image showing the chemical structure of heroin


Heroin is a highly-addictive drug created from the opium poppy. One of the leading causes of drug-related overdoses, heroin has caused thousands of deaths in the U.S., including almost 13,000 in 2015 alone. Death from heroin overdoses exceeded death by homicide for the first time this year. There has been a troubling rise in heroin addiction over the past few years. This partially caused by increased use of prescription painkillers. Once addicted, many users turn to heroin for a more accessible alternative.

Signs of Heroin Addiction:

People struggling with substance abuse are not always honest about their habits, even with themselves. If you think a loved one is addicted to heroin, then certain physical, mental, or lifestyle clues may help them see they have a problem.

Quiz: How Severe is your Heroin Addiction?

Heroin Paraphernalia:

Finding the things necessary for someone to use heroin may help you confirm a substance abuse problem. But what to look for depends on whether they inject, smoke, or snort heroin.

Smoking Heroin: People melt the drug and inhale the vapors. Clues that someone is doing this are:

  • Aluminum foil, wrappers, or cut up soda cans: Used to hold the drug while it’s cooked. Look for burns on the foil. 
  • Lighters or candles: Needed to burn the foil and cook the heroin
  • Straws: Needed to inhale the smoke. Look for a vinegar smell.  
Burnt Spoon


Spoons are often used to “cook” heroin for injection. Bent, burnt, and missing spoons or q-tips without cotton are common signs of intravenous heroin use.

smoking opioids


Heroin is often smoked off of tinfoil. For this reason, burnt pieces of foil are signs of use. Red flags also include burnt straws and pens.

Injecting heroin: People cook solid heroin into a liquid, put the liquid into a needle, and inject the drug directly. If you think someone is injecting heroin, look for:

  • Needles: Used to inject the prepared heroin into the bloodstream. There may also be white or brown residue on/in the needle. 
  • Cotton Balls, Q-Tips, or cigarette filters: Used to remove unmelted chunks before injection. 
  • Spoons or bottle caps: Used to hold the heroin while it is cooked into liquid form before injection. Look for burn marks, brown or white residue, or a faint vinegar smell. 
  • Lighters or candles: Heat that cooks the heroin into a liquid. Look for excessive amounts of lighters or a sudden interest in scented candles.
  • Shoelaces, rubber hose, or string: Used to tie-off the arm like a tourniquet during injection to make veins easier to find.
image of Melted heroin on a spoon with a needle for injection


Needles are used to inject heroin after it’s been cooked. If you find a used needle, handle it carefully since people sometimes share needles.

image of Heroin paraphernalia


Rubber hoses or shoelaces are used to make veins easier to find. These can be a sign of a more serious heroin habit.

Snorting Heroin: Though rare, some people also inhale powdered heroin through the nose. Things commonly used for this are pen cases, straws, rolled up money or papers, small rubber tubes, or nasal spray bottles. 

Physical Signs of Heroin Use:

If you suspect someone is using heroin, you can look for signs like:

  • Constant cough (if smoking)
  • Extremely small pupils if they are high or extremely large pupils if they are withdrawing 
  • Scabs from Skin Picking. Heroin causes the skin to itch, and users often pick at their skin to the point of causing sores or scabs. 
pinned pupils


Opioids, including heroin, cause the pupils to constrict, making them appear “pinned.” Also look for tired look, red, and puffy eyes.

heroin track marks


When heroin is injected, it created cuts on the arms, hands, feet, or neck known as “track marks.” Heroin users will often mask these marks by wearing long sleeves.

Behaviors of Heroin Abuse:

If you believe that a loved one may be using heroin, look for the following behaviors:

  • Being tired at odd times
  • Sudden disregard for personal hygiene. May stop bathing regularly or wearing the same clothes repeatedly
  • Sleeping or nodding off at odd times. 
  • Going from very high energy to very low energy
  • Wearing long sleeves or sweatshirts in hot weather to cover up injection spots
  • Constant disorientation
  • Slurred speech
  • Lack of appetite 
  • Being agitated or hostile towards others suddenly
  • Apathy or lack of motivation/energy to do things or go places.  

