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Signs of Heroin Use: How To Help an Addict

Posted on January 25, 2020

Signs of Heroin Use: How To Help an Addict

The reality for many faced with crippling heroin addictions, despite the known dangers and perils that await, the thrill and mystique of such a drug can prove hard to resist.

This guide will give you some perspective on what heroin addiction is and how it happens.

The different kinds of negative repercussions that follow heroin abuse are both mental and physical and this guide will give an indication of what to look out for, as well as what to do if you suspect a loved one has fallen victim to heroin addiction.

Heroin- What is it?

Heroin also referred to as smack, H, skag, china white and a variety of other names is an opioid that derives from the morphine of poppy plants found across swaths of Southeast Asia and Latin America.

Heroin comes in different forms largely dependent on the region in which it was produced.

Some notable heroin types include white powder heroin, which is commonly found on the East coast of the United States.

The common method of taking white powder heroin is injecting or “shooting” the drug directly into a vein, while others snort it in powder form.

Black tar heroin is infamous for its deadly effects and is commonly found on the west coast, as most black tar heroin is produced in Mexico.

Black tar heroin gets its name from its dark color, and it ranges in consistency from gummy like putty to solid rock-like pieces.

The most common method of consumption of black tar heroin is smoking, followed by injecting.

Brown powder is produced in Mexico, and acts as a middle ground between white powder and black tar; the brown powder is cheaper than white powder heroin variations but also more refined “pure” than black tar heroin.

Brown powder users typically smoke or snort the powder and due to its non-intravenous methods of consumption has become the go-to for those trying out of curiosity.

There are also other types of heroin which are typically cut and mixed with other substances (fentanyl is commonly used), China White is a slang term for heroin mixed with fentanyl or other similar variations.

Speedballs are to drugs what red bull Vodkas are to drinking, a dangerous combination of uppers (stimulants) and downers (depressants).

Cocaine is commonly used in speedballs (its nefarious offspring crack cocaine is used as well) which are extremely dangerous, creating a negative “push-pull” effect on the body.

Scientifically speaking heroin works by attaching itself to opioid receptors in the brain, once activated these receptors stimulate a significant release of dopamine, a chemical in the brain that spreads pleasure quickly throughout the mind and body.

Heroin users report feelings of extreme euphoria while high, as a rush of good feelings and happiness drowns users. As the high wears on, the world appears to have slowed down and a dreamlike period ensues. For more information on the types of heroin and their effects check out the link below:

Heroin Statistics

There are some frankly eye-popping numbers out there about heroin and its usage, here are five of the most staggering from the Center for Disease Control (CDC) and the National Institute on Drug Abuse (NIDA).

It should be noted that the CDC is an American based organization and the statistics below are representative of the United States.

Heroin-related deaths increased fivefold from 2010 to 2017. Among new heroin users from 2000 to 2013, nearly 3 out of 4 reported having misused prescription opioids prior to their first heroin experience.

In 2015 there were a reported 81,326 emergency room visits due to accidental heroin poisonings.

The number of people meeting the criteria for dependence on heroin or other related heroin use disorder increased dramatically from just under 215,000 in 2002 to over 625,00 in 2016.

Fentanyl which is commonly found in heroin is 50 to 100 times more potent than morphine.

How does heroin work?

Heroin addiction occurs when someone develops an addiction to, and dependence on Opioids – heroin is the form of the opioid, which in itself has several forms.

Addiction is characterized by users seeking out the drug despite being aware of the negative side effects, or the user may even be experiencing the negative side effects but their strong dependency on the drug does not allow them to stop using.

Heroin numbs and blocks out pain and as such most users are undergoing significant trauma that goes away while under the spell of heroin.

There is a significant correlation between heroin use and mental health issues, as with other drugs and substances. Heroin provides temporary relief to users, who are unwillingly pulling themselves further into the dark hole that is their addiction.

Heroin use may be hard to notice at first, however, as the addiction develops and usage increases, here are some visible and non-visible signs of misuse are likely to appear:


Physical Symptoms

  1. Persistent flu-like symptoms
  2. Bruising or scabbing of the skin, especially if the mode of delivery is injection
  3. Significant, stark loss of weight
  4. Exhaustion and lethargy

Social Symptoms

  1. Drastic mood swings that can include sudden bursts of anger
  2. Strained or ruined relationships
  3. Financial problems (users will become focused on getting their next fix, and sometimes nothing else matters)
  4. Job loss/unemployment
  5. Social isolation

Behavioural Symptoms

  1. Substandard performance at work or school
  2. Loss of interest in previously enjoyed activities
  3. Wearing long-sleeved shirts in warm weather to cover up needle marks and unsightly vein damage
  4. Increased lying and secrecy even to especially close loved ones
  5. Possession of syringes, pipes, spoons or bottle caps (used to “cook” heroin), aluminum foil and a straw (used for smoking heroin), as well as tie-offs which can be a variety of things but can include a shoelace, rubber hose, or other related item which are used to constrict blood flow, making a user’s veins pop prior to injection.

