By Edmund Murphy

Updated: 25 May 2023 & medically reviewed by Hailey Shafir

The majority of fatal overdoses involve the use of an opioid drug like heroin. Knowing the early warning signs of addiction can help prevent a fatal heroin overdose and save lives.

Key takeaways:

  • The biggest risk associated with heroin use is the risk of overdose death. Last year, over 81,000 people in the US died from a drug overdose, and the CDC reports that opioids like heroin are the primary cause
  • The longer a person continues abusing heroin, the more they are also at risk for overdose, as tolerance can develop quickly, causing people to increase their dose
  • The medication Naloxone can reverse a heroin overdose and save a person's life if administered early
Warning Signs of Heroin Abuse

Signs of heroin abuse

Heroin is an incredibly addictive drug similar to prescription opioid painkillers, so much so that nearly one in four people who try it once become addicted. Not all people who are addicted to heroin will show obvious signs, especially during the early stages of addiction. Below are some heroin addiction signs or indicators of other opioid addiction: [2][3]

  • Drowsiness, excessive yawning, or nodding off

  • Weight loss or neglecting appearance/hygiene

  • Itching or scratching

  • Needle marks on the arms, legs, or feet from injecting heroin

  • Finding drugs, syringes, or other drug paraphernalia

  • Lying or being overly secretive

  • Employment, legal or relationship problems

  • Financial problems or asking to borrow money

  • Changes in mood or personality

Related: What does heroin look, smell, and taste like?

Heroin overdose signs

Knowing the signs of a heroin overdose can help to prevent fatal overdoses. A heroin overdose can be fatal and requires immediate medical assistance. If someone is showing signs of a heroin overdose, call 911 or take them to an emergency room as soon as possible.

Signs of an opioid overdose or heroin overdose include:[2][3]

  • Small ‘pinpoint’ pupils

  • Extreme drowsiness or loss of consciousness

  • Blue lips or nails

  • Loss of pallor (looking pale or white)

  • Shallow breathing

  • Disorientation or confusion

The medication Naloxone can reverse a heroin overdose and save a person's life if administered early. [2] Most emergency workers and healthcare providers have this medication on hand. Depending on where you live, you may also be able to get this medication at a local pharmacy.

Related blog: Naloxone Could Become Widely Available Over-The-Counter

The dangers of heroin use

The biggest risk associated with heroin use is the risk of overdose death. Last year, over 81,000 people in the US died from a drug overdose, and the CDC reports that opioids like heroin are the primary cause.[1]

Synthetic opioids like fentanyl are often sold to unsuspecting buyers as heroin or other painkillers. Fentanyl is a highly potent drug that is 50-100 times more powerful than heroin or morphine and leads to many accidental overdoses.[4] The widespread use of fentanyl has greatly increased the risk of a heroin overdose.

Aside from the risk of dying from an overdose, other risk factors associated with heroin abuse include: [2][3][5][6][7]

  • Increased risk of infections, including blood-borne viruses like HIV

  • Increased risk of fetal harm, miscarriage, or complications for pregnant women

  • Worsened physical or mental health and higher risk of suicide

  • Nausea, vomiting, constipation, and other G.I. problems

  • Increased risk of contracting pneumonia and other lung problems

  • Fertility problems and menstrual problems for women

  • Impotence or reduced sex drive for men

  • Poor nutrition and reduced immunity

  • Loss of relationships, career, and home 

  • Damage to the blood vessels that lead to the lungs, liver, kidneys, and brain due to the additives mixed with heroin 

Heroin addiction symptoms

Diagnosing addictions such as heroin addiction is done by measuring the symptoms of drug use and its impact on the user's life. The symptoms of heroin use disorder (the official term for heroin addiction) are:[8]

  • Hazardous use: You have used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.

  • Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.

  • Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.

  • Withdrawal: When you stop using the substance, you experience withdrawal symptoms.

  • Tolerance: You have built up a tolerance to the substance so that you have to use more to get the same effect.

  • Used larger amounts/longer: You have started to use larger amounts or use the substance for longer amounts of time.

  • Repeated attempts to control use or quit: You've tried to cut back or quit entirely, but haven't been successful.

  • Much time spent using: You spend a lot of your time using the substance.

  • Physical or psychological problems related to use: Your substance use has led to physical health problems, such as liver damage or lung cancer, or mental health issues, such as depression or anxiety.

  • Activities given up to use: You have skipped activities or stopped doing activities you once enjoyed in order to use the substance.

  • Craving: You have experienced cravings for the substance.

The criteria are measured against the previous 12 months of substance use and a score of 2-3 is considered mild, 3-5 moderate, and 6 or more severe. It’s important to understand that left untreated, addictions tend to worsen over time.[8] Relationships, careers, and daily responsibilities often become unmanageable, falling apart as a result of neglect. 

The longer a person continues abusing heroin, the more they are also at risk for overdose, as tolerance can develop quickly, causing people to increase their dose. Seeking heroin addiction treatment can help people successfully overcome an addiction, no matter how severe it has become.

Related: How long does heroin stay in your system?

Treatment for heroin use disorder

Like a lot of people suffering from drug addiction, it can be hard for people to acknowledge the problem and seek help. This can be because they are in the early stages of heroin use and don’t feel they have the symptoms to warrant treatment. Those with more severe addictions often know they have a problem, but feel unable to stop.

While some people think that staging an intervention is the best way to help a person struggling with an addiction, this seldom works. In fact, interventions can make a person feel threatened and defensive and may lead the person to isolate themselves and allow their addiction to progress. 

Expressing care and concern for a person can be helpful, but it’s important to recognize that often, a heroin addict will not stop using until they have recognized there is a need to change. Often, this happens when they ‘hit rock bottom’ or experience a ‘wake-up call’ after a negative or scary experience with heroin. 

Thankfully, there are many effective treatments for people who are trying to stop using heroin or other opioids, including:

The best way to identify the right treatment is to set up an appointment with a local addiction treatment center or a licensed addiction specialist who can provide recommendations for treatment. Often, treatment for addictions is covered by health insurance. Seeking treatment greatly increases the likelihood of remaining clean and sober, helping people overcome their addictions and get their lives back on track.