Long-Term Effects and Health Risks of Heroin

Heroin is a highly addictive opioid drug that is illegally manufactured and sold through the drug trade. Its use is associated with several short- and long-term health effects and is extremely dangerous to consume.1

Nearly 130,000 people have died from a heroin overdose in the last two decades.2 The U.S. has declared opioid addiction a public health emergency, as drug overdose is now a leading cause of injury-related death.3

This article will cover the effects of heroin use, potential signs and symptoms of a heroin overdose, the long-term effects of heroin addiction, withdrawal symptoms from heroin, and what the treatment is for heroin use disorder.

What Are the Effects of Heroin Use?

People who use heroin report they feel a rewarding sense of pleasure or “rush” that is followed by a period of drowsiness. 4

Heroin is converted to morphine in the brain, which then attaches to and activates opioid receptors. While this drug-receptor interaction initiates the pleasurable effects of the drug, it can also lead to slowed breathing, slowed heart rate, and a decrease in awareness of surroundings.4

The immediate effects of heroin use include:1, 4

  • Warm flushing of the skin.
  • Dry mouth.
  • Heavy feeling in the extremities.
  • Nausea.
  • Vomiting.
  • Severe itching (in some cases).
  • Slowed breathing.
  • Slowed heart rate.
  • Overdose.

In recent years, heroin use has become potentially more dangerous due to the increasingly commonplace addition of another opioid called fentanyl. Fentanyl is a synthetic (man-made) opioid 50 to 100 times more potent than morphine.3

The increased use of fentanyl-laced heroin, often taken unwittingly, has directly impacted the number of fatal overdoses in the U.S. and around the world.

Heroin Overdose

A heroin overdose occurs when a person uses a large enough dose of the drug to cause a life-threatening reaction or death.1 Signs of a heroin overdose include:5

  • Not responding (cannot awaken).
  • Slowed or lack of breathing (shallow breaths).
  • Slowed or stopped heartbeat.
  • Purplish-blue lips, which indicate a lack of oxygen.

Signs of heroin overdose often indicate the person is not getting enough oxygen to the brain, a condition called hypoxia. Overdose-related hypoxia can lead to short- or long-term mental and nervous system effects including coma and permanent brain damage.1, 4

It is possible to stop an overdose with the use of naloxone (Narcan), a medication that can rapidly reverse the effects of heroin and other opioid overdoses.1 A person may need to use more than one dose of naloxone to reverse the overdose. It is critical to call 911 and get the person to emergency care, as other life-saving measures may be needed.

Long-Term Health Effects of Heroin Addiction

heroinLong-term heroin use may alter brain functioning over time and can result in hormonal and other neurochemical imbalances.6 Heroin-related brain changes may be associated with impaired decision-making abilities, behavior control, and response to stressful situations.6, 7 Repeated heroin use can increase the risk of addiction, which is the chronic, compulsive use of a drug.6, 7

Heroin use over a long period can lead to tolerance to the drug.7 Tolerance occurs when the body needs more heroin to get the same effect. Another long-term effect is when the person becomes dependent on the drug. Physical dependence means the body has adapted to having the drug in the body in such a way that without the drug, withdrawal symptoms occur.7

Other long-term effects of heroin use:1, 7, 8

  • Increased risk for fatal overdose.
  • Sexual dysfunction.
  • Irregular menstrual cycles.
  • Damaged mucosal tissue in the nose (when snorted/used nasally).
  • Perforated nasal septum (when snorted/used nasally).
  • Skin infections (boils called abscesses).
  • Collapsed veins (from injecting heroin).
  • Immune reactions (e.g., arthritis).