Psychological symptoms

  1. Depression and anxiety
  2. Low self-esteem
  3. Feelings of guilt and shame
  4. Inability to stop thinking about where, when, and how to get their next heroin fix
  5. Hopelessness and despair

Heroin/Opiate Painkiller

As noted early the number of first-time heroin users who had previously abused opiate pain killers is massive, over 70% in fact.

The reasoning is simple enough; as both painkillers and heroin are members of the opiate family they both bind to the mu-opiate receptors in the brain, releasing dopamine and creating feelings of euphoria.

Once someone has developed an addiction to an opiate they become almost interchangeable in the sense that an oxycodone addict can satisfy their craving for oxycodone by shooting heroin.

There are notable differences between the potency of prescription painkillers and heroin, the sad fact is that many people move on from oxycodone or other opiate painkillers due to the fact that heroin is cheaper and more potent, just what every addict craves.

Short Term Health Effects

The short term effects of heroin use include the heroin high, a brief induced sense of euphoria followed by a long period of drowsiness in a dream-like state.

There are other typical short-term effects of heroin use namely impaired mental functioning, incoherent speech, disorientation, the infamous heroin itch, as well as possible vomiting.

A heroin high and the short-term effects that accompany it typically last between three to five hours, of course, this depends on the potency of the heroin as well as the tolerance of the user.

Long Term Health Effects

The notable long term effects of heroin include damaged or collapsed veins, numerous cuts and scabs due to the short term itch heroin causes, frequent sniffing and nosebleeds.

Withdrawal symptoms include:

  1. Profuse sweating
  2. Nausea
  3. Vomiting
  4. Agitation/anxiety
  5. Increased heart rate

There are also more serious heroin-related conditions that affect heroin users in the long run, including infections of the heart lining and valves, liver, kidney, or even lung disease, in addition to being more likely (for intravenous users) to develop infectious diseases of the blood like HIV/AIDS, and or hepatitis B and C.

Heroin Overdose

An overdose occurs when a person takes too much/or too potent an amount of heroin. When an overdose occurs people can pass out and stop breathing, and death can occur quickly within minutes.

Naloxone can help save the life of someone overdosing on heroin and can be purchased at a pharmacy without a prescription almost anywhere. It can also come in nasal spray form, Narican,

Some states that were hit hard with the opioid epidemic made it a requirement to give out Naloxone when prescribing an opiate, in an effort to quell the grisly death by opiate overdose rates. The availability of over the counter naloxone seems to be a positive step.

It is important to note that while Naloxone acts as an antidote for opiates, it is in-effective against other drug overdoses say of methamphetamine or cocaine.

There are several signs and symptoms to be aware of that may indicate that someone is overdosing on heroin: blue nails, skin, or lips is a dramatically startling sign. A weak pulse and unresponsiveness are indicative of a likely overdose as well.

Should you be in the presence of someone experiencing an overdose, your best course of action is to call 911 as soon as possible. If you have instant access to naloxone that should be administered as well.

The majority of US states have laws in place protecting callers who inform emergency services of an overdose. Of course, it can be very difficult for outsiders to tell when another person is overdosing.

There are also several things that you should not do when you believe someone is undergoing an overdose of heroin, some of which may seem obvious but should still be pointed out.

Don’t try to reverse the effects by administering some kind of stimulant like meth or cocaine, do not shake them in an effort to wake them – despite your natural inclination to do so.

You should also avoid putting them in a cold shower or bath as well as avoiding sticking your fingers down their throat in an effort to induce vomiting.

Detoxification and treatment

The first step on the road to recovery entails finding a suitable treatment program. A consultation with your primary physician is a good first step, especially for those aiming to receive admittance into a government-funded program.

Another thing to consider is whether it would be more beneficial to your recovery and overall health to go with an inpatient treatment program (living at a facility with constant access to care), or an outpatient treatment program (regular visits and support offered while still living at home.

Inpatient programs, and in a greater sense the clinics in which they are housed, are ideally convenient and pleasant once inside. The detoxification process involves weaning an addiction through a deliberate withdrawal of a drug.

This process can either be a complete abrupt withdrawal, commonly referred to as going “cold turkey.” The alternative option is gradual weaning off of heroin often by using a replacement opioid drug such as methadone. to help ease the transition and overall impact of the withdrawal process.

