Topic Overview

Heroin is an illegal drug. It is a white or brown powder or a black, sticky substance (black tar heroin). It can be sniffed, snorted, smoked, or injected into a muscle or vein. It is often mixed (cut) with other drugs or substances, such as sugar or powdered milk. It may also be cut with poisons, such as strychnine. Other names for heroin are smack, junk, H, and ska.

The pleasurable sensation from heroin is called a rush, and the intensity of the rush depends on how much drug was taken and how rapidly the drug entered the brain. When a person injects heroin directly into a vein or smokes heroin, the rush occurs within seconds, whereas it takes at least 10 minutes when the drug is sniffed. Along with the rush, the person using heroin usually has a warm flushing of the skin, small pupils, watery eyes, runny nose, dry mouth, and a heavy feeling in the arms and legs. Heroin may also cause nausea, vomiting, and severe itching. Soon after the rush, the person feels drowsy and very relaxed. Breathing and heart rate slow, thinking becomes cloudy, and the person may fall into a state like a trance that can last 4 to 6 hours.

Heroin is often used along with other drugs, especially cocaine and alcohol. Some people snort alternate lines of heroin and cocaine, which is called crisscrossing. Or they may inject it with another drug (speedball).

With repeated use, heroin causes the person to need higher and higher doses of the drug to get the same effect (tolerance). It also causes the person's body to need the drug to function (physical dependence), which leads to withdrawal symptoms within a few hours if the person stops using it. Addiction can develop within a few weeks if the drug is used daily. Heroin addiction is also called opioid use disorder.

Several health problems can develop with heroin use, including:

• Bacterial infections of the blood vessels and heart valves.
• Liver or kidney disease.
• Lung problems, such as pneumonia and tuberculosis, from poor health.
• Hepatitis B and C, HIV, and other diseases, if using shared injection equipment or fluids.

Heroin can be detected in the urine for up to 24 hours and in blood for as long as 48 to 72 hours after use.

If you are worried that you or someone you know will take too much heroin, talk to your doctor or pharmacist about a take-home naloxone kit. This can be helpful and lifesaving if you took or take too much heroin. You can get naloxone without a prescription at most drugstores or through a community Take Home Naloxone program.

Signs of use

• Possession of injecting supplies, called an outfit or rig, that may consist of a spoon or bottle cap to cook the drug, a syringe or needle to inject it, a tourniquet or towel to find a vein, cotton, and matches to heat and dissolve the drug in water
• Restlessness, sleepiness, diarrhea, vomiting, chilled feelings, and leg movements if the person is dependent on the drug and has not had it recently
• Personality changes
• Unexplained scars on arms or legs or tattoos hiding scars