Very few people imagine that heroin will become a major part of their lives. It often comes into the picture quietly, brought on by stress, trauma, curiosity, or a search for relief that other options haven’t been able to provide.
What begins as a temporary escape, though, can gradually take hold, changing not only how a person feels, but how their body functions and how they interact with the people and world around them. Over time, the method of use becomes just as important as the drug itself.
Among the various ways heroin is used, injection carries the most risks. It makes the drug go directly into the bloodstream, producing rapid effects while exposing the person to a wide range of potential health consequences. Although the reasons behind injection vary, the outcomes usually follow a similar destructive path, which can be difficult to reverse without the right support.
In this article, you’ll learn more about:
- What heroin is
- What happens to the body and mind when heroin is injected
- The reasons behind heroin use
- The dangers of using heroin
- How to recognize the signs of withdrawal and overdose
- Where to find help for heroin addiction
If you or someone close to you is using heroin, help is available, and you’re not alone. First Step Behavioral Health is here to answer any questions you might have about our programs, including what to expect and how long they last. You can also call to verify your insurance coverage or schedule an intake appointment. Contact us whenever you feel ready to start your recovery journey.
What Is Heroin?
Heroin is a powerful opioid drug that’s made from morphine, a substance extracted from the seed pod of the opium poppy plant, which is grown in places like Asia, Mexico, and Colombia.
While morphine is used in medical situations to relieve severe aches and pains, heroin is not meant for medical use. It’s illegal in the United States and classified as a Schedule I drug due to its high potential for abuse and lack of accepted medical use.
Heroin can look different depending on where it’s sold and how it’s made. It may appear as a white powder, a brownish powder, or a black sticky substance commonly referred to as black tar heroin.
The drug can be smoked, snorted, or dissolved in water and then injected with a needle. Each of these methods carries its own risk of side effects and health problems, but injecting it directly into the bloodstream poses the greatest danger to both physical and mental health.
What Happens When Heroin Is Injected?
When someone is talking about injecting heroin, they may also call it “shooting up heroin.” Many people turn to heroin as their drug of choice because its effects happen so quickly and come on intensely. Within moments of taking it, most people experience a wave of euphoria and deep relaxation, followed by heavy drowsiness.
These effects are a result of how the drug binds to and activates the mu-opioid receptors in the brain, which are part of the body’s natural pain and reward system. Once heroin enters the brain, it’s quickly converted back into morphine, which then attaches to these receptors. This triggers the release of dopamine, a neurotransmitter responsible for feelings like pleasure and motivation.
Since the brain gets flooded with way more dopamine than it would ever naturally produce on its own, it creates the overwhelming sense of relief or escape for the individual consuming it.
Why Do People Inject Heroin in the First Place?
People may choose to inject heroin for a number of reasons, and it’s not always because they’re trying to get the strongest high. Often, injection is the result of becoming more dependent on the drug and needing more of it to get the same kind of high.
Someone may have started out by smoking or snorting the drug, believing that they wouldn’t get addicted that way, but then find that over time, those methods don’t bring the same relief they used to. As tolerance increases, the temptation to switch to injection becomes even greater, especially if the individual knows that the drug acts more quickly when it’s administered that way.
Others start injecting earlier because of influence or peer pressure from friends, family members, partners, or people they use with. In some communities or social circles, injecting is simply what people do, and the person doesn’t know any other way of life.
When access to clean supplies is limited, the dangers of infection and disease also become more of a risk.
Some people inject heroin because they’re trying to avoid withdrawal symptoms. Withdrawal from drugs like heroin can be incredibly uncomfortable due to both physical and mental symptoms. Injection may present a fast way to get the drug into the person’s system and stop the pain.
Whatever the reason, once someone starts injecting, it can be very difficult to stop. The speed and intensity of the high, combined with the body’s growing dependence on the drug, creates a cycle that’s hard to break without help from trained and experienced professionals, like therapists and doctors.
The Cycle of Heroin Dependence
Heroin eventually changes how the brain works, including how a person thinks, feels, and behaves. Over time, the brain stops producing certain chemicals, like dopamine, serotonin, norepinephrine, and endorphins on its own. Instead, it starts relying on heroin to function as usual, which is where physical dependence begins to form. The cycle of dependence usually looks something like this:
- Initial use: The person uses heroin and feels intense euphoria and relief.
- Tolerance builds: Over time, they need more heroin to feel the same effects.
- Withdrawal: When heroin isn’t in the system, the body reacts with painful symptoms.
- Compulsive use: Instead of using to get high, they do it so that they don’t get sick.
- Loss of control: Life starts to revolve around the drug, and quitting feels impossible.
This pattern happens quickly for some and more slowly for others, but the end result is usually the same.
If you’re wondering whether you or someone else has developed heroin dependence, ask yourself whether the drug has become the center of everyday life. When relationships, work, school, self-care, and responsibilities start to take the backseat to the next injection, it could point to dependence.
Keep in mind that this doesn’t mean that you or someone you care about is weak. It simply means that their body and brain have adapted to heroin in a way that makes quitting feel physically and emotionally impossible.
