What are the effects of heroin?

By Bryan Le 12/27/13

The effects of heroin—and its dangers—can be divided into its immediate and long-term effects. Both can be fatal.

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Short term effects

Heroin's immediate effects occur when the drug crosses from the bloodstream into the brain, where it is converted into morphine that binds to the brain's opioid receptors.

The most apparent and immediate effect—and the main reason heroin is used—is for the intense "rush" of pleasure that floods the brain, the speed and intensity of which is determined by its method of ingestion. As an opiate in the same category as painkillers such as oxycodone, hydrocodone, codeine and morphine, it will also block any pain signals from reaching the brain. Users may also start to feel some unpleasant side effects including a warm skin flush, dry mouth, heavy-feeling extremities, nausea, vomiting and severe itching. After the rush passes, users will become drowsy for hours. Their mental functions will become cloudy and they may pass out while their heart and breathing rate slows—sometimes to a lethal level.

Using heroin on the street also carries its own set of immediate risks. Because it's impossible to know how much or with what the heroin has been cut with, miscalculating a dose and ODing or being poisoned by toxic cutting agents is a real risk. Obtaining clean needles is difficult for non-medical personnel, so many users resort to sharing or reusing needles which can cause cross-contamination of blood-borne diseases. Desperate prisoners will even fabricate needles out of a pen and a paperclip to get their fix, and scarce resources in jail means a lot of sharing.

Long term effects

The brain is hard-wired to seek things that provide an endorphin rush to the brain, such as exercise, thrills, love and sexual excitement. When heroin is used, the morphine acts like a ton of endorphins dropped on to the brain at once—a biologically irresistible pleasure in the brain that keeps users coming back. The body starts becoming used to having that level of pleasure in the brain and any amount of time without it becomes agonizing. 

Not only does physical dependence build quickly with heroin, tolerance does as well. Users will eventually need more and more heroin to get high, and will dedicate more and more time to acquiring and using heroin until it virtually becomes their sole goal in life.

Absence of the drug after the body has become dependent upon it carries a bevy of negative effects called withdrawal. Withdrawal can come just hours after the last hit, leaving addicts with feelings of restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes and goose bumps (like a “cold turkey”), and leg movements. These symptoms peak between 24 and 48 hours after last use and typically taper off after about a week—but some have shown symptoms for months. These lingering symptoms are known as protracted withdrawal syndrome, or PAWS, which can cause mood swings resembling an affective disorder, anhedonia (the inability to feel pleasure from anything beyond use of the drug), insomnia, extreme drug craving and obsession, anxiety and panic attacks, depression, suicidal ideation and suicide, and general cognitive impairment.

Tolerance to heroin is lost as quickly as it is built, meaning if users haven't consumed heroin for a while and try their old usual dose, they can easily overdose. This is a risk particular to heroin, and many speculate this was how Cory Monteith and Philip Seymour Hoffman met their ends.

Pregnant women who use heroin can pass on their dependency to their baby, who will experience the same symptoms. Unfortunately, while heroin withdrawal is almost never fatal to adults, it will kill the fetus of a pregnant woman. Besides being born with an addiction, infants born to addicted mothers are prone to defects, premature birth, slow development and learning disabilities.

Constant needle injections can also severely damage and scar veins and other soft tissue. The regular pushing and stretching by the needles can burst veins and cause them to collapse, making them useless for transporting blood through the body or accepting IVs, which prompts addicts to find and eventually destroy another vein elsewhere. Relatively new users will start with injecting into their arms, but may later move on to their hands and neck when their arm veins are ruined. Disease and infectious bacteria can be spread by unsanitary needles, leading to infection buildups around heart valves or soft surface tissue, which causes boils to form on the skin.


Heroin-Specific Diseases

Toxic Leukoencephalopathy is a rare brain disease particular to heroin smokers—it does not affect heroin injectors or snorters—which causes slurred speech and difficulty walking that eventually give way to mental deterioration, vision loss, speech difficulty paralysis, coma and death. According to Heroin Helper, many believe the aluminum foil used to smoke heroin is the culprit, believing that either the flame or heroin's acidity breaks down the aluminum foil into a breathable vapor. However this is not the case—exactly what it is about smoking heroin that causes the disease is still a mystery.

Cotton fever is another heroin-related disease, however it only affects intravenous heroin users. Its symptoms include fever, headaches, chills, nausea and shortness of breath, starting almost immediately after injection—but the syndrome usually resolves itself within a day. Most cases of cotton fever are caused by the bacteria Pantoea agglomerans, which lives in cotton plants, but is sometimes caused by sepsis resulting from unhygienic injection practices.


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Bryan Le grew up in the 90's, so the Internet is practically his third parent. This combined with a love for journalism led him to The Fix. When he isn't fulfilling his duties as Editorial Coordinator, he's obsessing over fancy keyboards he can't justify buying. Find Bryan on LinkedIn or Twitter