Heroin
Heroin is an illegal opioid with a high overdose risk, increasingly contaminated with fentanyl. Learn its effects, risks, overdose signs, and treatment.
Also known as: Smack · Horse · Black tar · H
Effects
- Short-lived rush of euphoria
- Warm flushing of the skin and dry mouth
- Heavy feeling in the arms and legs
- Drowsiness and clouded thinking
- Slowed breathing and heart rate
Risks
- High overdose risk, sharply increased by fentanyl contamination
- Rapid tolerance, physical dependence, and addiction
- Breathing that slows or stops (respiratory depression)
- HIV and hepatitis C from shared needles
- Collapsed veins, abscesses, and heart-lining infection
Overdose signs
- Pinpoint pupils
- Slow, shallow, or stopped breathing
- Limp body and cannot be woken
- Pale, clammy skin; blue or gray lips and fingertips
- Gurgling or choking sounds
Treatment
Opioid use disorder is highly treatable. Three FDA-approved medications - buprenorphine, methadone, and naltrexone - reduce cravings and withdrawal and lower the risk of overdose death, and they work best alongside counseling. Naloxone (Narcan) can reverse an overdose if given in time.
Heroin is an illegal opioid made from morphine, which is taken from the seed pod of the opium poppy. It is highly addictive, and today much of the U.S. powder-heroin supply is contaminated with fentanyl - a far more potent opioid that has turned every dose into a gamble.
If you suspect an overdose
An opioid overdose is a medical emergency. Call 911 and give naloxone (Narcan) if you have it - it is safe, available without a prescription, and can restart breathing within minutes. Warning signs include pinpoint pupils, slow or stopped breathing, a limp body, and skin that has turned pale, gray, or bluish. Stay with the person, and give a second dose after 2–3 minutes if there is no response.
Why heroin is so dangerous now
Heroin slows the body’s most basic functions, including breathing. On its own that already makes overdose a real risk. Mixed with illicitly made fentanyl - which it very often is - the danger multiplies, because an amount too small to see can be fatal. People rarely know exactly what is in a given supply.
The health risks
Beyond overdose, regular use leads quickly to tolerance and physical dependence, and then to opioid use disorder. Injecting heroin carries its own dangers: collapsed veins, skin abscesses, infection of the heart lining, and - when needles are shared - HIV and hepatitis C.
Treatment works
Opioid use disorder is one of the most treatable substance use disorders. The three FDA-approved medications - buprenorphine, methadone, and naltrexone - ease cravings and withdrawal and lower the risk of dying from an overdose, especially alongside counseling and support. Recovery is realistic, and it often starts with a single phone call.
If you or someone you love is struggling with opioids, call or text 988 (US) anytime, or contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) for free, confidential treatment referrals.