I. The Basics

The Primary Dangers of Heroin

  • Addictiveness: Heroin is considered one of the most addictive drugs in the world. In a 2007 comprehensive study of illicit drugs, heroin yielded the highest score for addictiveness.
  • Risk of Overdose: Heroin overdoses have increased over the past decade with a sharp spike from 2012 to 2015. When heroin users take a high dosage, their breathing slows drastically which causes hypoxia. Hypoxia can produce permanent brain damage, put the user into a coma, or cause death.
  • Long-Term Bodily Damage: Recent data shows that the majority of heroin users inject the drug, which has some possible long-term consequences. Infectious diseases like Hepatitis and HIV spread when multiple people share syringes. Also, the additives cut into heroin can cause permanent damage to the liver, kidney, and blood vessels.
  • Legal Risks: The legal ramifications of possessing heroin and for selling it are significantly higher than many other drugs because the Drug Enforcement Agency (DEA) classifies heroin as a “Schedule I” drug.

Heroin Background Information

Derived FromOpium poppy plants
Ways UsedInjected, Snorted, Sniffed, or Smoked
Scientific NameDiacetylmorphine (among others)
Slang/Street Names for HeroinH, hell dust, smack, black eagle, black tar, black pearl, brown crystal, brown tape, brown sugar, brown rhine, dirt, diesel, golden girl, orange line, red rock, red eagle, red chicken, salt, spider blue, white stuff, white nurse, white junk, brain damage, hard stuff, hard candy, hell dust, holy terror, nice and easy, joy flakes, rush hour, sweet dreams, aunt hazel, big harry, dr. feelgood, helen, hazel, henry, hombre, nickel deck, big H, capital H, galloping horse, h caps, hero, horse, antifreeze, skag, tootsie roll, little boy, foil
Slang/Street Names for Heroin Mixtures
  • Heroin and Cocaine: speedball, smoking gun, back to back, goofball, H and C, he-she, dynamite, bipping or crisscrossing (snorting both), chasing the dragon, dragon rock, moonrock, scramble, or eightball (heroin with crack cocaine), and tar (smoking both)
  • Heroin and Xanax: bars
  • Heroin and Marijuana: atom bomb or a-bomb, canade, dust
  • Black tar heroin with Diphenhydramine: cheese
  • Heroin and Meth: screwball, methball (injected),
  • Heroin and LSD: neon nod
  • Heroin and Ecstasy: H bomb, on the ball
Length of Time in Body/BloodstreamTypically two days, longer with regular usage
Punitive Legal MeasuresFederal law states that the first offense of heroin possession may be sentenced to one year in prison and fined $5,000, and a second possession charge doubles both time spent and fines. If caught selling or manufacturing, the typical charge is 10-15 years in prison and between $25,000-$100,000 fine.
DEA Drug RatingSchedule 1

White heroin is the purest form and also the most potent

Like any other drug, various processing methods yield different forms of the same drug with varying potencies. Heroin has three primary forms that are ingested in distinct ways, as described below.

Forms of Heroin
 DefinitionMethods of Use Potency
Brown Also known as diamorphine base, brown heroin comes from the first stage of purifying diacetylmorphine.Brown heroin is typically smoked because it burns at a lower temperature than other forms. Sometimes it is injected, but it needs an acid to become soluble in water.Brown heroin falls between the other two forms, having a medium potency.
White Also known as diamorphine hydrochloride, white heroin is the purest form but has a bitter taste and is the most complicated form to produce.White, highly pure heroin can be snorted or injected. It has a higher burning temperature, so it is typically not smoked.White heroin is the purest and therefore has the strongest potency of the forms.
Black Tar “Black tar” heroin is sticky like roofing tar or hard like coal. The dark color results from crude processing methods that leave behind impurities, making it the cheapest form to create.Black Tar is usually dissolved, diluted, and injected into veins, muscles, or under the skin.Due to the crude processing, black tar heroin has the least amount of heroin in it.

II. Heroin Usage

Global Heroin Use

An estimated 0.4% of the world’s population (17 million people) have tried heroin

According to the U.N.’s 2016 World Drug Report, heroin has fewer total users than most other illegal drugs, but it has one of the highest death rates. While Heroin usage is on the rise in the U.S. (unlike every other area), the percentage of Americans that use the substance is still lower than most other areas of the world.

