Heroin Effects by Method of Use and Abuse

What is Heroin?

Drug Class and Schedule

Heroin is a semi-synthetic opioid made from naturally occurring morphine found in poppy plants that have been chemically processed. It enters the brain quickly and produces an immediate “high.”

Heroin is a Schedule I drug with no currently accepted medical use and a large potential for abuse.

How Many People Use It?

According to the National Survey on Drug Use and Health, 1.8% of people have used heroin at least once in their lifetime.¹ That may sound small, but it translates to more than 5 million people in the U.S. alone.

How Is It Used?

Research also suggests that injection is the most common method of using heroin. About half of people who use heroin inject the drug.² The other two most common methods include snorting and smoking.

Dangers

Each method produces somewhat different heroin effects, ranging from an intense “rush” that can last for about two minutes to feelings of heaviness in extremities and drowsiness. The long-term dangers of using heroin vary from one mode of use to another. They can include side effects such as:

Bacterial infections
Fungal infections
Decline in lung function
asthma attacks

Injecting Heroin

How Is Heroin Injected?

The most common-and dangerous-way for using heroin is by injecting it intravenously for an immediate and intense effect. Heroin is typically injected directly into veins through the use of a hypodermic needle.

Effects of Injection

Injecting heroin has the quickest-acting effect, reaching the brain in seven or eight seconds. Once the drug reaches the brain, it converts into morphine and binds to opioid receptors, which results in the release of dopamine. This effect is called a “rush” that can last for about two minutes.

Some other common heroin effects include:

Dry mouth
Warm flushing of the skin
Heaviness in the extremities

Dangers of Injection

The most common hazard to injecting heroin is vein issues. Injecting heroin regularly can lead to collapsed veins, and a narrowing and hardening of the veins called venous sclerosis.

Venous sclerosis can result in a range of medical problems. These include abscesses and a higher risk of catching HIV/HCV.³ The narrowing and hardening of the veins can make it difficult to inject heroin in the same vein multiple times. Despite this, some people attempt to inject heroin into the damaged vein or switch to injecting it into muscles.

Moreover, bacterial and fungal infections are also a common problem in IV heroin use. Staphylococcus aureus was the most common pathogen found. Bacteria can enter the body through the syringe used for injecting heroin, leading to life-threatening consequences such as paralysis and death.

Injecting heroin also carries the most significant risk for an overdose. In 2018, nearly a third of all opioid deaths involved heroin. Around 15,000 Americans died from a heroin overdose-almost five deaths for every 100,000 Americans.⁴

Snorting Heroin

How is Heroin Snorted?

In recent years, snorting heroin has become more prevalent as it is mistakenly considered less risky than injecting it. Injecting and smoking heroin involves using several tools. In contrast, snorting heroin requires a pure powder form of the drug, a flat surface, and a straw or rolled-up paper.

When heroin is snorted, the drug goes from the nasal passages into the arteries and then into the brain.

Effects of Snorting

As opposed to injecting, it takes about 10 to 15 minutes to experience the effects of snorting heroin. Snorting heroin does not lead to that initial “rush” that comes with injection.

The individual was exposed to: actual or threatened death, injury, sexual violence through:

Feeling a "rush"
Flushed, warm skin
Dry mouth
Heaviness in extremities
Drowsiness

Dangers of Snorting

Snorting heroin poses no risk of damaging blood vessels or contracting HIV or hepatitis. However, although it is less dangerous than using it intravenously, snorting heroin can still cause severe damage to the body and brain.

For instance, snorting heroin carries the risk of asthma attacks, nose bleeds, breathing issues, and damage to the nasal passages, sinuses, and cartilage of the nose. Sharing straws and paper while snorting heroin can also lead to contracting viral and bacterial infections from other users.

The risk of an overdose is lower than injecting heroin, but it is still high.

Smoking Heroin

How is Heroin Smoked?