Many long-term effects, if left untreated, can lead to severe consequences and even death. Early recognition and treatment of the following types of infections can be lifesaving:7
  • Lung complications like pneumonia and tuberculosis may be more likely in people who experience chronic respiratory depression or are otherwise in poor health in association with heroin use.8
  • Mental health disorders such as depression can lead to suicidal thoughts, tendencies, and acts.
  • Heart infections like endocarditis, an inflammation of the inner lining to the heart’s chambers and valves, require intensive cardiac care intervention.9
  • Bacterial blood infections, or sepsis, require acute medical intervention. Sepsis can occur when people injecting drugs share injection needles that are contaminated with a type of bacteria called Staphylococcus aureus (i.e., staph).9
  • Viral blood infection, caused by viruses, can become a chronic health problem. Hepatitis B, C, and HIV are all caused by viruses. These infections can be spread by sharing drug paraphernalia (e.g., spoons, needles, straws, razor blades), sexual contact, or by any means where the blood of an infected person enters the bloodstream of an uninfected person.9

Heroin Tolerance

Regular use of an opioid like heroin can lead to the person developing a tolerance. This means that they need higher and/or more frequent doses of the drug to feel the desired effects, like the euphoric high. A phenomena like tolerance may in some cases fuel a cycle of compulsive use.10

Dependence on Heroin

Increasingly problematic patterns of use may also lead to physiological dependence and an associated withdrawal syndrome, where a person experiences severe symptoms that are minimized or disappear completely by taking heroin or another opioid. This may also solidify patterns of compulsive use10

Heroin Use Disorder

When a person can no longer control their heroin use and experiences negative impacts in major areas of their life, such as school, work, or family life because of their drug use has developed into an opioid use disorder.

Medical or clinical professionals are the only healthcare providers who can diagnose any type of substance use disorder. Heroin use disorder, or HUD, falls under the medical condition of an opioid use disorder (OUD). The American Psychiatric Association’s criteria for an opioid use disorder is when a person exhibits 2 or more of the following signs and symptoms over the last 12 months:11

  • Opioids (e.g., heroin) are taken in larger amounts to get the same effect.
  • There is a persistent desire to use opioids or an inability to control the use.
  • A great deal of time is spent seeking, using, and recovering from opioids.
  • Craving the drug is persistent.
  • Repeated opioid use despite its impact on major life obligations (e.g., family, work, school).
  • Continued use of opioids, even though this causes family and social problems.
  • Important social, occupational, or recreational activities are given up or reduced because of using opioids.
  • Opioid use continues even in hazardous situations.
  • Opioid use continues even though health problems are caused by or worsened by use.
  • Tolerance is present.
  • Withdrawals present after reducing or stopping the use of the drug.

Heroin Withdrawal

A person who uses heroin may begin to have withdrawal symptoms as early as a few hours after the last use of the drug. Symptoms of heroin withdrawal include:1, 11

  • Restlessness.
  • Severe muscle and bone pain.
  • Sleep problems.
  • Diarrhea and vomiting.
  • Cold flashes with good bumps.
  • Uncontrolled muscle movements (e.g., restless legs syndrome).
  • Severe heroin cravings.

Heroin withdrawal can last up to a week or more. Medically assisted detox is a safe way to detox. It also helps reduce the severity of withdrawal symptoms while providing medical and mental health support that increases detox completion rates.

Treating Heroin Addiction

Heroin use disorder can be treated through effective behavioral and pharmacological (medications) therapies. Research suggests that integrating both types of treatment may work best.12

Medications used for OUD have proven to increase retention in recovery programs, decrease drug use, decrease exposure to infections, and decrease criminal activity.11 Although there is a risk for people on medication to divert (misuse) their medication, the benefits outweigh this risk in most cases.

Medications prescribed to treat opioid use disorder include:12

  • Methadone, a full opioid receptor agonist medication. Methadone is taken orally for treatment of OUD. Its oral route of use results in a relatively slow-acting effect to dampen the opioid “high” that might otherwise be felt using other routes. It is an effective treatment for preventing withdrawal and minimizing cravings. Methadone is highly regulated—only approved outpatient treatment programs can administer this medication to patients daily.
  • Buprenorphine, a partial opioid agonist. Buprenorphine helps with cravings without producing a “high” or creating the dangerous side effects that other opioids can produce. Suboxone (buprenorphine and naloxone combination) is taken by mouth or dissolved under the tongue. Buprenorphine can be prescribed by DEA waivered providers and emergency medical providers.
  • Naltrexone (Vivitrol), an opioid antagonist (non-opioid), is non-addictive and does not sedate or result in dependency. Vivitrol is an extended-release injection administered by a health provider once a month. There is also an option to take naltrexone by mouth daily; it is a cheaper option for those whose insurance plan does not cover Vivitrol.
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