Heroin 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

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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

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

Updated March 2010
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


Heroin abuse is associated with serious

health conditions, including fatal overdose,

spontaneous abortion, and—particularly

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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

Updated March 2010

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


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

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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.

Updated March 2010

· 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

· 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 opioid-

free for several days before taking


· Naloxone is a shorter-acting opioid

receptor blocker, used to treat cases of

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


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

Updated March 2010

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


Monitoring the Future Survey†

According to the Monitoring the Future

survey, there was little change between

2008 and 2009 in the proportion of 8th-

and 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 10th-

graders; 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

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8th Grade

10th Grade

12th Grade





Past Year




Past Month




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.


Data Sources

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.


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.

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


Updated March 2010

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

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

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

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