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Identifying Paraphernalia for Heroin Addiction

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Heroin is a highly addictive and illegal opioid. People abuse it for the intense feelings of euphoria and pleasure that it produces. With long-term use, however, people who use heroin can experience serious health issues, such as liver and kidney disease, lung complications, infectious diseases, such as HIV and hepatitis, heart infections, and death.1

Many people who use heroin attempt to hide their habit due to fear of getting caught, shame related to societal stigmas and judgment, or the threat of legal consequences. Nonetheless, there are many signs and risk factors to look out for if you are concerned a loved one may be struggling with heroin abuse.

Methods of Administration

Heroin often appears as a white or brown powdery substance, but it can also be found as a dark, sticky drug, which is referred to as “black tar heroin.” Street names for heroin include smack, horse, big H, junk, ska, and hell dust.1,2 People may mix heroin with other illicit substances, such as cocaine. The street name for combining heroin and cocaine is speedballing.1 It’s helpful to know some of these common names in the event that you overhear your child or loved one discussing heroin.1

Like other addictive substances, people can use heroin via multiple methods of administration. Users can sniff, smoke, or inject heroin. Each method of administration entails different paraphernalia to prepare and take the heroin.

What to Look For

Depending on the route of administration, there are different items associated with heroin use. Be mindful that heroin users often attempt to be discreet about their drug use. As a result, it’s important to know common equipment related to each method of use. These methods include:3

  • Injecting: Intravenous use of heroin may include the presence of hypodermic needles, cigarette lighters, small cotton balls (for straining the drug), spoons or bottle caps (for liquefying the drug), and a tie-off/tourniquet, such as a cloth, string, or shoelace (for cinching the arm and helping veins protrude).
  • Smoking: When a user smokes heroin, there may be the presence of aluminum foil (for providing a surface), lighters, straws (for inhaling the smoke), and cigarettes/pipes (for rolling heroin inside to be smoked).
  • Snorting: Snorting or sniffing powdered heroin typically involves similar paraphernalia to smoking. Users may have straws (for guiding heroin up the nostril), rolled-up dollar bills, and razor blades (for chopping up the heroin).

Physical Signs & Symptoms

In addition to paraphernalia, there are also many physical signs and symptoms of heroin abuse that are important to be aware of. Knowing the following signs can help you to identify a heroin addiction in a loved one:1,2,3

  • Poor mental functioning
  • Shifting back and forth between consciousness and semi-consciousness
  • Nausea and vomiting
  • Heavy extremities
  • Excessive itching
  • Changes in behavior
  • Insomnia
  • Depressed mood
  • Dangerously slowed breathing or coma
  • Sexual dysfunction in men
  • Irregular menstrual cycles in women

Some observable signs specific to intravenous heroin abuse include:1,8 

  • Collapsed veins.
  • Abscesses.
  • Puncture marks.

Signs of intranasal heroin use you should be on the lookout for include:1,8

  • Nose bleeds.
  • Perforated nasal septum.

Lastly, if someone smokes heroin, they may experience pneumonia, or other lung-related problems.1,3 If you suspect that someone you know may be abusing heroin, it’s likely that you’ll want to help them get clean; however, before you approach them, you’ll want to learn more about how to do so with compassion and empathy.

How to Help a Heroin Addict

Heroin addiction can be confusing, frightening, and devastating for both the addicted person and their loved ones. You may be scared or unsure about how to intervene without worsening the problem. However, early intervention coupled with compassion and empathy is often a key factor in your loved one’s recovery.

The Community Reinforcement Approach and Family Training (CRAFT) method provides an evidence-based, skills-based approach for engaging loved ones in a discussion about their addiction without confrontation or shaming.4 The main objectives of CRAFT include reducing and/or abstaining from substance use in the identified patients (IPs) and improving the lives of concerned significant others (CSOs).5

CRAFT teaches CSOs to develop appropriate reactions and expectations towards the IP, motivate the IP to seek and engage in treatment, and promote the importance of self-care for the entire family system.

In CRAFT, there are a number of steps CSOs typically complete in 1-hour group sessions. These steps include:6

  • Determining if they are a good fit for the CRAFT treatment approach.
  • Understanding the triggers and consequences that come from using. CSOs and IPs both need to have a realistic view of the current environment.
  • Improving assertive communication with the IP (rather than aggressive, passive-aggressive, or nonexistent communication).
  • Providing positive reinforcements for sober choices and behaviors.
  • Allowing and even encouraging natural consequences (medical, legal, and/or relational issues) for the IPs using behaviors (rather than giving punishments).
  • Finding self-care strategies and ways to improve a person’s own well-being.
  • Identifying and embracing the best opportunities to mention treatment options to IP.
  • Practicing patience and acceptance of the IP’s unique treatment process.

In general, CRAFT blends psychoeducation about addiction with compassion and acceptance for the drug user without attempting to control or change him. For this reason, loved ones should be careful to avoid harsh accusations, confrontations, or difficult ultimatums. These kinds of approaches can be shaming and often backfire, causing the drug user to become defensive.

Where to Refer Them

For many drug users, admitting that they need help can feel shameful and embarrassing. If your loved one admits to having a problem with heroin or other drugs and displays openness and a desire for help, there are several options available. You should have a referral list with descriptions ready if your loved one comes to you seeking help. It can be helpful for the heroin user to meet with a primary care physician, addiction professional, or licensed therapist, any of whom can assess the individual and determine the appropriate level of substance abuse care.

With that said, recovering from heroin addiction usually starts at a detox facility because opioid withdrawal symptoms can be extremely uncomfortable and painful. While heroin withdrawal itself is seldom fatal, supervised detoxification offers medical stabilization and can prevent potentially life-threatening complications that may result from other medical conditions. For most, detox is the first point of contact within the treatment system, and it represents the first step to sustained recovery.7

However, detox alone does not rectify the maladaptive behaviors that motivate heroin abuse, and it does not help individuals develop appropriate coping skills to maintain sobriety. For this reason, most heroin users will be referred to comprehensive substance abuse treatment to continue their care. While each program offers different specialties, comprehensive recovery often contains a multidisciplinary approach that includes individual therapy, group counseling, family therapy, medication, and discharge and aftercare planning.7

Recovering heroin users often also find comfort and fellowship within peer support groups, such as Heroin Anonymous (HA) or SMART Recovery. Heroin Anonymous is a free, 12-step program open for anybody with a desire to stay sober. SMART Recovery is also a free peer support group that focuses on empowering drug users to stay sober. Both groups offer numerous meetings throughout the United States.


  1. National Institute on Drug Abuse. (2018). What is Heroin?
  2. National Institute on Drug Abuse for Teens. (2017). What is heroin?
  3. Center for Substance Abuse Research. (2013). Heroin.
  4. Robert J. Meyers, PhD. (2007). CRAFT.
  5. Center for Motivation & Change. (2014). What is CRAFT?
  6. Scruggs, S., Meyer, R., & Kayo, R. (2014). Community Reinforcement and Family Training Support and Prevention. South Central Mental Illness Research.
  7. Substance Abuse and Mental Health Services Administration. (2006) Detoxification and Substance Abuse Treatment.
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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