Barbara E. Kaplan, MHDL

Counseling for Individuals, Couples, Partners, Marriages, Families




According to a Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 National Survey on Drug Use and Health of people 12 years and older in the civilian population (excluding those people institutionalized) of the United States, there were:

  • in 2014, approximately 435,000 people who were current heroin users of which 82,000 were adolescents (age 12 years - 17 years old)
  • for the past year (2014) use, approximately 914,000 people (.3% of US population) used heroin of which 28,000 were adolescents (age 12 years – 17 years old).
  • in 2014, approximately 586,000 people (.2% of the US population) had a heroin use disorder.   In each year from 2002 – 2010, the percentage was .1%.   Therefore, the % of people with a heroin use disorder has doubled!

According to the Centers for Disease and Control (CDC):

  • More than 9 in 10 people who used heroin also used at least one other drug.
  • 45% of people who used heroin were also addicted to prescription opioid painkillers.

Regarding heroin-related deaths, according to the CDC:

  • Heroin-related overdose deaths have more than tripled since 2010.
  • From 2013 to 2014, heroin overdose death rates increased by 26%, with more than 10,500 people dying in 2014.
  • In 2013, non-Hispanic whites aged 18 to 44 years had the highest rate for heroin overdose death (7.0 per 100,000).

According to the CDC, the likelihood of a person being addicted to heroin if addicted to alcohol or marijuana or cocaine or opioid painkillers is as follows respectively: 2 times, 3 times, 15 times, 40 times.

According to the CDC:

A wider variety of people are using heroin. Rates remained highest among males, 18–25 year olds, people with annual incomes less than $20,000, people living in urban areas, and people with no health insurance or those enrolled in Medicaid. … They doubled among women and more than doubled among non-Hispanic whites.

About Heroin

Heroin is a highly addictive opioid drug that is processed from morphine.  The pods of specific poppy plants contain opium (a sticky milky sap) that is removed by slitting the pod, collecting this substance and then processing it into morphine which in turn is processed into heroin.  Heroin usually appears as a powder, either white or brown in color but also black (or dark brown) referred to as black tar heroin.  According to National Institute on Drug Abuse (NIDA):

Pure heroin is a white powder with a bitter taste that predominantly originates in South America and, to a lesser extent, from Southeast Asia, and dominates U.S. markets east of the Mississippi River. … Highly pure heroin can be snorted or smoked and may be more appealing to new users because it eliminates the stigma associated with injection drug use.   “Black tar” heroin is sticky like roofing tar or hard like coal and is predominantly produced in Mexico and sold in U.S. areas west of the Mississippi River. … The dark color associated with black tar heroin results from crude processing methods that leave behind impurities.

To increase profits, this street drug, before sold, is often “cut” (mixed) with other substance(s) such as sugar, powdered milk, starch or quinine (which is a toxic substance banned in the US in 1995 except for the treatment of malaria) and strychnine (a poison).  Being unaware of what heroin is mixed with can put the user at great risk. Overdose can occur leading to coma or death. 

Heroin may be introduced into the body in the following ways: injection (intravenous referred to  as "mainling"; subcutaneous referred to as "skin-popping”), nasal insufflation (snorting), smoking or inhaling (referred to as “chasing the dragon”), anal and vaginal suppository (referred to as “plugging”), ingestion (swallowing).  Heroin is highly addictive regardless of route of administration.  After entering the body, the drug user typically reports feeling a surge of pleasurable sensation (referred to as the "rush").   The intensity of the rush is contingent upon the amount used and how quickly it enters the brain to bind to receptors. With the rush (pleasurable feelings), the following usually occurs: warm flushing of the skin, dry mouth, nausea, vomiting, severe itching, heavy feeling in arms and legs.  After this, the person who used heroin typically feels drowsy.  According to NIDA: “mental function is clouded; heart function slows; and breathing is also severely slowed, sometimes enough to be life-threatening.  Slowed breathing can also lead to coma and permanent brain damage. …”

According to NIDA:  Once a person becomes addicted to heroin, seeking and using the drug becomes their primary purpose in life.

Some street names for heroin are:  Smack, H, China White, White Horse.  Some street names for Black tar heroin are: Mexican Mud, Chiva, Brown, Black, Tar, Hop. La Negra, Brown.

Brain Chemistry

The brain consists of trillions of cells and about billions of nerve cells called neurons.  It is these neurons that send and receive messages from other nerve cells via chemical and electrical signals and these nerve cells also process this transmitted information.  The chemicals are referred to as neurotransmitters, one of which is dopamine.  Dopamine regulates emotions, movement, motivation and feeling of pleasure.  Heroin provides a release of dopamine in the body when after converting to morphine, it binds to specific receptors called mu-opioid receptors (MORs) in the brain and activates these receptors.  According to NIDA, the MORs “regulate pain, hormone release, and feelings of well-being."  When dopamine is released, it results in a sensation of pleasure. The dopamine that has been released gets recycled back into the cell that released it (so it can be used later on) and the signal between nerve cells gets shut off.  Heroin and other drugs of abuse can disrupt this natural communication process, the normal balance of the body.  It is important to note, that according to NIDA:  “Repeated heroin use changes the physical structure … and physiology of the brain, creating long-term imbalances in neuronal and hormonal systems that are not easily reversed. … Studies have shown some deterioration of the brain’s white matter due to heroin use, which may affect decision-making abilities, the ability to regulate behavior, and responses to stressful situations.”

For a very informative video by Dr. Hall-Flavin regarding heroin, please view:

By permission of Mayo Foundation for Medical Education and Research. All rights reserved.

  • nausea
  • shaking
  • nervousness
  • cold sweat
  • chills
  • diarrhea
  • abdominal pain,
  • muscle spasms,
  • anxiety
  • depression,
  • insomnia,
  • excessive yawning
  • severe muscle and bone aches and pains,
  • fever
  • runny nose
  • teary eyes
  • goose bumps
  • agitation
  • tense craving for heroin 

Withdrawal symptoms occur if use is reduced abruptly.  It may occur within a few hours after the last time the drug is taken and usually subsides after a week.  However, some users have withdrawal symptoms that extend many months.


Long-Term Effects

Chronic users of heroin may experience the following long-term physical effects from its use:

  • insomnia
  • constipation
  • collapsed veins
  • bacterial infections of heart lining and valves
  • lung complications ( e.g., pneumonia, tuberculosis)
  • irregular menstrual cycle
  • sexual dysfunction in males
  • arthritis and other rheumatologic problem
  • liver disease
  • kidney disease
  • gastrointestinal cramping
  • damage the nasal mucosal tissues and  perforated nasal septum in users who snort heroin

When needles or fluids are shared, the user is at risk for hepatitis B and C, HIV and other blood-borne viruses.  Heroin that is diluted with other substances may not readily dissolve and therefore can clog the blood vessels leading to organs (brain kidney, liver, lungs), resulting in permanent damage.

With use of heroin during pregnancy, there is a risk of spontaneous abortion.  Regular use during pregnancy may lead to neonatal abstinence syndrome (NSA).  According to National Institute on Drug Abuse:

With use of heroin during pregnancy, there is a risk of spontaneous abortion.  Regular use during pregnancy may lead to neonatal abstinence syndrome (NSA).  According to National Institute on Drug Abuse:

NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent along with the mother. Symptoms include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhea, vomiting, and possibly death. NAS requires hospitalization and treatment with medication (often morphine) to relieve symptoms; the medication is gradually tapered off until the baby adjusts to being opioid-free. Methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the outcomes associated with untreated heroin use for both the infant and mother, although infants exposed to methadone during pregnancy typically require treatment for NAS as well.

