What should you know about heroin addiction?

Heroin addiction robs you of so much; your mental and physical wellbeing, healthy relationships, financial security and quality of life. Repeated heroin use can cause irreversible changes to your brain structure and damages grey matter that regulates your behaviour, decision-making abilities, and your response to stimuli.

Heroin is highly addictive, and tolerance builds rapidly, leading to a chronic, relapsing condition called heroin use disorder. The more you know about the signs and symptoms of heroin use disorder, the better. It’s essential you seek treatment for heroin addiction sooner rather than later to prevent the street drug from ruining your life. South Africa is home to a burgeoning population of recovering addicts, counsellors, and specialists, making it an excellent setting for alcohol rehabilitation centresGet in touch with us for more information on our long term rehab centre.

What is heroin?

Heroin is an opioid drug made from morphine derived from the seed pod of opium poppy plants cultivated in Mexico, Colombia and Southeast and Southwest Asia. The chemical name for heroin is diacetylmorphine. It is the fastest-acting opiate in the world.

It was first produced in 1898 and was hailed a wonder drug initially for its morphine-like properties. It was used as a powerful treatment for pain relief and analgesic medicine.
In the 1910s, the ‘wonder drug’ abuse was growing rapidly, and heroin addiction was a serious problem. Heroin was declared a narcotic drug, and restrictions were placed on its production, distribution and use. By 1924, legislation imposed a total ban on heroin production for commercial supply. This has not stopped the drug underworld from producing the illicit street drug in clandestine jungle kitchens or laboratories.

Heroin is produced as a white or brownish powder. It is also sold as a sticky black substance called black tar heroin. Street names for heroin include smack, skag, skunk, brown sugar, hell dust or white horse. Heroin mixed with night-time cold and flu medicine is called Cheese, and A-bomb when mixed with marijuana. People mix heroin with crack cocaine, known as speedballing.

How is heroin used?

Heroin users sniff, snort, smoke or inject the drug. It is a highly addictive opioid. Tolerance builds rapidly, and people are at risk of becoming ‘hooked’ on heroin within days or weeks of the first time it is used.

Heroin rapidly enters your central nervous system and binds to opioid receptors found in parts of your brain that regulate feelings of pleasure and pain, control your heart rate, breathing and sleeping, and regulate your behaviour and decision-making abilities.

What should you know about heroin addiction?

Did you know?

Bayer first marketed the street drug under the brand name Heroin. The name comes from the German medical term “heroisch”, meaning “large, extreme, powerful; one with pronounced effect even in small doses.”

How does heroin make you feel?

Heroin produces a surge of pleasure or euphoria, known as a “rush”. The intensity of a heroin rush depends on how the drug is consumed (snorted, smoked or injected) and how much is taken. Euphoria occurs within seven to ten seconds of injecting the drug into a vein and between ten to fifteen minutes if you sniff or smoke it. A heroin high lasts from ten to thirty minutes and is followed by drowsiness, lethargy and apathy.

Common side-effects of heroin include flushed, warm skin, drowsiness, dry mouth, and your arms and legs feel heavy.

The more unpleasant side-effects of heroin include nausea, vomiting and severe itching. Your heart and breathing slow down, and your brain becomes foggy. A heroin overdose can lead to severe respiratory distress, coma, irreversible brain damage and death.

Did you know?
“Being on the nod” is a red flag for a heroin overdose. It describes the state where a user alternates between drowsiness and wakefulness for several hours, where their head drops low as they get sleepy and then jerks up as they awake. Nodding occurs because heroin is a powerful sedative and can cause you to go into a deep sleep that you cannot be woken up from, leading to the point where you lose consciousness, slip into a comatose state and stop breathing.

Signs and symptoms of heroin use disorder?

Repeated heroin use causes uncomfortable short-term side effects as well as life-threatening long-term side effects. The way heroin rapidly binds to opioid receptors in your brain eventually changes your brain’s chemistry structure and function. These brain changes are not easily reversed and can result in permanent brain damage.

People who inject heroin into their veins with needles several times a day develop needle marks, known as tracks. This can cause permanent scarring.

Heroin users are at risk of contracting Hepatitis B, Hepatitis C or HIV if they share dirty needles.

Physical signs and symptoms of heroin use

  • warm, flushed skin
  • dry mouth, cracked lips
  • constricted, pinpoint pupils
  • extreme itching
  • bruising or track marks at injection sites
  • acne, weeping facial sores
  • scabs from itching
  • skin necrosis, open sores
  • extreme weight loss
  • slurred, slow or forced speech
  • breathing difficulties, shortness of breath
  • needle track marks on legs, feet, arms
  • poor personal hygiene, dirty hair and body odour
  • aggressive, defensive, hostile to others
  • agitated, irritable, restless
  • anti-social, avoid loved family, friends and social activities
  • manipulative, deceitful, lie about drug use and behaviour
  • hyperactive, restless
  • drowsy, listless, exhausted, nod off easily
  • poor work performance, drop school grades
  • apathetic, lack motivation
  • drug use paraphernalia inc. burned spoons, needles, syringes, glass pipes
  • wear long-sleeved shirts and pants in hot weather
  • damaged nasal tissue
  • collapsed veins at injection sites
  • constipation, stomach cramps
  • frequent respiratory infections, pneumonia
  • liver, heart and kidney disease
  • sexual dysfunction
  • irregular or ceased menstrual cycles

Psychological signs and symptoms of heroin use

  • depression, anxiety
  • mood swings
  • personality disorder, social phobia
  • overly joyful, euphoric
  • bad mood, irritable
  • disorientated, confused
  • delusions
  • hallucinations
  • paranoia
What should you know about heroin addiction?