Other Lifestyle Signs of Heroin Use:

There may be other clues around your loved one as well that may indicate he is using heroin. 

  • Missing money or valuables that may have been taken to pay for drugs
  • New locked boxes or areas that nobody is allowed or able to open
  • Missing prescription bottles. Especially painkillers like Vicodin, Percocet, Oxycontin, or Codeine. 
  • Lost interest in former friends, hobbies, or romantic partners
  • Heroin withdrawal: Nausea, shakes, flu symptoms, diarrhea

What Does Heroin Look Like?

If you believe you have found heroin and want to confirm it, you can also order an at-home-urine-drug-test. To use the test, add the heroin powder to a small amount of water, and run the test.

In its purest form, heroin is a white powder, but it may appear differently depending on how it’s cut. In simple terms, drug dealers make their money by “cutting” (or adding) other things into their drugs so that they have more to sell. So even though heroin may appear pink, green, blue, or grey, it is most often one of the following:

image of white heroin showing what heroin looks like.


White powder heroin is the purest and most potent form of the drug. Because of this, it is also the rarest and most expensive. Typically white powder heroin is cut with other chemicals that will make it appear less white. People buying white heroin often inject it to take advantage of its potency. However, they may also smoke it (a process known as “chasing the dragon”)

image showing What does brown heroin look like


Brown heroin is a dark powder and a more common form of the drug. Though not as crude and impure as black tar heroin, brown heroin is also not as pure or potent as the white powder. Since brown heroin is very difficult to dissolve, it is usually smoked.

image showing What does Black Tar Heroin look like


Black heroin is not a powder but a tar. It may appear lighter or darker depending on how it was cut or processed. It is generally dark and sticky goo that must be melted instead of dissolved. Black Tar is the least pure and most crude form of the drug, often containing many other dangerous additives. It is most widely produced in Mexico and sent to other countries.

What Does Heroin Feel Like? The Cause of Addiction:

One of the first questions you might have if you think your loved one is using heroin is how did this happen? Many stories of opioid abuse begin with a prescription for painkillers. About 21-29% of all opioid prescriptions in the US are abused [1]. And 80% of heroin users say they started with prescribed pain killers [2].

These pain pills create profound relief either from something physical or emotional. They keep taking it until one day it’s not available, but heroin is — so they try it and quickly become addicted to the high of heroin. It’s for this reason that heroin is much more about self-medication than recreational use. Its effects are:

Euphoria: Heroin causes profound chemical changes in the brain, which creates false feelings of euphoria. This is part of what makes it appealing to people with anxiety, depression, or a history of trauma who are desperate for relief. But over time heroin will make these problems worse. 

False Feelings of Warmth or Safety: Past heroin users describe sensations of intense warmth or safety from heroin, which may be appealing to someone experiencing strife like homelessness or trauma. However, just because you feel warm doesn’t mean you are, and people on heroin can still get hypothermia, for example. 

Pain Relief: As an opioid, heroin has pain relief properties like prescription painkillers. People who are desperate to escape from chronic physical pain may turn to heroin if they can’t get more pain medicine for a current or former injury.  


Signs of Heroin Overdose:

If you think someone is overdosing, call 911. Most states have Good Samaritan Laws that will prevent anyone from being prosecuted. Signs of overdose include: 

  • Shallow breathing
  • Very pale or bluish skin
  • Blue lips or fingertips
  • Gasping for air
  •  Very small pupils
  • Weak pulse
  • Nausea and vomiting
  • Coma
  • Inability to stay awake
  • Seizing or having continued spasms

Heroin overdoses are the number one cause of drug-related deaths in the US. A person’s tolerance to heroin can change drastically depending on their weight, how they use it, and how often they use it. For example, if someone relapsed then it would be very easy for them to overdose if they tried to use as much as they were before stopping. Likewise, someone who usually smokes heroin may overdose when injecting it for the first time.

