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Long-Term Effects of Heroin Abuse

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Heroin use has increased dramatically in the US over the past decade. One unfortunate counterpart to the increasingly prevalent numbers of heroin users is an alarming surge in the number of heroin-related overdose deaths.1 Chronic heroin use can lead to serious problems, such as heart infections, miscarriages, contraction of infectious diseases (e.g. HIV and hepatitis), liver disease, kidney disease, addiction, and more.2,4 Additionally, long-term heroin abuse dangerously increases the risk of a potentially fatal overdose, particularly as tolerance increases. Heroin detox treatment is an effective way to stop using heroin and start on the road to recovery.

What is Heroin?

 Heroin is a highly addictive opioid synthesized from morphine alkaloids first extracted from an opioid poppy plant supply hailing from various parts of the world, including Colombia, Mexico, and Southwest and Southwest Asia.4 The Drug Enforcement Administration (DEA) classifies heroin as a Schedule I drug, meaning it has a high potential for abuse and no currently accepted medical use.3

Much of the world’s supply of heroin is produced as a white or brown powder. When encountered in relatively less pure forms, it may more closely resemble a black sticky substance, often referred to as black tar heroin. Heroin is used via a number of methods and routes of administration. It is sometimes mixed with other substances prior to use, including cocaine (a practice called speed-balling).4

Heroin is a very dangerous drug because it can lead to addiction, overdose, and even death. Additionally, people who use heroin in certain ways have higher risks of developing specific health problems. For example, people who inject heroin have a higher chance of contracting infectious diseases, such as HIV or hepatitis.4

The Scope of Heroin Abuse

 People abuse heroin in a number of ways. Each method of administration poses its own unique risks. Some of the common ways in which people use heroin include:2,5

  • Injection: People dissolve heroin in water and administer it intravenously, intramuscularly, or subcutaneously with a needle.
  • Snorting/sniffing: The powdered forms of heroin can be inhaled into the nasal cavities. People may also inhale liquefied forms of heroin using nasal spray bottles, a practice known as “shabanging.”
  • Smoking: People burn heroin in a pipe or heat it on a piece of foil and inhale the vapors.

Globally, an estimated 13.5 million people use opioids, including 9.2 million who use heroin.6 The National Institute on Drug Abuse (NIDA) reports that in 2015, roughly 591,000 Americans suffered from heroin addiction.7 Further, heroin overdose death rates are also on the rise; in 2016, nearly 15,500 Americans were reported to have died due to a heroin overdose.8

These rising heroin abuse statistics may be, in part, fueled by the current prescription opioid crisis. Between 21 and 29% of people who are prescribed opioid painkillers (such as oxycodone and hydrocodone) misuse them, which means that they use them in a way other than prescribed; of these numbers, up to 12% develop an addiction to opioids. Approximately 4 to 6% of those who misuse or abuse prescription opioids transition to using heroin.7 People sometimes transition to heroin from painkillers because heroin produces similar effects, but is often cheaper and more easily obtainable.4 In fact, an estimated 80% of heroin users report that they began abusing prescription opioids first.7

Long-term heroin abuse can cause many negative consequences in a person’s life. The longer you continue using heroin, the harder it can be to stop. Quitting heroin allows you to take control of your life, improve your health and happiness, and prevent or minimize the consequences of chronic heroin use.

Consequences of Chronic Use

 Long-term heroin use can significantly distress your interpersonal, financial, emotional, physical, and psychological well-being. One of the most debilitating consequences of heroin abuse is that of addiction, which is a condition characterized by cravings, drug-seeking behaviors, and continued drug use despite knowing the negative consequences.9 Heroin addiction develops in association with distinct structural and functional brain changes, some of which are not easily reversed.9

Physical Effects

 A number of physical health issues are associated with long-term, repeated heroin use. Some of these effects vary based on method of administration. Of the long-term physical effects of heroin use, some of the most significant include:

  • Differential tolerance development, which means that people can quickly become tolerant to a lot of the subjective effects of the drug, such as pain-relief or euphoria, while the tolerance to respiratory depressive effects develops much more slowly. So people will increase use to get subjectively similarly high, but their respiratory depression will continue to be dangerously impacted, which increases the risk of overdose.14
  • Physiological dependence, which means that you require the drug to feel normal. If you suddenly quit using or dramatically reduce your use, you may experience withdrawal symptoms, which can include:5,10
    • Heroin cravings.
    • Restlessness.
    • Muscle and/or bone pain.
    • Nausea or vomiting.
    • Diarrhea.
    • Excessive tearing of the eyes or runny nose.
    • Dilated pupils.
    • Excessive yawning.
    • Insomnia.

