Blog - Beach House Rehab Center
boy in front of bathroom mirror
September 27, 2018

Signs of Heroin Abuse

boy in front of bathroom mirror

Even with the staggering increase in drug overdose deaths in 2017 linked to heroin (15,858), other synthetic opiates, predominantly fentanyl (29,406) and drug combinations including heroin, the signs of heroin abuse are not always easy to recognize or as obvious as you might think. Not every heroin addict or heroin abuser stagger around or falls into a stupor when high on the extremely potent narcotic— although these are classic signs of heroin abuse.

Signs and Symptoms of Heroin Use

If there were clear-cut signs and symptoms specific to heroin use, it would be much easier to spot heroin users than it is. However, there are telltale signs of drug use, including heroin use, that can help you detect when someone may be on the drug.

  • Behavioral – Look for behavioral changes that seem to have come on suddenly. The person you knew to be outgoing and social may now display a pattern of secretiveness and lying. Avoiding eye contact, missing work, school, not showing up for appointments, plummeting grades, and getting fired from a job are all behavioral signs associated with heroin (and other drug and alcohol) abuse and addiction.
  • Need for money – Heroin costs add up, particularly with chronic misuse and addiction. Money and/or valuables start to go missing from home, work or school.
  • Use of slang terms – The heroin user who’s desperate to hide his or her escalating use will often use street names for heroin or slang terminology you might not be familiar with.
  • Presence of drug paraphernalia – Items commonly used by heroin addicts are a clear sign of heroin abuse. Such items include, but are not limited to, spoons for cooking heroin, pipes and tin foil for smoking heroin, cotton balls to filter heroin, small straws or tubes for snorting heroin, and needles for injecting heroin.
  • Visible “track marks” – When the heroin addict always covers his or her arms, legs or other commonly used areas for injecting heroin, it’s likely to hide the marks left by repeated heroin injections. These are called “track marks.”
  • Legal problems – Lying, stealing, embezzling money, causing an accident, getting violent and harming others, along with other behaviors against the law can result in a series of legal problems.

According to the Centers for Disease Control and Prevention (CDC), nearly all heroin users used at least one other drug and most used three other drugs. Alcohol or marijuana addicts are twice and three times, respectively, more likely to be addicted to heroin. Cocaine addicts are 15 times more likely to be heroin addicts. Those addicted to prescription painkillers are 40 times more likely to be addicted to heroin.

What are the physical and psychological signs of heroin abuse?

Physical signs

Some of the external signs that indicate someone is high or using heroin include:

  • Drowsiness
  • Dry mouth
  • Excessive sleeping
  • Flushed skin
  • Hyperalertness
  • Itchy skin
  • Nodding off
  • Pinpoint pupils
  • Poor hygiene
  • Runny nose
  • Shortness of breath
  • Slurred speech
  • Watery eyes

Psychological signs

Not all signs are visible on the outside when someone is using heroin. Many are psychological.

  • Apathy
  • Decline in self-care
  • Disorientation
  • Hostility
  • Lack of motivation
  • Loss of self-esteem
  • No interest in hobbies or activities once enjoyed
  • Withdrawal from family and friends

Signs of Heroin Withdrawal

When a heroin user comes down from the drug, if another hit doesn’t come quick enough, he or she begins to go through withdrawal. This is a stage characterized by specific symptoms or signs that are fairly easy to recognize. They include:


  • Intense cravings for heroin
  • Aches in muscles and bones, often severe
  • Chills
  • Cold sweats
  • Cramping, sometimes intense, followed by “kicking” limbs
  • Crying
  • Diarrhea


  • Excessive sweating
  • Fever
  • Heaviness feeling
  • Insomnia
  • Nausea
  • Non-stop runny nose
  • Vomiting


In addition to the obvious signs of withdrawal, the person may engage in drug-seeking behavior, planning for, looking for a dealer, preparing to score heroin, to stop the withdrawal effects and get back the heroin high. Heroin withdrawal symptoms begin to set in within a few hours after the last dose was taken.

