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Heroin is an opiate drug that is synthesized 

from morphine, a naturally occurring 

substance extracted from the seed pod of 

the Asian opium poppy plant. Heroin usually 

appears as a white or brown powder or as a 

black sticky substance, known as “black tar 

heroin.”

How Is Heroin Abused?

Heroin can be injected, snorted/sniffed, or 

smoked—routes of administration that rapidly 

deliver the drug to the brain. Injecting is 

the use of a needle to administer the drug 

directly into the bloodstream. Snorting

is the process of inhaling heroin powder 

through the nose, where it is absorbed into 

the bloodstream through the nasal tissues. 

Smoking involves inhaling heroin smoke into 

the lungs. All three methods of administering 

heroin can lead to addiction and other 

severe health problems.

How Does Heroin Affect 

the Brain?

Heroin enters the brain, where it is converted 

to morphine and binds to receptors known as 

opioid receptors. These receptors are located 

in many areas of the brain (and in the body), 

especially those involved in the perception 

of pain and in reward. Opioid receptors are 

also located in the brain stem—important for 

automatic processes critical for life, such as 

breathing (respiration), blood pressure, and 

arousal. Heroin overdoses frequently involve a 

suppression of respiration.

After an intravenous injection of heroin, users 

report feeling a surge of euphoria (“rush”) 

accompanied by dry mouth, a warm flushing 

of the skin, heaviness of the extremities, and 

clouded mental functioning. Following this 

initial euphoria, the user goes “on the nod,” 

an alternately wakeful and drowsy state. 

Users who do not inject the drug may not 

experience the initial rush, but other effects 

are the same.

With regular heroin use, tolerance 

develops, in which the user’s physiological 

(and psychological) response to the drug 

decreases, and more heroin is needed to 

achieve the same intensity of effect. Heroin 

users are at high risk for addiction—it is 

estimated that about 23 percent of individuals 

who use heroin become dependent on it.

What Other Adverse Effects 

Does Heroin Have on 

Health?

Heroin abuse is associated with serious 

health conditions, including fatal overdose, 

spontaneous abortion, and—particularly 

Heroin
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in users who inject the drug—infectious 

diseases, including HIV/AIDS and hepatitis. 

Chronic users may develop collapsed 

veins, infection of the heart lining and 

valves, abscesses, and liver or kidney 

disease. Pulmonary complications, including 

various types of pneumonia, may result 

from the poor health of the abuser as well 

as from heroin’s depressing effects on 

respiration. In addition to the effects of 

the drug itself, street heroin often contains 

toxic contaminants or additives that can 

clog blood vessels leading to the lungs, 

liver, kidneys, or brain, causing permanent 

damage to vital organs.

Chronic use of heroin leads to physical 

dependence, a state in which the body 

has adapted to the presence of the drug. 

If a dependent user reduces or stops 

use of the drug abruptly, he or she may 

experience severe symptoms of withdrawal. 

These symptoms—which can begin as 

early as a few hours after the last drug 

administration—can include restlessness, 

muscle and bone pain, insomnia, diarrhea 

and vomiting, cold flashes with goose 

bumps (“cold turkey”), and kicking 

movements (“kicking the habit”). Users also 

experience severe craving for the drug 

during withdrawal, which can precipitate 

continued abuse and/or relapse. Major 

withdrawal symptoms peak between 48 

and 72 hours after the last dose of the 

drug and typically subside after about 1 

week. Some individuals, however, may 

show persistent withdrawal symptoms for 

months. Although heroin withdrawal is 

considered less dangerous than alcohol or 

barbiturate withdrawal, sudden withdrawal 

by heavily dependent users who are in poor 

health is occasionally fatal. In addition, 

heroin craving can persist years after drug 

cessation, particularly upon exposure to 

triggers such as stress or people, places, 

and things associated with drug use.

Heroin abuse during pregnancy, together 

with related factors like poor nutrition 

and inadequate prenatal care, has been 

associated with adverse consequences 

including low birthweight, an important risk 

factor for later developmental delay. If the 

mother is regularly abusing the drug, the 

infant may be born physically dependent on 

heroin and could suffer from serious medical 

complications requiring hospitalization.

What Treatment Options 

Exist?

A range of treatments exist for heroin 

addiction, including medications and 

behavioral therapies. Science has taught us 

that when medication treatment is combined 

with other supportive services, patients are 

often able to stop using heroin (or other 

opiates) and return to stable and productive 

lives.
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Treatment usually begins with medically 

assisted detoxification to help patients 

withdraw from the drug safely. Medications 

such as clonidine and buprenorphine can 

be used to help minimize symptoms of 

withdrawal. However, detoxification alone 

is not treatment and has not been shown 

to be effective in preventing relapse—it is 

merely the first step.

Medications to help prevent relapse include 

the following:

•	 Methadone has been used for more 

than 30 years to treat heroin addiction. 

