As prescription opioid abuse spreads throughout the nation, so does heroin addiction. The mass prescription of pharmaceutical opioids has resulted in dependent patients seeking relief for their addiction on the streets. Thus, many families, employers, and friends are finding that those close to them are addicted to street or pharmaceutical opioids. Since addicts are often ashamed of their use, it can be hard to detect. However, over time, there are always indications of heroin use.


As the addict delves deeper into her substance abuse, certain behavioral tics might arise. They may appear sluggish during the day, sometimes even nodding off at work or other inappropriate times. Addicts may start to become irritable when they are in need of a fix, so watch for a change of attitude and a growing sensitivity. Some will also pick at their skin, scratching the same spot repeatedly, even though there appears to be no insect bite or other inflammation.

Physical Signs

Heroin addicts are often malnourished and their physical presentation will reflect their lack of a proper diet. They often lose a dramatic amount of weight, have reduced skin tone, and exhibit a generally unkempt and unhealthy presentation. They may also have infections where they have used a dirty needle.

If they are using heroin intravenously, they will often start showing small bruises on their forearms, or elsewhere. They may be increasingly protective of their personal space and items, which may be where they are stashing their needles, baggies full of drugs, and spoons to “cook” the heroin prior to injection. Note that heroin is not only available in powder form. It can also come as a tarry, black substance (black tar heroin.)

Cognitive Problems

Mentally, a heroin addict will underperform relative to their previous levels. Their thoughts may seem slow and scattered. An addict’s memory often suffers and they will have little self-control, possibly blurting out inappropriate comments or insulting loved ones. However, it has also been noted that some addicts are able to complete graduate level coursework at top universities despite their use. They may have little or no memory of the experience, but it is possible.

Financial Indicators

Addicts are often in financial straits. The drug is expensive and they may resort to maxing out credit cards, selling personal items, or stealing to finance their habits. Others may quit their “straight” jobs and seek out professions that pay cash. Some will resort to working illegal jobs or may even make ends meet by stealing. Though they may initially seem financially stable as a result of working these jobs, this will seldom last. A heroin addiction is most often all-encompassing and will eventually destroy everyone it touches.

If you know someone who is abusing heroin, there is help. Check out our treatment options section for more information on how to get help for someone you love.

Heroin is one of the most addictive substances known. Some become addicted after the first use, though it takes others 3 or more uses before addiction sets in. Once addicted, the user soon finds that they are using with greater and greater frequency, and larger doses, until use becomes daily. The addiction takes over the entire life of the person, rendering them a virtual slave to the substance, their dealer, and a routine that cannot be broken without tumbling into deep withdrawal.

The High

One of the first side effects of Heroin use comes from the high itself. Users often feel a deep, luxurious euphoria. Some liken it to being wrapped in a warm blanket, safe from the jarring realities that plague them while sober. During the high, addicts will often nod off to sleep, or will struggle to retain consciousness. They will appear sluggish and dreamy in affect. Their cognitive abilities will be slow and their memory may be impaired.

Tolerance and Increased Use

As use continues, the addict will experience an increasingly high tolerance for the drug. In order to get the desired effects, they must use more of the drug, and administer it more often. With higher doses and frequency comes greater danger of overdose, intensified withdrawals, and associated illnesses. IV heroin users are at increased risk for developing infections, contracting blood-borne diseases, and at a minimum they will find their bodies marked with tracks at the injection points.

Dope Sick

 At this point, a significant side effect of heroin use is dope sickness. This is the phenomenon of agitation, craving, sweating, and aching (among other symptoms) that begins once the drug has passed out of the addict’s system. Dope sickness is increasingly unpleasant as time goes on. This is, essentially, early withdrawal and is a state that addicts seek to medicate as soon as possible. Some addicts have their lives routinized so that they are approaching their dealer’s house at the moment that dope sickness starts rearing its head.

Final Symptoms

Inevitably, addicts will begin to encounter difficulties in their life. They may lose their job, find that relationships are difficult or impossible to maintain, and will struggle to make ends meet, as the financial burden of a heroin addiction can be crushing. Once they have exhausted whatever resources they have from their normal lives, they may resort to stealing or illegal activities to finance their habit. Prostitution is not uncommon, nor is other cash-based, illegal work. The final side effects from heroin use are incarceration, institutionalization, and death.

Withdrawal from Heroin

Heroin is one of the hardest drugs to quit. Its ability to provide a dopamine rush to the brain is rivaled by only a few other drugs. Over time, the addict becomes dependent on the drug for any sense of well-being and soon it overtakes their entire life. They cannot seem to function without it, but they also cannot function with it. Thus, it is vital that they “kick” the drug in a grueling process known as detoxification. During detox, the addict will experience some of the worst known withdrawal symptoms.

The First Stages of Withdrawal

Detoxification begins approximately 8 hours after the last use, though sometimes the discomfort does not begin for sixteen hours. At the onset of the withdrawal process, the addict may have a familiar sense of unease, followed by increasingly strong cravings. This is the feeling of “dope sickness” that is part of the addiction cycle. To break that cycle, things need to get much, much worse. The addict will start feeling achy, experience hot and cold flashes, and their eyes may dilate. Other symptoms include profuse sweating, twitching, gooseflesh, anxiety, and sleeplessness.

As the withdrawal process continues, the symptoms only intensify. Users may experience hallucinations, increased twitching, sweating, and diarrhea. As cravings amplify, addicts are in danger of abandoning the withdrawal process and seeking more drugs. It is important to keep them safe and away from the next fix, which may restart the whole cycle of addiction and necessitate a repeat of the withdrawal process.

Duration, Prognosis, and Medications

Even though the process is long and grueling, lasting up to 72 hours, Heroin withdrawal is not deadly. It can be shortened by taking Naloxone, a drug that inhibits the opioid receptors. Though that method drastically diminishes the duration of withdrawal, it also intensifies the symptoms, concentrating them in a short time frame. Under non-overdose conditions, Naloxone is avoided.

Clinical or At-Home Detoxification

It is recommended that addicts seek a medical detoxification clinic where they can go through the process with the least amount of discomfort, and the most safety. However, some choose to go it alone at home. If this is the case, try to prepare for the process with several gallons of water, blankets, changes of clothing or bedding, and a good friend or family member nearby to help with various cleaning duties. Some also use calming herbs, take extra vitamins, and use acupuncture to relieve some of the symptoms. It may also be helpful to be practiced in deep breathing routines to help calm the body down during periods of intense craving and agitation.