Treating Heroin Overdose — Naloxone:

Heroin overdoses can be fatal, and there is no home remedy. So if someone is overdosing call 911 immediately. Emergency responders can use Naloxone to reverse heroin overdoses.

Naloxone works by blocking the neural receptors that opioids affect, thereby undoing the effects of opioids like heroin and reversing overdoses. But, Naloxone can wear off before the heroin. Meaning that overdose symptoms can resume. This is why Naloxone should never be used in place of calling 911 for a heroin overdose.

Once at a hospital heroin overdoses are very treatable. Doctors can use iv fluids, naloxone, induced vomiting, and other methods to stabilize an individual until the drugs fully wear off.

Image of a Narcan nasal spray box. A medication for Treating Heroin Overdoses.

How Do People Start Using Heroin?:

Today, the stories of heroin users are strikingly similar. It begins with a pain pill that they were prescribed, borrowed from a friend, or tried at a party. The feeling is immediately gratifying so they get more. Usually this involves creating or exaggerating injuries to get another prescription or lying to friends for more pills. This lasts until their friends or their doctor cuts them off. Now to get more pills the person finds a way to buy them online or from a dealer. As their tolerance grows, they require more pills more frequently. To fund their habit, they might start using savings or stealing from others. 

Then, one day they don’t have enough money for pills or their dealer is out. In either case, the dealer may suggest heroin which is cheaper and more potent than pain pills. By this point the person will likely have withdrawals if they don’t use opioids, so even if the idea of heroin is initially off-putting they eventually give in and try it to get rid of the withdrawals. 

This whole journey may take weeks or years but the story is one heard repeatedly from people in recovery for heroin abuse. While most people think that a heroin user has to be a “junkie” the truth is that anyone can become addicted to heroin thanks to how available pain pills are now.

History Of Heroin:

Heroin’s creation starts with opium, which is made by curing the sap or “latex” of the Opium Poppy Plant that grows indigenously in the Middle East, Asia, and Mexico. When smoked, opium dulls pain and induces a euphoric twilight state. 

Opium Poppy Plant:

Opium Poppy

The history of the opium plant is a long one. It has been grown and traded for its pain relief properties for thousands of years — going as far back as 3400 BC. Archaeologists have unearthed pictographs of the opium poppy from the ruins of Ancient Sumeria (think Biblical times) where it was referred to as Hul Gil or “joy plant.”

Three thousand years later, opium would reach China via Arab traders. From then until the 13th century opium was only used by doctors in India, Asia, and the Middle East for treating pain or by priests for certain religious healing rituals. However when opium reached Europe in the 1300s it became available for recreational use. Addiction and overdoses skyrocketed.

Street Names For Heroin:

  • H
  • Horse
  • Smack
  • Junk
  • Brown 
  • Hell Dust
  • Dope
  • Tar
  • Black Tar
  • White
  • White Horse
  • Chiba
  • China White
  • Scag
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Treating Heroin Addiction:

There are a number of proven (or evidence-based) therapies used to bring heroin addiction into remission and allow someone to live their life outside of their Substance Use Disorder. This begins with overcoming withdrawals, continues with discovering what makes heroin feel so appealing, and ends with developing and practicing other healthier ways to cope. 

Medical Detox: 

Any treatment for heroin should start with a supervised medical detox. This will help a person remain safe and comfortable while their body goes through withdrawals. If you need help finding a detox center that takes your insurance, call us at 855-202-2138. 


After detox, it’s important to identify the thing or things that primed you to enjoy the feelings produced by heroin. Of course, every addiction is unique, but the root of a person’s heroin condition can be a combination of mental, physical, or social factors. That’s why the best rehabs will use a biopsychosocial (biology, psychology, social) approach. 


Recovery doesn’t end after rehab. And returning to everyday life can present stressors that weren’t around in rehab. That’s why it’s crucial to leave treatment with a set of skills and strategies to maintain sobriety over the long term.

Getting Over Heroin:

Heroin addiction is very treatable. If you believe someone you love is using it, you should plan to have a conversation about getting them help. Give us a call at 855-202-2138, or: