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Signs of Heroin Use

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

If you believe someone you know is using heroin, you can look for the signs listed below. These may suggest a problem that requires professional treatment.

People struggling with heroin addiction do not often reach out for help on their own. They may be in denial or ashamed. Therefore, family members and friends may have to take the first step and talk to the person about the issue.


What Are the Signs of Heroin Use?

Heroin use can have many effects on a user’s appearance and behavior. Although every person is different, the following are some of the most common signs and symptoms of heroin use:1,2

Man passed out from heroin

  • Euphoria
  • Drowsiness
  • Lack of attention to surroundings
  • Trouble remembering things and paying attention
  • Depressed mood
  • Confusion
  • Lack of coordination
  • Slurred speech
  • Runny nose
  • Constricted pupils
  • Clammy skin
  • Constipation
  • Track marks
  • Wearing long sleeves or hiding arms

Other signs of heroin use include:2

  • Small bags with powdery or sticky, tar-like residue.
  • Syringes
  • Burnt or missing spoons (used to “cook” the heroin prior to injection).Missing shoe laces or belts (items used as tourniquets prior to injection).

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.

Further, they build 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 can be very uncomfortable, and many people keep using to avoid withdrawal.

A diagnosis of heroin addiction, or a heroin use disorder, is made based on several diagnostic criteria—each representing characteristic behavior changes, signs, and symptoms associated with heroin use, including:3

  • Losing interest in friends or favorite hobbies/activities.
  • Strong drug cravings.
  • Taking heroin for longer than you meant to.
  • Being unable to control heroin use.
  • Devoting a large portion of your time to getting heroin, using it, and recovering from its effects.
  • Avoiding responsibilities at home, school, or work due to heroin use.
  • Using heroin despite social or personal problems caused by heroin.
  • Taking heroin in situations in which it is dangerous, such as while operating machinery.
  • Continuing to use in spite of a physical or psychological problem from drug use.
  • Tolerance to the effects of heroin, so that you need to use more to get the same effect as before.
  • Experiencing withdrawal symptoms when you stop using or cut down on use.

To be diagnosed with a heroin addiction, a person must show at least 2 of the above symptoms over a 12-month period.3

A heroin addiction can range from mild (2-3 symptoms) to moderate (4-5 symptoms) to severe (6 or more symptoms).3 The severity can determine the level of care someone needs to treat the addiction. For example, someone with a mild addiction might benefit from a less restrictive outpatient program, while someone with a severe addiction may need the 24-hour medical supervision and live-in care that an inpatient program provides.
Without treatment, the person’s behavior can become more self-destructive over time. Long-term use can also lead to diseases from contaminated needles, such as HIV and hepatitis, as well as overdose and death.

Getting Help

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.

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 can address both the to the drug (through detox, counseling, and aftercare). This comprehensive approach is the most effective way to help a person start on the path to recovery.

If the person refuses help, you can try an intervention. 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 person to enter rehab and get help.4
Doctor with patient discussing treatment options
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.4

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.5

You can search for more information on our site that will help you find the right facility for your addicted loved one or call our toll-free number anytime.


[1]. Indiana State Department of Health. Signs and Symptoms of Drug Misuse.

[2]. New York State Government. Recognizing the Signs of Addiction.

[3]. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

[4]. National Council on Alcoholism and Drug Dependence. (2015). Intervention – Tips and Guidelines.

[5]. National Institute on Drug Abuse. (2016). What to Do If Your Adult Friend or Loved One Has a Problem with Drugs.

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