Heroin Usage Demographics in the U.S.

The U.S. has over half a million regular heroin users, many of whom are unemployed

According to the UNODC 2016 study, heroin has the highest unemployment rate for illicit drugs at 35%. The second highest unemployment rate is among crack cocaine users at 26%. According to a RAND study, the high level of unemployment is further complicated by the cost of heroin. Regular users spend at least $17,500 on heroin per year, compared to the second most expensive addiction, cocaine, at $10,600.

According to 2014 data, 4.8 million Americans had tried heroin, and those numbers are rising

SAMHSA’s 2014 NSDUH study reported that over 4.8 million Americans had tried heroin at some point in their lives, and the average age of first use was 28 years old. They also estimate that over 200,000 people used heroin for the first time in 2014.

Opioid painkiller addicts are 40 times more likely to use heroin than the average person

Heroin use has been steadily rising since 2007. Some argue that the rising figures are due to a surge of prescription drug addictions. Heroin is cheaper and more easily accessible, so it’s a recourse for people who can no longer get prescription drugs.

According to a 2013 study by NSDUH and SAMHSA, 4% of people who misused prescription opioids used heroin within five years, but when looking at heroin users as a whole, nearly 80% reported first overusing prescription opioid painkillers. This data shows that most people who abuse prescription painkillers do not transition to heroin, but most heroin users were first addicted to prescription opioid painkillers.

III. Heroin Addiction

Heroin poses a double threat to the human brain: it targets the opioid receptors which makes the drug extremely pleasurable and dulls other pleasurable experiences after, and it reduces the pain signals the body sends to the brain. These effects cause lasting damage to the brain and the body, making withdrawal from heroin extremely uncomfortable and sometimes long-lasting.

How Heroin Addiction Works

The human brain contains chemicals called neurotransmitters that bind to mu-opioid receptors throughout the brain and body. These receptors regulate pain, hormone release, and feelings of well-being. When they are activated, they release dopamine, which makes the person feel pleasure. Heroin targets these receptors and other areas of the body to create a very addictive experience that changes the brain’s understanding of pleasure and pain.

When heroin enters the body, it is converted to morphine and has pleasurable effects

Morphine has a similar chemical structure to endorphins, the hormone that makes you feel good when running or after having a baby. Endorphins activate opiate receptors, lessening pain and giving a strong sense of well-being. Morphine (originally heroin) activates the same receptors, but more intensely. The morphine attaches to mu-opioid receptors (MORs), resulting in extreme pleasure, or “a rush.”

During this short rush, the individual experiences less pain, which is called the analgesic (painkiller) effect. For instance, if a person breaks their hand, the hand’s receptors send a message that something is wrong to the central nervous system. The messages are called neurotransmitters, and they get from the hand to the brain by neurons passing them one to another until pain quickly registers in the brain and the body gets to work. Painkillers, or analgesics, fill the space between nerve cells, preventing them from sharing messages to the brain, and thus suppressing any recognition of pain, making it seem as though it doesn’t exist.

Morphine causes an unprecedented euphoria that leaves the brain wanting more

When morphine attaches to MORs, the effect is much stronger than the body would feel under normal circumstances with endorphins. Heroin is concentrated and gives the brain a much higher dose than what the body naturally gives itself. After the initial rush that lasts 1-2 minutes, the body slows down drastically which results in a high that lasts anywhere from 4-5 hours. During the high, the breath slows, the user feels very drowsy, and mental functioning slows, sometimes causing confusion or dizziness.

The withdrawal is just as extreme as the euphoria

Regular use can cause dependence, meaning the brain becomes reliant on the drug. When a person doesn’t use the drug for a short period, the neurons start working again. The brain then gets overwhelmed because it’s not used to that sensation of neurons firing anymore. This process results in a chemical imbalance, leading to the typical withdrawal symptoms of anxiety, nausea, muscle spasms, fever, cramps, anxiety, and diarrhea.

Withdrawal begins anywhere from 8-12 hours after the last hit and causes flu-like symptoms. If the user cannot get rid of the withdrawal by using more heroin, they will experience more severe symptoms over the following 2-3 days. The extreme discomfort can last 7-10 days total, with lingering withdrawal symptoms lasting months for heavy users. Heroin addicts sometimes lose any feeling of a “rush” and only continue using heroin to offset withdrawal symptoms.

