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Heroin is a synthetic opiate drug that is

highly addictive. It is made 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 release

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, 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, and a heaviness of the extremities. Following this 

initial euphoria, the user goes “on the

nod,” an alternately wakeful and drowsy

state. Mental functioning becomes clouded. 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. This means the abuser must use

more heroin to achieve the same intensity of effect. Eventually, chemical changes

in the brain can lead to addiction.

What Other Adverse Effects

Does Heroin Have on

Health?

Heroin abuse is associated with serious

health conditions, including fatal overdose, spontaneous abortion, and—

particularly in users who inject the

drug—infectious diseases, including

HIV/AIDS and hepatitis. Chronic users

may develop collapsed veins, infection

Heroin
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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

the 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, they may experience severe symptoms of withdrawal.

These symptoms, which can begin as

early as a few hours after the last drug

administration, include restlessness, muscle

and bone pain, insomnia, diarrhea and

vomiting, cold flashes with goose bumps

(“cold turkey”), kicking movements

(“kicking the habit”), and other symptoms. Users also experience severe

craving for the drug during withdrawal,

precipitating continued abuse and/or

relapse. Major withdrawal symptoms

peak between 48 and 72 hours after the

last dose and typically subside after

about a week; however, some individuals 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. 

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

integrated with other supportive services,

patients are often able to stop using

heroin (or other opiates) and return to

stable and productive lives.

Treatment often begins with medically

assisted detoxification, to help patients

withdraw from the drug safely.

Medications such as clonidine and, now,

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: 

• Methadone, which has been used for

more than 30 years to treat heroin

addiction. It is a synthetic opiate
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medication that binds to the same

receptors as heroin; but when taken

orally, as dispensed, it has a gradual

onset of action and sustained effects,

reducing the desire for other opioid

drugs while preventing withdrawal

symptoms. Properly prescribed

methadone is not intoxicating or

sedating, and its effects do not interfere with ordinary daily activities. At

the present time, methadone is only

available through specialized opiate

treatment programs. 

• Buprenorphine is a more recently

approved treatment for heroin addiction (and other opiates). It differs

from methadone in having less risk

for overdose and withdrawal effects,

and importantly, it can be prescribed

in the privacy of a doctor’s office.

• Naltrexone is approved for treating

heroin addiction but has not been

widely utilized because of compliance issues. It is an opioid receptor

blocker, which has been shown to be

effective in highly motivated patients.

It should only be used in patients

who have already been detoxified in

order to prevent severe withdrawal

symptoms. 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 also is a safe and

effective treatment during pregnancy,

although infants exposed to either

methadone or buprenorphine prenatally

may 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: contingency management, which

uses a voucher-based system where

patients earn “points” based on negative

drug tests, which they can exchange 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 Survey1

According to the 2007 Monitoring the

Future survey, there were no significant

changes since 2006 in the proportion of

students in 8th, 10th, and 12th grades
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reporting lifetime,2 past-year, and pastmonth use of heroin overall. 

Heroin use has been steadily declining

since the mid-1990s. Recent peaks in

heroin use were observed in 1996 for

8th-graders, 1997–2000 for 10thgraders, and 2000 for 12th-graders.

Annual prevalence of heroin use in

2007 dropped significantly, by between

38 percent and 40 percent, from these

recent peak use years for each grade

surveyed.

National Survey on Drug Use and

Health (NSDUH)3

According to the 2006 National Survey

on Drug Use and Health, the number of

current (past-month) heroin users in the

United States increased from 136,000

in 2005 to 338,000 in 2006. The corresponding prevalence rate increased

from 0.06 to 0.14 percent. There were

91,000 first-time users of heroin aged

12 or older in 2006, down from

108,000 reported in 2005. Among persons aged 12 to 49, the average age at

first use of heroin was 20.7 years. 

Other Information Sources

For additional information on heroin,

please refer to the following sources on

NIDA’s Web site, www.drugabuse.gov:

• Heroin Abuse—Research Report

Series 

• Various issues of NIDA Notes (search

by “heroin” or “opiates”)

For a list of street terms used to refer 

to heroin and other drugs, visit 

www.whitehousedrugpolicy.gov/

streetterms/default.asp.

Heroin Use by Students

2007 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade

Lifetime 1.3% 1.5% 1.5%

Past Year 0.8 0.8 0.9

Past Month 0.4 0.4 0.4
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1 These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, DHHS, 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 online at www.drugabuse.gov.

2 “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.

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

12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest 

survey are available at www.samhsa.gov and from NIDA at 877-643-2644.

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.