The time period for detoxification varies from patient to patient, those who do experience withdrawals will notice their first symptoms between 6-12 hours after their last hit of heroin.


The most dreaded part of the recovery process, often compared to having the severe flu, many people end up relapsing and re-using heroin due to the difficulties they experience during the withdrawal stage.

Recovering heroin addicts report feeling incapable of making good decisions, or any decisions at all during their period of withdrawal. The only thing that commonly matters is sourcing the next dose of heroin.

Physical signs of withdrawal include:

  1. Dehydration
  2. Runny nose
  3. Muscle spasms and aches
  4. High blood pressure.

Intense cravings for heroin often afflict those attempting to wean off heroin, users will plead, and beg for just a little bit of heroin, or even be left alone, so they can pursue their pursuit of Heroin.

A huge benefit that specialized in-patient care has over out-patient care is the ability to be dedicated to the person going through withdrawals 24/7 with a rotating staff trained in dealing with those exact situations.

A potentially beneficial option for individuals suffering from especially bad physical withdrawal symptoms is medical detox. Taking place in a supervised facility with trained staff, medical detox’s remove some of the pain and suffering of withdrawals by using counteractive medications, combatting the negative effects that occur during withdrawal periods.

Should an individual decide to detox at home, it is a must that they have someone watching them at all times. Home detoxes run a much higher risk of relapse than do in-patient programs.

However, it is understandable that some people prefer to detox around loved ones. Although there is a great degree of variance between individuals, below you will see a general timeline of heroin withdrawals from the last hit to stability.


6 to 12 hours after their last dose: the earliest symptoms include drug-seeking activity, and anxiety as time progresses other, more physical symptoms begin to appear including runny nose, sweating, and possibly watery eyes.

24 to 26 hours after their last dose:  The most severe effects of the withdrawal symptoms are reported to hit within the first few (2-3) days. Symptoms range from irritability and muscle twitches to more serious symptoms like diarrhea, vomiting, rapid breathing, and overall weakness.

7 to 10 days after their last dose: After peaking symptoms tend to begin subsiding around the one week mark. For many the symptoms will have disappeared by this time period.

10 plus days after their last dose: Feelings of sleeplessness, anxiety, muscle aches, and overall weakness may preside for months. The craving for heroin may exist for even longer, some former addicts report it never goes away.

The most pertinent threat to a successful detoxification and withdrawal period are of course relapse, the user using again. To hammer it down during at least the first 72 hours, the addict attempting recovery will need supervision and guardianship to prevent relapse and the possibility of any even worse threat continued addiction with the possibility of an overdose.

Therapy Options

In addition to successfully detoxifying and surviving the horrors that can be withdrawals an important part of the recovery process is staying motivated and not letting your guard slip.

Therapy is wonderful in many ways as it provides a map to the possible source of trauma, and other neurological factors that lead to the user trying heroin in the first place. Some of the notable therapy options out there for recovering addicts include:

1. Cognitive Behavioral Therapy (CBT)

This form of therapy allows patients to discover which thought patterns, and or behaviors are likely to precede them using, as well as working to increase coping skills and remove the need for negative reinforcement sought by users in the form of heroin.

2. Motivational Interviewing

This therapy technique involves addicts and therapists working collaboratively to help the former addict develop an internal desire for positive change, in this case removing heroin from their life.

3. Medication Management

Medications that are used to treat opioid disorders, attach themselves to the same receptors as heroin itself the difference being these medications are less dangerous and not nearly as addictive, likely not inducing an addiction among users. Popular medicines taken by those in recovery include:

a. Methadone – Taken orally methadone reaches the brain slowly, dampening the high effect. Oftentimes those on government-funded programs will be given methadone as a part of their patient care, you may have seen people lined up outside a methadone clinic in your area.

b. Buprenorphine – Sold under the brand name Subutex, this medication works to remove the feelings of desire addicts have towards heroin and does not produce a high of any kind.

c. Naltrexone – Sold as Vivitrol, this medication is an opioid antagonist meaning that the drug works to block the action of opioids. There is a once a month injection form that has proven more effective than the once-daily dosing.

How can I help?

To finish up this guide we will leave you with some knowledge on how to help a heroin addict in the throes of addiction. Approach them about getting treatment, come to them as a loved one who is only trying to help them improve their life.

Try to avoid negative dialogue when attempting to help them seek treatment. It can be wise for you, someone dealing with this difficult process from a different but still vulnerable position, to seek therapy and advice on the situation with your loved one.

The setting of boundaries is important and necessary so long as the addict knows that you are there for them and are willing to stick by their side.

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