Those who go to treatment will quickly learn that the process isn’t only about stopping the drug, but retraining the brain, learning routines again, and understanding how to manage life’s stressors without using again.
Short-Term Dangers of Shooting Up Heroin
Injecting heroin even once can lead to dangerous and sometimes life-threatening consequences—mentally, physically, and emotionally. Since heroin suppresses the central nervous system, it can cause key bodily functions, like breathing, heartbeat, and temperature regulation, to slow down dramatically. Some of the most common short-term risks include:
- Flushed skin: When heroin enters the bloodstream, it can trigger a histamine response, causing a warm, reddened flush that spreads across the face, chest, and arms. Some people describe it as a rush of heat, while others find it more uncomfortable or alarming than anything.
- Nausea and vomiting: Heroin can upset the part of the brain that helps control nausea, which is why many people feel sick to their stomach after using it. This reaction is particularly common if the drug is taken on an empty stomach or in a high dose.
- Abscesses and cellulitis: If the skin isn’t properly cleaned, or if a needle is reused or dull, bacteria can enter the body. This often leads to painful swelling or pus-filled lumps near the injection site. Left untreated, these can become severe infections requiring medical attention.
- Dry mouth: Heroin can reduce saliva production, leading to an uncomfortably dry mouth and throat. While this may seem minor, chronic dry mouth can increase the risk of dental issues and oral infections over time.
- Impaired judgment: Heroin can make it hard to think clearly, as it dulls activity in parts of the brain responsible for decision-making, awareness, and self-control. This can result in risky choices, including unsafe sex, sharing needles, or using more than intended.
- Blood poisoning (sepsis): When bacteria introduced by injection spread into the bloodstream, the immune system may start to work harder and harder, going into overdrive. This response, known as sepsis, can lead to dangerously low blood pressure, organ failure, or even death without immediate treatment.
- Severe itching: Histamine release can also cause intense itching all over the body, much like what happens during an allergic reaction. Some people scratch until their skin breaks, which increases the risk of infection.
- Overdose: Heroin slows breathing and heart rate. When taken in high doses or mixed with other substances, these vital bodily functions may cease altogether. Overdose can happen to anyone and often occurs without warning.
Heroin that’s sold on the streets rarely comes in its pure form, meaning that users often don’t know exactly what they’re putting into their bodies. People who sell the drug may mix it with substances like soda, powdered milk, or fentanyl to make their supply last longer. That’s one reason overdoses happen so often, even among experienced users.
Long-Term Effects of Heroin
While the short-term effects of heroin can be dangerous and even deadly, the long-term consequences are equally as damaging. With prolonged use, the drug starts to take a toll on nearly every system in the body, leading to:
Physical Health Effects
A host of physical health effects can make life as a heroin user exhausting. However, when the person tries to stop using, they’re often met with a range of other symptoms—known as withdrawal—keeping them stuck in a painful cycle.
Some of the most common lasting physical health effects include:
- Chronic infections: Repeated injection increases the risk of exposure to bacteria, especially when using non-sterile needles or injecting into unclean skin. This can cause lasting damage to the veins, skin tissue, and internal organs. It may also lead to serious infections.
- Liver and kidney problems: Since the liver and kidneys play an essential role in filtering toxins from the body, chronic heroin use can put a strain on them. Over time, this can lead to conditions like hepatitis, kidney failure, or other forms of long-term organ damage.
- Collapsed veins: Sticking the needle in the same place over and over can irritate and scar the vein, causing it to collapse. This not only takes away a spot for future injections, but also increases the risk of accidentally injecting into tissue, which can lead to further injury or infection.
- Hormonal changes: Long-term heroin use can interfere with reproductive hormones, leading to missed menstrual cycles, infertility, lowered testosterone levels, and sexual dysfunction in both men and women. These effects may persist even after stopping the drug.
- Respiratory issues: Heroin suppresses breathing, which can lead to chronic conditions like pneumonia, tuberculosis, or fluid in the lungs.
- Endocarditis: Dirty needles or contaminated heroin can introduce bacteria that travel to the heart, infecting its inner lining or valves. This condition can be hard to treat and may lead to serious complications if left unaddressed.
- Infectious Diseases: One of the most well-known risks of injecting heroin is the transmission of blood-borne viruses like HIV/AIDS, Hepatitis B, and Hepatitis C. In 2018 alone, around 11% of all new HIV cases were linked to injection drug use. These diseases carry not only hefty health care bills, but also long-lasting health effects.
Mental/Emotional Health Effects
The effects of heroin aren’t just physical. The drug changes people’s actions, feelings, and thoughts, which can be just as challenging to cope with as the physical health problems. Some of these include:
- Depression and/or anxiety: Long-term use alters brain chemistry, especially in areas tied to mood and motivation. Many people feel hopeless without the drug, which can lead to ongoing depression or anxiety between uses.
- Stigma and shame: The way society views heroin use can have a powerful effect on mental well-being. People who inject the drug may feel judged, ashamed, or unwanted, which can keep them from seeking help. This stigma can make recovery more difficult by reinforcing isolation and self-doubt, especially for those who have already lost their support system.
