimated that as many as 60% of heroin users may be infected with HIV.3
  • Overdose. Every day, more than 115 people die from an opioid overdose in the United States. In 2015, more than 33,000 Americans died from an overdose on opioids such as heroin. Many people overdose because heroin, as well as any adulterant drugs it is mixed with, are too powerful and may overwhelm the user with symptoms such as dangerously slowed breathing. One of the biggest recent dangers of heroin use is that the drug people intend to use might not be just heroin. With increasing frequency, synthetic opioids such as fentanyl (50–100 times more potent than morphine) and carfentanil (10,000 times more potent than morphine) are mixed with heroin to increase its effects.4,5

Other serious issues related to IV heroin addiction that every user should be aware of include:

  • Infections. People who inject drugs can develop skin and soft-tissue infections such as abscesses and cellulitis, as well as endocarditis (infections in their heart lining and valves) and musculoskeletal infections. Repeatedly injecting a site of the body can also lead to inflammation, redness, and swelling at the injection site.6,7
  • Track and puncture marks. Injection-site inflammation and scarring commonly result in track marks on the arms of people who inject heroin. When arm veins become unusable, addicts may switch to injecting in the legs, neck, or groin.3
  • Hepatitis. Hepatitis C (HCV) is a virus that affects the liver and can be spread through the exchange of blood and other bodily fluids. HCV is present in up to 90% of people who inject opioids such as heroin.3 Heroin addicts or users who share needles put themselves at significant risk for contracting the disease.
  • Tuberculosis. Tuberculosis (TB) is a serious problem among people who inject heroin. Many people don’t have symptoms, and the only way to diagnose TB is with a positive tuberculin skin test.3 Generally, TB affects a person’s lungs, but it can also affect the kidneys, spine, or brain. A person can die from TB if they do not receive proper treatment. Symptoms of TB include weight loss, fever, night sweats, and weakness. 8
  • Damage from additives. Additives (e.g., sugar, starch, other powders) are often put into heroin to add bulk to a batch or enhance the high. They can clog blood vessels that lead to the lungs, liver, kidneys, or brain.9,10
Needle Exchange Programs

Needle exchange programs or syringe services programs (SSPs) provide sterile needles and syringes to people who shoot heroin. SSPs provide free syringes as well as a place to leave used needles. Access to clean needles through such programs may decrease a person’s risk of getting and transmitting HIV, hepatitis, and other blood-borne infections 11  To find a needle exchange program near you, visit the North American Syringe Exchange Network.

Effects of Snorting and Smoking

Users who snort or sniff the drug can develop nasal damage including septum perforation (hole in the nasal septum), ulcers, erythema (redness), septum necrosis (death of cells in the septum), and orofacial lesions. Symptoms of these conditions include pain, mucus, trouble swallowing, and swelling.12

Overdoses in association with snorting and smoking heroin may be more likely among new users or if a person mixes the drug with other depressants, such as alcohol.13

Treatment for Addiction

Doctor with patient discussing treatment options
People who are ready to get help for heroin addiction can find treatment at a drug rehabilitation center. Treatment for heroin dependence often begins with detox—a period of time during which their body processes any remaining heroin in their system and medications or other supports are used to lessen the discomfort of withdrawal.

They then transition into the next step of treatment—either inpatient or outpatient rehab. Depending on the person’s situation and level of addiction, treatment may last 30 to 90 days. They may be prescribed medications to help stabilize and maintain them in recovery, and they address the reasons they used heroin as well as any other issues related to addiction, including family, employment, or educational problems.

Before they discharge from the treatment program, the person will meet with their treatment team to craft an aftercare plan that may include 12-step program participation, individual or group counseling sessions, or residence at a sober living facility.

Twelve-step meetings are places where those in recovery can meet regularly to share experiences and support each other in sobriety. Those in recovery from heroin addiction may feel comfortable in a Heroin Anonymous (HA) or Narcotics Anonymous (NA) group.

A sober living home, or halfway house, is a temporary residence where a person lives with other people who are in recovery. Many people use these homes as a transition between rehab and their day-to-day lives. They are expected to pay rent and do chores, and they are often encouraged to attend 12-step meetings, look for a job, or work on their education.

Do you know someone who needs help with heroin addiction? Browse our directory of treatment listings to find a rehab that can help you or your loved one quit using and regain sobriety.


[1]. National Institute on Drug Abuse. (2018). What is heroin and how is it used?

[2]. Centers for Disease Control and Prevention. (2015). HIV Risk Behaviors.

[3]. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

[4]. Centers for Disease Control and Prevention. (2017). Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016.

[5]. National Institute on Drug Abuse. (2018). Opioid Overdose Crisis.

[6]. Garber, B., Glauser, J., and Velez, L. (2015). Complications of Injection Drug Abuse. Emergency Medicine Reports.

[7]. World Health Organization. (2008). Management of common health problems of drug users. WHO Regional Office for South-East Asia.

[8]. Centers for Disease Control and Prevention. (2011). Tuberculosis: General Information.

[9]. Department of Veterans Affairs. (2018). Heroin.

[10]. National Institute on Drug Abuse. (2018). Heroin.

[11]. Centers for Disease Control and Prevention. (2018). Syringe Services Programs.

[12]. Peyrière, H., Léglise, Y., Rousseau, A., Cartier, C., Gibaja, V., & Galland, P. (2013). Necrosis of the intranasal structures and soft palate as a result of heroin snorting: a case seriesSubstance abuse34(4), 409-414.

[13]. Drug Policy Alliance. Heroin Facts.

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