Heroin is smoked by heating the drug using a pipe and inhaling the released fumes. When smoked, the fumes go from the lungs into the arteries and on to the brain.

Effects of Smoking

The effects are felt 10 to 15 minutes after smoking heroin. Once the initial high fades, the heroin effects tend to last for a few hours. Some of the most common effects include:

Dry mouth
Warm flushing of the skin
Heaviness in extremities
Drowsiness

Dangers of Smoking

The long-term effects of smoking heroin can be life-threatening. One study found that smoking heroin can increase respiratory impairment with a continuous decline in lung function over time.⁵ Another severe long-term effect is liver disease.

Taking Heroin Orally

How is Heroin Taken Orally?

Orally taking heroin is the least common method of using the drug as it produces little to no “rush,” and the effects are less potent.

Effects of Taking it Orally

When taken orally, heroin is converted to morphine through the first-pass metabolism, leading to deacetylation when ingested. This means there is no intense “heroin high.”

Dangers of Taking it Orally

Although oral heroin use is less potent than injecting heroin, it can lead to a range of physical and mental issues if taken for a long time. For instance, it’s possible to develop tolerance to the drug, requiring higher doses each time to experience the same high. Tolerance can quickly lead to dependence and possibly addiction.

Speedballing

What is a Speedball?

Speedball is a slang term used for the combination of illicit drugs, heroin, and cocaine.

Generally, speedballing involves injecting the mixture into veins, although it is also sometimes snorted.

What is in a Speedball?

Speedball is made up of heroin, an opioid depressant, and cocaine, a stimulant.

Effects of Speedballing

People who have abused this mixture report experiencing more intense feelings from speedballing than from using the two substances separately.

Using a speedball can have many life-threatening effects. Although some people think that the two substances cancel each other out, it is not true.

Cocaine leads to the body taking in and using more oxygen, while heroin depresses breathing. This push-pull effect can strain the lungs, heart, and brain, causing confusion and turmoil in the body. Potential fatal side effects of speedballing include stroke, heart attack, an aneurysm, and respiratory failure.

Speedball's Celebrity Death Toll

River Phoenix

On October 31, 1993, the 23-year-old River Phoenix overdosed outside a Hollywood nightclub. The actor played in popular movies like Stand By Me and My Own Private Idaho. He drank a “speedball” of heroin and cocaine dissolved into a drink before chasing it with Valium. He fell into convulsions and died on the sidewalk.

John Belushi

In 1982, on March 5, comedian John Belushi was found dead in his hotel room at the Chateau Marmont in Los Angeles. The official cause of death was an accidental overdose of heroin and cocaine, or “speedball.”

Ken Caminiti

Ken Caminiti, an American baseball player, died on October 10, 2004, after going into cardiac arrest and dying due to a speedball. An autopsy showed that Caminiti had an enlarged heart and coronary artery after years-long drug use.

Addiction Treatment for Heroin

Heroin addiction can be successfully managed and treated with the help of several approaches.

As heroin addiction can lead to the onset of withdrawal symptoms, such as muscle spasms, depression, and abdominal pain, an addiction specialist will help recovery with an individualized plan that includes one of two approaches to stopping heroin: maintenance therapy or detox.

Detox

During detox, medications are typically provided to help manage withdrawal symptoms during the early stages of recovery. As recovery progresses, these medications are slowly weened away.

Maintenance Therapy

Maintenance therapy involves switching from heroin to a medically supervised medication such as methadone or buprenorphine.

Behavioral Therapies

Another recommended treatment for heroin addiction is behavioral therapies that promote positive thought patterns and behaviors. Behavioral therapies can help build coping skills when faced with cravings, recognize triggers of drug use, and identify any issues that might be causing emotional discomfort. Behavioral therapy can include group therapy, 1-on-1 therapy, and contingency management.

It’s possible to attend behavioral therapies during inpatient or outpatient care, depending on the addiction’s severity and the unique circumstances.

We understand that mental health issues can prevent people from staying sober.