Did you know?

Severe itching is a tell-tale sign of heroin use. Opioids can cause histamines to be released, which irritate the skin. Histamines are compounds your body produces during an allergic reaction. Heroin can make you feel like biting ants are crawling over your body, and you scratch excessively to relieve the itching. Itching usually coincides with your skin becoming warm and flushed.

Heroin withdrawal symptoms

Heroin is highly addictive and one of the hardest opioid drugs to quit. The withdrawal symptoms are extremely unpleasant, resulting in severe cravings and causing users to seek the illicit drug to satisfy their cravings constantly.

Drug tolerance builds rapidly, and users experience uncomfortable side effects within hours of reducing or stopping the drug.

Common heroin withdrawal symptoms include:

  • diarrhea and vomiting
  • cold flashes, goosebumps
  • severe muscle cramps and bone pain
  • jerking legs, uncontrollable muscle spasms
  • insomnia
  • yawning
  • restlessness, agitation
  • aggression, hostility
  • depression, anxiety
What should you know about heroin addiction?

Did you know?

Severe withdrawal symptoms peak between 48 and 72 hours after the last dose of heroin and can last a few months after stopping the drug. It can be fatal to suddenly stop using heroin if you are heavily addicted to the drug. A medically-supervised detox is essential to manage withdrawal symptoms safely.

What is laced heroin?

Pure heroin is an expensive commodity and is rarely found on the streets. It is commonly laced or cut with additives to bulk up the weight or other narcotic drugs to increase its potency. The aim is to make bigger profits and increase the rate of addiction to boost ‘supply and demand’.

Heroin overdose is common because it is difficult to determine what is in the product and users often underestimate the potency of a batch.

Common additives used to cut heroin and increase its bulk include:

  • white or brown sugar (sucrose)
  • cake flour
  • powdered milk (lactose)
  • baking soda
  • corn starch
  • calcium
  • caffeine
  • quinine (used to make tonic water)
  • chalk
  • zinc
  • laundry detergent
  • rat poison
  • copper, manganese, cadmium
  • ethanol
  • arsenic

Dangerous intoxicants used to lace heroin to increase its potent effect include:

  • cannabis (A-bomb)
  • cocaine (speedball)
  • ecstasy (Molly)
  • morphine
  • Fentanyl (30 to 50 times stronger than heroin)
  • Rizzy powder (a toxic substance used to colour plant petals)
  • tranquilisers
  • Angel Dust (hallucinogenic drug)

What is a heroin overdose?

A heroin overdose occurs when a user experiences life-threatening complications from the powerful drug, most often severe respiratory distress. Heroin is an opioid drug that causes breathing difficulties, resulting in losing consciousness and falling into a coma or death. Opioids cause more than 70 percent of drug overdose deaths.

A user’s breathing slows or stops when they overdose on heroin, causing hypoxia. This is when the amount of oxygen reaching the brain decreases significantly, resulting in short- and long-term brain damage.

Naloxone (Narcan) is used to treat a heroin overdose. The quick-acting drug binds rapidly to opioid receptors and blocks the effect of heroin on the central nervous system. The person should start breathing properly again, but they may require a second dose in severe cases. Narcan is given to people as an injectable solution or nasal spray.

How is heroin addiction treated?

Brain changes resulting from heroin use disorder are not easily reversible, but you can treat heroin addiction with various medicines and psychotherapy. Medical detox at an addiction treatment clinic is recommended to manage debilitating withdrawal symptoms, and inpatient or outpatient treatment at an addiction treatment facility is recommended for long-term recovery.

Various medicines are used to help with withdrawal symptoms.

  • Lofexidine is a non-opioid medicine used to reduce symptoms.
  • Buprenorphine and methadone are used to help people stop using heroin. Both drugs work by binding to opioid receptors in the brain but to a lesser extent than heroin, helping to reduce cravings and withdrawal symptoms while weaning off heroin.
  • Buprenorphine, naltrexone, and an extended-release naltrexone formulation are commonly used to tackle cravings and withdrawal symptoms and help people with heroin use disorder stop using the drug.


Psychotherapy – talk therapy – forms part of an integrated treatment programme for heroin use disorder, either at an inpatient or outpatient addiction care facility.

Cognitive behavioural therapy (CBT) is one of the most popular talk therapy methods used to treat substance use disorders. It focuses on a person’s behaviour and how they think, feel and view themselves relative to the world around them. CBT explores the relationship between your beliefs, thoughts, feelings and behaviour, and the divide between what you want to do and what you actually do in certain circumstances (trigger moments).

Other popular psychotherapy methods include:

Psychodynamic therapy
Psychodynamic therapy focuses on how certain relationships and life events affect your current feelings, choices and behaviour. The aim is to help you understand and acknowledge repressed emotions and negative feelings and resolve internal mental conflicts to improve your self-esteem, relationships and quality of life.

Dialectical behaviour therapy (DBT)
DBT is similar to CBT, but the goal is to provide people with coping skills to regulate their emotions, make better choices, handle stress, improve relationships and improve their quality of life. DBT was developed initially to treat borderline personality disorder and is now used to treat various mental illnesses, including substance use disorder.

Humanistic/experiential therapy
Humanistic therapy focuses on the whole person and their nature rather than their behaviour. The aim is to identify positive attributes and boost your ability to heal, grow, and self-actualise through self-exploration. Humanistic therapy is effective for people with depression, anxiety, panic disorders, low self-esteem and self-harming tendencies.

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