Tolerance to all opioids increases with use

Over time the brain builds tolerance, so the user needs more heroin to feel the drug’s effects. Building a tolerance is typical of many drugs, especially psychoactive ones like heroin. Likewise, the tolerance applies to other drugs that affect the brain similarly (called cross-tolerance). Someone who has built a tolerance to heroin will also have a cross-tolerance to other opiates like codeine, opium, and morphine.

IV. Heroin Effects and Dangers

Effects of Heroin

When coupled with the relapse rate of 78%, the adverse effects of heroin make it one of the most dangerous drugs. Even after just one use of heroin, the user will experience flu-like symptoms caused by withdrawal within a day of using the drug. Negative effects are magnified by long-term use, lasting longer and becoming more intense, while the positive effects (like euphoria) lessen over time due to tolerance.

The tables below show the possible effects of short-term and long-term use.

Short-Term Effects of Heroin Use
Rush (direct effects of drug, 1-2 min.)
  • Skin flushes
  • Dry mouth
  • Heavy feeling in extremities
  • Nausea
  • Vomiting
  • Itchy
  • Euphoria
High (within 4-5 hours of taking the drug)
  • Slowing of the heart
  • Slower breathing
  • Feeling mentally “numb”
  • Feeling apathetic
  • Drowsiness
  • Confusion
  • Cloudy mental functioning
  • Overly slow breathing (called hypoxia) that possibly results in a coma, brain damage, or even death


Long-Term Effects of Heroin Use
Chronic Use
  • Snorting: Perforatation of the septal column (tissue that separates nasal passages)
  • Injection: Scarred or collapsed veins, bacterial infection of blood vessel and heart valves, boils, skin infection, arthritis, clogging blood vessels which could lead to death, liver and kidney disease, Hepatitis B and C, HIV, other bloodborne pathogens
  • Constipation
  • Lung complications (could include pneumonia and tuberculosis)
  • Permanently and negatively impacts decision-making ability and stress response
  • Insomnia
  • Depression
  • Antisocial personality disorder
  • Sexual dysfunction
  • Restlessness
  • Muscle and bone pain
  • Weakness
  • Sneezing
  • Muscle cramps and spasms
  • Vomiting
  • Diarrhea
  • Cold flashes
  • Depression
  • Nausea
  • Insomnia

Significant Dangers

Heroin overdoses increased fivefold between 2002 and 2014

In 2014 alone, the Centers for Disease Control counted 10,574 heroin overdose deaths, and they are on the rise. Heroin overdose results in hypoxia: slowing breathing so much that the body and brain do not get enough oxygen. This lack of oxygen can have similar effects as drowning, including severe and permanent brain damage, a coma, or death.

Heroin is one of the most addictive illegal drugs

A 2007 comprehensive study by Dr. David Nutt placed drugs on a rating scale of addictiveness based on factors including pleasure, physical dependence, and psychological dependence. The scale put heroin at 2.78/3, the highest addictiveness score of all the drugs surveyed. Heroin’s effect on lifestyle, relationships, and high risk of relapse all contributed to the score.

Most users inject heroin, putting them at high risk for contracting blood-borne illnesses

Many heroin users inject the drug, but that method can have serious ramifications. Being under the influence may cause poor decisions like sharing syringes, which could result in contracting Hepatitis or HIV.

According to the National Institute on Drug Abuse (NIDA), injection drug users (IDU) are the highest risk group for contracting Hepatitis C. Each IDU that has Hepatitis C will likely share it with over 20 more people. However, programs through organizations like NIDA are working to educate drug users about safe practices to help prevent spreading these infectious diseases.

Effects on Pregnant Women and the Fetus

When pregnant mothers use heroin during pregnancy, 48-94% of the time their fetus will get neonatal abstinence syndrome (NAS), which means the baby becomes addicted to heroin. Mothers can help prevent NAS by starting a medication-assisted treatment program, which they can do at rehab or with a qualified doctor. It’s crucial to seek assistance because quitting heroin “cold turkey” can result in miscarriage or death of the fetus, especially if it has been exposed to heroin or become addicted. See our guide to Heroin Rehab for more information.

