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Heroin Abuse Signs And Symptoms

Dr. Richard Foster, LICDC-CS

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 21, 2019

Heroin abuse signs and symptoms can be numerous and are often the beginning signs of addiction. Because heroin is a highly addictive drug, abuse of it can lead to addiction and physical dependence after only a short time.

Heroin is a central nervous system depressant which works by slowing functions in the brain and body, producing feelings of calm, relaxation, and euphoria (surge of happiness). Signs and symptoms of heroin abuse can be behavioral, physical, or psychological, as heroin abuse can affect a person’s health and lifestyle.

With time, addictive behaviors and constant heroin intoxication can signal that someone is chronically abusing heroin.

Behavioral Signs Of Heroin Abuse

A person new to heroin abuse may try to hide or cover up their drug use. They may become secretive, begin lying, or even take money or items to sell from a family member or friend, even if this is uncharacteristic of them.

Addiction affects the brain communication pathways, aligning a person’s thinking with seeking and using the drug. Abusive behaviors reflect the heroin addiction a person is developing or has already developed.

Common behavioral signs of heroin abuse can include:

  • apathy, or general lack of motivation
  • avoiding friends or family members to hide drug use
  • defensiveness when confronted about drug use
  • withdrawing from friends, activities, or hobbies
  • decreased performance at work or school
  • risky behavior, like stealing or operating a vehicle while high
  • excessive sleeping
  • hostile actions toward others
  • mood changes like agitation or irritability
  • lack of hygiene
  • being very active then very inactive (extreme highs and lows)
  • slurred speech
  • wearing long pants/shirts, even in summer (signs of heroin abuse by injection)
  • going “on the nod” frequently, or slipping in and out of consciousness

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Physical Signs Of Heroin Abuse

Many of the physical signs of heroin abuse are side effects of the drug. Heroin causes an initial rush of euphoria (first few minutes after use) followed by a period of calm, relaxation, and feelings of well-being. During this time, the person will be drowsy, have clouded mental functioning, and will have slowed vital functions, such as breathing and heart rates.

The following physical signs may also point to heroin abuse:

  • constant runny nose
  • chronic constipation
  • chronic respiratory infections
  • dry mouth
  • extreme itching of the skin
  • flushed skin
  • heaviness to arms and legs
  • nausea/vomiting
  • “pinpoint” pupils
  • shallow or slowed breathing
  • skin lesions, scabs, or bruising (from injection or picking at skin)
  • track marks, especially on arms and legs
  • weight loss

Psychological Signs Of Heroin Abuse

Heroin works in the brain by attaching to opioid receptors and affecting the way a person perceives pain, altering the natural feel-good chemicals produced in the brain. With time and repeated abuse, this can lead the body to mentally rely on heroin, manifesting in a number of symptoms.

Psychological or mental symptoms of heroin abuse can include:

  • anxiety
  • confusion
  • depression
  • delusions
  • disorientation
  • hallucinations
  • paranoia

Heroin Withdrawal Signs

Because many people new to abuse attempt to hide their drug use, they may not recognize their abuse has become a problem until they experience withdrawal symptoms. Heroin withdrawal symptoms can include body and muscle aches, tremors, nausea and vomiting, lack of sleep, and extreme nervousness or agitation.

Identifying Heroin Abuse By Paraphernalia

Heroin is most often abused by intravenous (IV) injection, but the drug can also be smoked or snorted. Signs of abuse may include paraphernalia (items used for abuse) tied to the person’s method of administration. The following are common paraphernalia items based on method of intake that may point to heroin abuse.

Signs Of Heroin Abuse By Injection

Abusing heroin by injection leads to a rapid high, as this method bypasses the digestive system and puts the drug directly into the bloodstream. Common paraphernalia associated with heroin injection can include:

  • bottle cap or spoon: to melt the solid heroin into a liquid form
  • cotton balls for absorbing impurities from the heroin
  • hypodermic needle
  • items used for tying around the arm to cut off blood flow, such as strings, belts, or straps

Signs Of Heroin Abuse By Snorting

People may believe snorting heroin to be a safer method than injection. Even though many people begin either snorting or smoking heroin, they often move on to injecting heroin once they develop a tolerance to the drug. Snorting paraphernalia can include:

  • razors or credit cards to separate the drug into lines
  • mirrors or other flat items used to hold the drug during snorting
  • cut straws, pens, or rolled dollar bills or other papers to aid in snorting
  • small spoons to hold the drug while snorting
  • small vials or other petite containers used to house the drug until time of use
  • powdery residue on hard surfaces

Signs Of Heroin Abuse By Smoking

Because heroin is sold in solid or powder form, smoking it involves heating the drug and inhaling both the fumes and the smoke, which is different from smoking other drugs of abuse. People who are concerned about the dangers of injecting heroin often smoke it instead.

Paraphernalia signs of heroin abuse by smoking can include something to heat the drug, such as a metal can or foil, and a tubing of some sort to inhale the fumes, such as a straw.

Factors That Affect Heroin Abuse Signs And Symptoms

A few different factors can affect the signs and symptoms of heroin abuse. These include how much of the drug a person abuses and how often, a person’s genetic makeup, and the severity of their addiction to or dependence on the drug.

If a person abuses heroin frequently, they will experience side effects from the drug often. If they abuse heroin heavily, they will likely experience increased and/or worsened effects.

How much a person weighs, if they have eaten, and if they abuse other drugs with heroin can also affect the signs of abuse they will exhibit. A person abusing alcohol and heroin together, for instance, can experience amplified depressant effects, like extremely slowed breathing, lack of energy, and even lack of consciousness.

Severe addictions become apparent due to their nature—once a person becomes addicted, their life will become aligned with finding heroin, using it, and getting more of it before the effects wear off or withdrawal occurs. Signs and symptoms of heroin abuse become clear and frequent at this time.

What To Do If Your Loved One Is Abusing Heroin

If someone you know is displaying signs of abusing heroin, it is best to approach them with only love and understanding. Heroin abuse and addiction are very serious conditions, but treatment is ever more available and effective.

Reputable drug rehab centers can provide information on treatment options for your loved one, offer access to resources and support, and may also be able to help you stage an intervention, if that is the right choice for you and your loved one.

Treatment For Heroin Abuse And Addiction

Depending on the level of severity of the heroin abuse and/or addiction, medically supervised detox may be a necessary first step to ensure the person comes off the drug safely. Medications such as buprenorphine (Suboxone) are available to help ease withdrawal symptoms and manage cravings during treatment.

The most effective treatments for opioid use disorders are inpatient addiction treatment programs, which typically involve counseling, therapy, and behavioral therapy. Learn more about treatment for heroin abuse and addiction by speaking to a treatment specialist today.

National Institute on Drug Abuse - Heroin

National Institute on Drug Abuse - Signs of Heroin Use

U.S. National Library of Medicine - MedlinePlus — Heroin

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