Signs and Symptoms of Heroin Use

Heroin User

For some people, heroin use is very quickly addictive. Other people may not use heroin every day but return to it repeatedly. Either way, the effects of heroin use and addiction are intensely damaging to an individual’s mental, physical and spiritual well-being. If the signs of heroin addiction are seen, fast action should be taken to get the person the help they need.

Across the country, approximately 900,000 people use heroin each year. 1 The severity of the problems created and suffered by this group of people is magnified by the presence of fentanyl in the heroin supply. Fentanyl is far more potent than heroin, so a person who thinks they are buying heroin when they actually have their hands on fentanyl is at great risk of suffering a fatal overdose.

Whereas at one time, heroin and prescription painkillers were the big killers among drug users, now, drugs from the fentanyl family cause 73% of all drug overdose deaths. Anyone using heroin risks encountering fentanyl instead.2 Either drug can cause a fatal overdose, but fentanyl’s risks are far more severe.

Physical Signs of Heroin Addiction

A person using heroin is very likely to do their best to conceal their use. To detect heroin use, it may be necessary to add small clues together from physical and behavioral signs. Here are the direct effects of heroin addiction that might be observed.

  • Dopiness or sleepiness
  • Slow, sluggish movement
  • Slurred speech
  • Nausea
  • Dry mouth
  • Flushing
  • Itching
  • Vomiting
  • Constipation or using laxatives
  • Pale, unhealthy skin
  • Tiny pupils
  • Weight loss

Behavioral and Emotional Signs of Heroin Use

Young Man

To realize that there are behavioral or emotional signs of heroin use present, an observer may have to watch the heroin user over a period of time and add up small signs. It is not uncommon for a family member to be using heroin and for those around them to not realize what is causing the changes they are observing. Look for these behavioral signs of heroin use:

  • Erratic waking and sleeping schedule
  • Loss of appetite
  • Withdrawing from social contact
  • Mood swings from euphoria to depression
  • Hostility
  • Secretiveness
  • Trouble concentrating
  • Reduced performance at work or in school
  • Missing items of value
  • Chronically short on money
  • Repeatedly making excuses for poor performance or lack of money
  • Hard to reach
  • Evasive when they are reached
  • Argumentative or fault-finding, especially when there is any challenge
  • Lost relationships with blame placed on the other person
  • Poor decision-making and self-control
  • Wearing long-sleeved clothes in warm weather
  • Damaged or dirty possessions
  • Poor personal hygiene and grooming

Drug Paraphernalia

The use of heroin requires certain equipment. If it’s hard to identify the direct effects of heroin use because of a person’s secretiveness and concealment, it might be possible to find some of the paraphernalia left behind.3 The exact equipment found depends on whether the person is smoking, injecting, ingesting or otherwise consuming this drug.

Heroin itself may be a powdery or crumbly substance, ranging all the way from off-white to dark brown. Black tar heroin is nearly black and is sticky instead of powdery. These are common tools a heroin user would use:

  • Bent spoons
  • Glass pipes
  • Tiny plastic bags or small wax paper envelopes
  • Syringes, clean or used
  • Tiny balloons
  • Lighters
  • Straws
  • Small sheets of aluminum foil
  • Bottle caps
  • Belts or rubber tubing lying around
  • Missing shoelaces in their shoes
  • Laxatives

The Long-Term Physical Damage of Heroin Addiction

A heroin user is more likely to develop certain illnesses. If a person complains of any of the conditions below or needs medical treatment for them, especially more than once, then there is a possibility of heroin or other injected drug abuse.


Heroin or any opioid suppresses the function of the lungs, which is how they kill a person. Their breathing becomes so slow that they expire. Because of this suppression of the lungs, a heroin user is more susceptible to lung infections like pneumonia. But because heroin is a strong painkiller, the individual may not even realize they are sick. Thus their pneumonia or other lung ailments can become advanced without their knowing it. This is an additional life-threatening aspect of heroin abuse.

Anyone injecting drugs runs a serious risk of becoming infected with diseases that are commonly passed from one drug user to another by sharing needles. The most common of these are HIV or Hepatitis C.

A heroin-addicted person is also more likely to suffer from these health problems:4

  • Staph infections (MRSA)
  • Strep infections
  • Candida
  • Endocarditis
  • Abscesses
  • Fungal infections
  • Botulism
  • Stomach pain
  • Miscarriages

The Long-Term Emotional and Mental Damage of Heroin Addiction

The exact effects of heroin addiction may vary slightly from one addicted person to the next but will very commonly include these effects:

  • Poor decision-making
  • Depression
  • Anxiety
  • Compulsive seeking of opioids
  • Placing drug use above self-care or care of loved ones
  • Deteriorating lifestyle
  • Low self-esteem
  • Guilt

Heroin Overdose


A person overdosing on heroin struggles to breathe and cannot stay conscious. They may snore heavily and irregularly, pause their breathing or gasp and gurgle as they try to get air. Their lips and fingertips may become blue. If they stop breathing entirely, they need to receive an opioid antidote instantly to save their life.

If the person is still breathing, a preliminary test to determine if they are overdosing is to rub one’s knuckles hard, up and down their sternum. The person should respond to this pain. If they don’t, they are in danger of a fatal overdose and need immediate help.

Withdrawal from Heroin

Withdrawal from heroin makes a person feel very sick, like they have the “worst flu ever.” Withdrawal usually starts several hours after a person takes their last dose of heroin. Symptoms peak a few days later, and the worst is usually over within seven days.5

  • Restlessness, especially of the legs
  • Deep muscle and bone pain
  • Stomach cramps
  • Severe, uncontrollable diarrhea and vomiting
  • Chills with goosebumps
  • Yawning
  • Tearing of eyes
  • Runny nose
  • Insomnia

What to Do When the Signs Are Seen

Rehab is vital at the first sign of heroin addiction because of the constant risk of overdose. It is important not to go on accepting promises that a person will do better or get sober on their own. They may offer excuses that attempt to explain all the signs away or justify the person’s reliance on drugs. If the person persists in making excuses and refuses any help, professional intervention can help resolve the situation.

When looking for rehab programs, it’s possible to find programs that support true recovery from heroin addiction and don’t simply administer medications. Every person deserves the chance to break free from drugs so they can learn to live an independent life without reliance on drugs.


  1. SAMHSA. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health.” Substance Abuse and Mental Health Services Administration. SAMHSA. SAMSHA Article ↩︎

  2. CDC. “Drug overdose deaths.” Centers for Disease Control and Prevention, 2021. CDC. CDC Article ↩︎

  3. OJP. “Heroin paraphernalia.” Office of Justice Programs, 1974. OJP. OJP Article ↩︎

  4. CDC. “Prevent Bacterial & Fungal Infections In Patients Who Inject Drugs.” Centers for Disease Control and Prevention. CDC CDC Publication (PDF) ↩︎

  5. NIH. “Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.” National Institutes of Health, 2009. NIH. NIH Article ↩︎