When a baby is born with NAS, it will have symptoms similar to typical heroin withdrawal: fever, irritability, crying, seizures, slow weight gain, tremors, diarrhea, vomiting, and possibly death. Likewise, babies with NAS are usually a quarter the weight of their peers and born prematurely. If a baby has NAS, doctors will use morphine to wean it off opioids.

V. Recent Studies and Understandings about Heroin

Recent Heroin-Related Developments

Heroin vaccine blocks heroin uptake, preventing any pleasurable feelings from the drug

A new vaccine may help counter what many call the current “opioid epidemic.” The vaccine prevents positive feelings users get after taking heroin, ideally preventing people from wanting to use heroin at all. While the vaccine would address the physical response a person has, it does not solve or prevent the social and psychological reasons that people use drugs. Some argue that the vaccine would stop heroin-use but cause a rise in other drug use instead.

Fentanyl, a synthetic substance, is making heroin overdose more common

Fentanyl is a purely synthetic substance that works similarly to heroin but is not derived from the poppy plant. Fentanyl is a fine-grain powder and cheap to produce, making it easy to cut into heroin. However, because its potency is so high, heroin users may buy what they think is pure heroin, take a regular dose, and accidentally overdose.

Some dealers cut heroin with elephant tranquilizer and equally dangerous additives

Besides Fentanyl, dealers in Ohio and other states cut heroin with substances like Carfentanil. This substance is known as an “elephant tranquilizer” to zookeepers, and it’s equally as strong. When injected, Carfentanil and other additives can clog blood vessels, cause liver and kidney disease, and lead to immediate death.

Current Research

Because of heroin’s highly addictive nature and the high level of opioid abuse in the U.S., scientists have been studying what makes heroin and opiates so addictive to better understand how best to treat them and prevent addiction. Below is an overview of some of the newest, significant findings.

New Research and Findings
FieldStudy NameImportance (Controversial, New, Supportive)Analysis
Heroin’s Effect on Brain and Body2016 – Adolescent athletes’ heroin useNEW – Builds on NIDA’s Monitoring the Future study to determine if student athletes use heroin more than peersResults of the study showed that competitive sports made little difference in the likelihood of a student using heroin except for ice hockey, whose players had “substantially greater odds” of using heroin.
2016 – Heroin Overdose MysteryCONTROVERSIAL – Argues that situational cues affect tolerance and therefore overdose likelihoodSometimes users overdose on a typical dose amount. This study demonstrates that overdose and the body’s tolerance to heroin may be based on situational cues that, when lacking, fail to provide tolerance, causing the user to overdose accidentally.
Heroin Addiction2016 – Relationship between nonmedical prescription opioid use and heroin useSUPPORTIVE – Supports evidence that prescription painkiller misuse and heroin use are connectedGives an overview of previous studies, arguing that understanding heroin use and painkiller misuse are interconnected, and solutions should be built around that understanding.
2017 – Initial heroin use to daily useNEW – Investigates how quickly users move from first use to regular useThis study shows that heroin use by injection results in the shortest time between initial and chronic use, leaving less time for an intervention.
Other2016 – Trends in Hospital Costs for Heroin OverdoseSUPPORTIVE – Analyzed data from 2001-2012 to analyze hospital and social cost of heroin and prescription opioid overdose.The study found that health care costs for treating overdose increased over this period and that heroin users were typically younger while prescription overdose users became more frequent.

Note: The sources used in the “Current Research” should be taken as unverified due solely to the fact that the research is new and therefore not widely tested. We do however require a CiteScore® from the publishing journal of 3 or more; this third-party service ranks the journals based on metrics that measure overall credibility and prestige. This requirement increases the overall reliability of information in this section to the standard of good peer-review practices of trusted scientific journals.

VI. How to Get Help for Heroin Addiction

Heroin detox and withdrawal is difficult and can be dangerous, which is why it is important to seek out medical assistance for the process. Going to rehab can provide that assistance in the form of medication-assisted therapy (MAT). There are some rehab centers specifically designed to treat opioids using MAT, and they are available all across the U.S.

If you are looking for rehab options for yourself or a loved one, find out more about rehab programs for heroin and how to find one near you in our guide to Heroin Rehab.