It is a synthetic opiate medication that 

binds to the same receptors as heroin; 

but when taken orally, it has a gradual 

onset of action and sustained effects, 

reducing the desire for other opioid drugs 

while preventing withdrawal symptoms. 

Properly administered, methadone is not 

intoxicating or sedating, and its effects do 

not interfere with ordinary daily activities. 

Methadone maintenance treatment 

is usually conducted in specialized 

opiate treatment programs. The most 

effective methadone maintenance 

programs include individual and/or 

group counseling, as well as provision 

of or referral to other needed medical, 

psychological, and social services. 

•	 Buprenorphine is a more recently 

approved treatment for heroin addiction 

(and other opiates). Compared with 

methadone, buprenorphine produces less 

risk for overdose and withdrawal effects 

and produces a lower level of physical 

dependence, so patients who discontinue 

the medication generally have fewer 

withdrawal symptoms than those who 

stop taking methadone. The development 

of buprenorphine and its authorized use 

in physicians’ offices give opiate-addicted 

patients more medical options and extend 

the reach of addiction medication. Its 

accessibility may even prompt attempts 

to obtain treatment earlier. However, not 

all patients respond to buprenorphine—

some continue to require treatment with 

methadone.

•	 Naltrexone is approved for treating 

heroin addiction but has not been widely 

utilized due to poor patient compliance. 

This medication blocks opioids from 

binding to their receptors and thus 

prevents an addicted individual from 

feeling the effects of the drug. Naltrexone 

as a treatment for opioid addiction is 

usually prescribed in outpatient medical 

settings, although initiation of the 

treatment often begins after medical 

detoxification in a residential setting. To 

prevent withdrawal symptoms, individuals 
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must be medically detoxified and opioidfree for several days before taking 

naltrexone. 

•	 Naloxone is a shorter-acting opioid 

receptor blocker, used to treat cases of 

overdose.

For pregnant heroin abusers, methadone 

maintenance combined with prenatal 

care and a comprehensive drug treatment 

program can improve many of the 

detrimental maternal and neonatal 

outcomes associated with untreated heroin 

abuse. Preliminary evidence suggests 

that buprenorphine may also be a safe 

and effective treatment during pregnancy, 

although infants exposed to either 

methadone or buprenorphine prenatally 

may still require treatment for withdrawal 

symptoms. For women who do not want or 

are not able to receive pharmacotherapy 

for their heroin addiction, detoxification 

from opiates during pregnancy can be 

accomplished with medical supervision, 

although potential risks to the fetus and the 

likelihood of relapse to heroin use should be 

considered.

There are many effective behavioral 

treatments available for heroin addiction—

usually in combination with medication. 

These can be delivered in residential 

or outpatient settings. Examples are 

individual or group counseling; contingency 

management, which uses a voucher-based 

system where patients earn “points” based 

on negative drug tests—these points can 

be exchanged for items that encourage 

healthy living; and cognitive-behavioral 

therapy, designed to help modify a patient’s 

expectations and behaviors related to drug 

abuse, and to increase skills in coping with 

various life stressors.

How Widespread Is Heroin 

Abuse?

Monitoring the Future Survey†

According to the Monitoring the Future 

survey, there was little change between 

2008 and 2009 in the proportion of 8thand 12th-grade students reporting lifetime,††

past-year, and past-month use of heroin. 

There also were no significant changes in 

past-year and past-month use among 10thgraders; however, lifetime use increased 

significantly among this age group, from 

1.2 percent to 1.5 percent. Survey measures 

indicate that injection use rose significantly 

among this population at the same time.

Use of Heroin by Students 

2009 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade 

Lifetime 1.3% 1.5% 1.2% 

Past Year 0.7% 0.9% 0.7% 

Past Month 0.4% 0.4% 0.4% 
Updated March 2010 Page 5 of 5

National Survey on Drug Use and 

Health (NSDUH)†††

According to the 2008 National Survey 

on Drug Use and Health, the number of 

current (past-month) heroin users aged 12 

or older in the United States increased from 

153,000 in 2007 to 213,000 in 2008. 

There were 114,000 first-time users of 

heroin aged 12 or older in 2008. 

Other Information Sources

For additional information on heroin, please 

refer to the following links on NIDA’s Web 

site, www.drugabuse.gov:

• 	Heroin Abuse—Research Report Series

• 	Various issues of NIDA Notes (search by 

“heroin” or “opiates”)

For street terms searchable by drug name, 

cost and quantities, drug trade, and drug 

use, visit www.whitehousedrugpolicy.

gov/streetterms/default.asp.

Data Sources

† These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National 

Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s 

Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 

1991, 8th- and 10th-graders were added to the study. The latest data are on line at www.drugabuse.gov. 

†† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during 

the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days 

preceding an individual’s response to the survey. 

††† NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans aged 

12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of Health 

and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone from NIDA at 

877–643–2644.