Medical Side Effects of Heroin Abuse

Heroin abuse and dependence can cause a number of physical and medical side effects, some of which can be life-threatening.

Short-term physical effects of heroin abuse include excessive picking at the skin (due to uncontrolled itchiness), shallow or depressed breathing, impaired mental functioning, emotional deadness

More serious medical conditions may arise from heroin abuse, among them:

  • Abscesses
  • Arthritis
  • Bacterial infections
  • Blood clots
  • Chronic pneumonia
  • Heart problems – including serious conditions with heart valves and lining
  • Infectious diseases caused by needle sharing – HIV, Hepatitis B, and Hepatitis C
  • Liver disease
  • Tissue death

By far, the most serious medical consequence of long-term heroin abuse, dependence, and addiction is overdose and death. This risk is magnified due to the highly potent heroin that’s on the street, sometimes mixed with fentanyl or other dangerous drugs, both illicit and prescription drugs used recreationally. In addition, some street heroin contains poisons such as strychnine, which can cause death.

If you know or suspect someone is using heroin, be alert for signs of a heroin overdose and call 911 immediately. If you have access to naloxone, the life-saving medication that reverses the effects of a heroin overdose, you can save someone’s life.

Street Names for Heroin

A worldwide societal scourge for generations, heroin has many colorful street names:

  • Brown sugar (also brown crystal)
  • China white – heroin and fentanyl (the latter a synthetic opiate pain reliever that’s 50-100 times more potent than morphine)
  • Chocolate rock (also called Eightball, dragon rock and moonrock) – heroin and crack
  • H
  • Hell dust
  • Horse
  • Junk
  • Mexican mud (or mud)
  • Smack

Talking to Someone about Heroin Abuse

It may seem like a taboo subject or a discussion you’d much rather avoid, yet the knowledge or suspicion that someone you know is using heroin demands action. You must take the initiative to speak with them. This won’t be the easiest one-on-one interaction, but it is a necessary one. Your concern and intercession just may save their life.

The closer you are to a heroin addict, the more likely you are to notice changes indicative of a problem with drugs, even if you aren’t initially aware the drug of abuse is heroin. A cascading effect of behavioral changes, coupled with physical, psychological and emotional signs, alternating signs of being high and coming down withdrawal symptoms, and drug-seeking patterns will alert you to the problem.

Confrontation is not the way to approach talking to someone about heroin abuse. Use compassion, good judgment, and appropriate timing to initiate the conversation. Become as knowledgeable as you can about heroin abuse, dependence, and addiction before starting any discussion, as the heroin user likely knows much more about the drug than you do and can easily dissuade you about his or her use.

If you do get the acknowledgment of heroin use and the user indicates a willingness to get help, encourage professional heroin detox and subsequent treatment. Be ready with information about heroin detox and drug treatment programs, so that you can get the addict the help they need. Remember, detox is only the first step in overcoming abuse, dependence, and addiction to heroin. Without professional, evidence-based drug addiction treatment, the cycle of addiction will only continue— and may ultimately end in death.

For related information, see these articles:


[expand title=” Sources:” targclass=”highlight”]


Centers for Disease Control and Prevention. “Today’s Heroin Epidemic Infographics.” “Heroin use is part of a larger substance abuse problem.” Retrieved from

Drug Enforcement Administration. “Drug Scheduling: Drug Schedules.” “Schedule I.” Retrieved from

National Institute on Drug Abuse. “Heroin.” “How do people use heroin?” Retrieved from

National Institute on Drug Abuse. “Heroin.” “Overview.” Retrieved from

National Institute on Drug Abuse. “Heroin.” “What is heroin?” Retrieved from

National Institute on Drug Abuse. “Overdose Death Rates.” “National Overdose Deaths: Number of Deaths Involving Heroin.” Retrieved from

National Institute on Drug Abuse. “Overdose Death Rates.” “National Overdose Deaths: Number of Deaths Involving Other Synthetic Opioids (Predominantly Fentanyl).” Retrieved from Association of Counties. “The Signs.” Retrieved from