- Cognitive decline: Regular use makes it harder to focus, remember things, or make decisions. Some people feel mentally foggy or detached, even when they’re not actively high.
- Emotional detachment: As heroin becomes the focus of daily life, other things that used to matter start to lose their importance. People often say they feel numb, isolated, or emotionally disconnected from others, including friends and family.
Symptoms tend to vary from person to person, meaning that everyone’s experience will be different. Some people have more serious symptoms than others, making it important to be able to recognize the early warning signs of heroin use. Noticing changes early on can help someone get help and prevent things from getting worse.
Common Heroin Withdrawal Symptoms
When someone who’s been using heroin regularly suddenly stops taking it (even if they miss a dose), the body starts to react. This is called withdrawal, and it’s one of the hardest parts of addiction to cope with.
Withdrawal typically starts within a few hours of the last use and may feel like coming down with a bad case of the flu, only worse. People describe their legs aching, stomach cramping, skin crawling, and emotions swinging between anxiety and despair.
For some, just the thought of going through that again is enough to make them use heroin again, even when they desperately want to stop.
The intensity and length of withdrawal can vary depending on how long the person has been using, how much they’ve been taking, and whether other substances are involved or not. Some of the symptoms people usually report experiencing include:
- Cravings
- Mood swings
- Diarrhea and stomach cramps
- Runny nose
- Yawning
- Sweating and/or chills
- Muscle, joint, and bone pain
- Nausea and vomiting
- Insomnia
While the most intense phase of withdrawal usually peaks within two to four days and improves within a week, some people experience post-acute withdrawal symptoms (PAWS), which linger for weeks or even months. These can include depression, disrupted sleep patterns, low motivation, or brain fog.
When someone develops PAWS, it puts them at an even higher risk of overdose should they choose to use heroin again.
While it’s rare for withdrawal to lead to death, it can feel unbearable without the necessary support. It’s for this reason that medically supervised detox is usually the first part of the treatment process. It can help ease symptoms, lower the risk of relapse, and make the process not only more manageable but safer as well.
Symptoms of a Heroin Overdose
While withdrawal can be painful and persistent, overdose is a more immediate and life-threatening concern. Even experienced users can go through it, but the risk is greater when the drug is injected or mixed with something stronger. Knowing what an overdose looks like and how to respond can be the difference between losing someone and helping them survive. Signs of an overdose can include:
- Very slow or shallow breathing, or not breathing at all
- Blue or purple lips and fingertips
- Pale or clammy skin
- Discolored tongue
- Unresponsiveness or coma
- Gurgling, choking, or noises that sound like snoring
- Pupils that don’t respond to light
- Drowsiness
- Uncontrolled movements
- Confusion
It may look like the person is just taking a nap or has drifted off to sleep for the night, but remember that the symptoms don’t have to be dramatic for them to be real. Without intervention, it can be fatal.
Can a Heroin Overdose Be Treated?
An overdose can be reversed, but only if you act quickly. The sooner someone gets treatment, the higher their chances of survival are. If you suspect an overdose, it’s vital to call 911 and provide the operator with as much information as you can. This might include the person’s weight, age, or how much of the drug they consumed.
The most effective treatment for an opioid overdose is Naloxone (also known as Narcan), a medication that temporarily blocks heroin’s effects and helps restore breathing. It’s available as a nasal spray or injection and can be used safely even if you’re unsure whether opioids like heroin were involved.
While Naloxone works quickly, its effects may wear off within 30 to 90 minutes. Multiple doses might also be needed, especially if fentanyl was involved. Since heroin can stay in the person’s system longer than Naloxone lasts, it’s important that they be monitored in a hospital until medical providers confirm that they’re stable.
Having Naloxone on hand and knowing how to use it can save a life, especially in situations like overdoses when every second counts.
Where to Find Support For Heroin Addiction
If you or a loved one is struggling with an addiction to heroin, whether through injection or another means, know that recovery is possible with the right treatment. Whether you’re ready to quit or simply want more information, the first step is recognizing the problem and reaching out for help.
At First Step Behavioral Health, we provide personalized treatment plans based on your unique needs. From support groups to individual therapy and detox, our staff will ensure you feel as comfortable as possible throughout the process. Reach out today to see how we could help you get on a healthier, more positive path.
Resources:
- https://nida.nih.gov/research-topics/heroin
- https://www.ncbi.nlm.nih.gov/books/NBK537318/
- https://www.justice.gov/archive/ndic/pubs3/3843/3843p.pdf
- https://www.ncbi.nlm.nih.gov/books/NBK424849/
- https://my.clevelandclinic.org/health/drugs/21127-opioids
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4953807/
- https://nida.nih.gov/publications/research-reports/heroin/what-are-immediate-short-term-effects-heroin-use
- https://www.cdc.gov/persons-who-inject-drugs/vulnerable/index.html
- https://medlineplus.gov/ency/article/002861.htm
- https://nida.nih.gov/publications/drugfacts/naloxone