People who inject heroin may also suffer from:5,10

  • Risk of contracting hepatitis B and C or HIV, especially if needles are shared.
  • Risk of tuberculosis.
  • Peripheral edema, or excessive fluid accumulation, often in the upper extremities (such as your arms) in heroin users.
  • Potential to inject bacterial contaminants or other blood-borne pathogens, especially if needles are shared.
  • Localized skin infections and abscesses.
  • Circulatory system inflammation.
  • Collapsed veins.
  • Track lines.
  • Abscesses.
  • Infection of the heart lining and valves.

Snorting heroin can cause:10

  • Irritation of the mucous membranes of the nose.
  • Perforated nasal septum (a hole in the membrane that divides your nostrils).

Regardless of the method of administration, heroin users can suffer from other long-term physical developments, such as:5,9,10

  • Deterioration of brain white matter.
  • Liver disease.
  • Reproductive dysfunction (such as an inability to achieve erection in males, or irregular periods in females).
  • Severe constipation.

People who abuse heroin also have a risk of overdose, which occurs if you take too much heroin, use impure heroin, if you resume using after a period of abstinence, or if you combine heroin with other drugs. All of the aforementioned factors can result in respiratory depression, coma, and death.

These physical consequences aren’t the only risks associated with long-term heroin use. Chronic heroin use can also increase one’s risk of serious and debilitating psychological symptoms.

Psychological Effects

Psychological effects of chronic heroin use can be just as distressing as the physical consequences. Some of the long-term psychological effects of heroin use include:10

  • A pattern of compulsive drug-seeking behaviors, such that you are no longer able to function normally in everyday life.
  • Conditioned response to seeing drug-related stimuli (such as seeing any substance that resembles heroin) that causes cravings.
  • An increased risk of suicide.
  • Severe depression.
  • Anxiety.

While the physical and psychological long-term effects of heroin use can be serious and incapacitating, there are additional issues that can further complicate matters for someone who is addicted to heroin.

Other Issues

Chronic heroin use can wreak havoc on a person’s entire life. In addition to impaired psychological and physical health, long-term heroin use can also cause other general issues, such as:10

  • Relationship, family, or other interpersonal issues, such as divorce, losing custody of your children, or loss of friendships.
  • Job difficulties or job loss.
  • Educational difficulties, such as getting kicked out of school.
  • Financial hardship due to spending money on drugs or neglecting financial responsibilities. This can lead to conditions such as losing your house, severe debt, or bankruptcy.
  • Legal problems/criminal behavior. Heroin use is often associated with drug-related crimes such as possession or distribution of drugs, forgery, burglary, robbery, or larceny. You can also be arrested for DUI if you drive under the influence of heroin.
  • Increased risk of injury or death due to accidents or violent behavior.

Seeking help before it’s too late is one of the best ways to prevent or minimize many of the effects of chronic heroin use. For most people with a long-term heroin addiction, professional detox treatment is the first step on the path to recovery.


  1. Scutti, S. (2016). Worldwide Drug Use Steady, But Heroin on Rise in U.S., U.N. Report Says.
  2. U.S. National Library of Medicine. (2017). MedlinePlus, Heroin.
  3. United States Drug Enforcement Administration. Drug Schedules.
  4. National Institute on Drug Abuse. (2017). DrugFacts: Heroin.
  5. Center for Substance Abuse Research. (2013). Heroin.
  6. World Health Organization. Opiates.
  7. National Institute on Drug Abuse. (2017). Opioid Overdose Crisis.
  8. National Institute on Drug Abuse. (2017). Overdose Death Rates.
  9. National Institute on Drug Abuse. (2014). Heroin: What are the long-term effects of heroin use?
  10. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Arlington, VA: American Psychiatric Publishing.
  11. Centers for Disease Control and Prevention. (2017). Opioid Overdose: Heroin: Today’s Heroin Epidemic.
  12. Chitnis, D. (2015). Heroin Smoking Linked to Emphysema.
  13. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  1. Hayhurst, C.J. & Durieux, M.E. (2016). Differential Opioid Tolerance and Opioid-induced Hyperalgesia: A Clinical Reality. The Journal of the American Society of Anesthesiologists, Inc., 124, 483-488.

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