Opioid Use Disorder may occur with other disorders such as substance use disorders (e.g., Alcohol Use Disorder), depressive disorders, Posttraumatic Stress Disorder.



The good news is that Opioid Use Disorder is treatable with a number of effective therapies available. Treatment may consist of medication and/or behavioral therapy.  One behavioral treatment approach is Contingency Management, also referred to as Motivational Incentive, which is utilized in community treatment programs and shown to be effective when used in them.   It uses rewards for patients who abstain from heroin and other drugs.  Another approach is Cognitive Behavioral Therapy that may be utilized in inpatient and outpatient treatment with individuals and groups.   It assists clients in acquiring skills in an effort to achieve long-term abstinence.   Cognitive Behavioral Therapy (CBT) recognizes that one’s feelings and behavior are largely influenced by one’s thought(s).  It consists of identifying, testing and correcting unhealthy thinking to change the view of self and the world in an effort to decrease psychological disturbance, unwanted, problematic and self-destructive behaviors and improve functioning.  There is a focus on acquiring skills.  These learned skills may be applied during and following counseling to aid in obtaining and maintaining abstinence from heroin use and throughout life to apply to other issues or problems such as relationship difficulties, stress, anxiety, depression, anger.  According to NIDA, a "central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies. ...  Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment.

Because heroin users may also use other drugs, it is important that treatment include any other substance use disorders.  It is also not unusual for people with heroin use disorders to have other psychiatric disorders such as mood disorders.  It is of importance for treatment to focus on these disorders as well.


For more information about Cognitive Behavioral Therapy, please click on the following link:

Something to Consider in Making a Decision to Seek Professional Assistance

People may wonder when to seek help for heroin use.  Although not an exhaustive list, the following may be considered in amaking a decision to seek professional assistance:

  • heroin use as a way to sope with stress
  • repreatedly unable to stop heroin use when desired
  • driving a vehicle while impaired from heroin
  • giving up or reducing participation in pursuits that were enjoyable because there is a preference to use heroin instead or due to recovering from negative efeffects of use
  • heroin use is repeatedly causing arguments with others or making the arguments or relationship worse
  • receiving complaints or concerns from others abut one's heroin use
  • repeated craving for heroin
  • repeatedly can't wait to get off from work to use heroin
  • heroin use interferes in caring for family, meeting household or school obligations
  • absences frm work or repeatedly going into work late due to heroin use
  • repeatedly spending a lot of time in heroin use or recovering from the negative effects of its use
  • stealing or prostituting self to obtain money for heroin use
  • the same amount /quality of heroin consumed for some time has less of an effect that it use to have
  • withdrawal symptoms are causing impairment in functioning or are very bothersome
  • morning heroin use
  • if you think you have a problem with heroin use
  • repeatedly using more heroin than on one's mind to use

Medications available for the treatment of Opioid Use Disorder are: methadone, buprenorphine, naltrexone.  The first two medications suppress the symptoms of withdrawal and the third blocks the effects of opioids at their receptor sites in the brain. Methadone may only be obtain at approved outpatient programs and  buprenorphine is only prescribed by certified physicians.  

Another medication is worthy of mention, that of naloxone.   According to NIDA: “Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with heroin or prescription opioid pain medications. …There are three FDA-approved formulations of naloxone … “  They are injectable, autoinjectible and a nasal spray.

Although not treatment, participation in support group may supplement treatment.   However, the effectiveness of Narcotics Anonymous is difficult for researchers to determine due to the anonymity of its participants.  Please be aware that this 12-step group is not confidential!


For additional information about counseling regarding heroin issues or counseling in general, please call 704  333-1510.



This article is solely for information purposes.   It is not advice.   It is not intended for minors, and minors are instructed to leave the site.   It is not intended and it does not constitute professional or clinical advice.  The user of this page should not take any steps, or refrain from taking any steps, based on the information in this page, but should instead consult a qualified mental health professional.

This article was written some time between January 1, 2016 and January 22, 2019.