10 Telltale Signs of Heroin Use

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Heroin use is extremely dangerous and can lead to dependence, tolerance and addiction.  If you believe that someone you know may be using heroin, watch for these 10 telltale signs of use. 

1. Track Marks

One of the most obvious signs that someone is abusing heroin is the presence of “needle marks or ‘tracks'” on their skin. Most individuals have them on their arms and legs and will often wear long sleeves and pants to hide them. Others may try to hide them by injecting the drug in other, less obvious places such as the neck, thigh, armpit or feet. 

2. Isolation

Drowsiness is a common sign of heroin use.

Isolation from family and friends is very common among heroin addicts. If someone you know once showed enjoyment for life and spent a lot of time with others, then suddenly becomes isolated and refuses to talk to anyone, they may be using heroin or other substances.

3. Street Names

Someone who constantly uses street names for drugs (especially heroin) may be abusing the drug.  Some of these street names include:

• Smack
• Horse
• Skag
• Mud
• Junk
• Dope
• Chasing the dragon
• Speedballing (heroin and cocaine)
• Mainlining (injecting heroin into a vein)

4. Small Pupils

Heroin makes the pupils (the black circle in the center of each eye) very small. Contracted pupils are an obvious sign of opioid abuse, including heroin. When someone is high, their pinpoint pupils are hard to miss. Additionally, this can be a sign of a heroin overdose. If you see someone with extremely small pupils and they are exhibiting other signs of a heroin overdose, such as respiratory depression, call 911 immediately. 

5. Withdrawal

Someone who is abusing heroin will experience withdrawal syndrome when they reduce or stop their heroin use.  Heroin withdrawal syndrome includes some obvious symptoms, such as: 

• Nausea, vomiting and diarrhea
• Poor appetite
• Anxiety, restlessness and agitation
• Elevated heart rate and blood pressure
• Muscle and bone pain
• Headaches
• Chills and hot flashes
• Goose bumps
• Runny nose and increased tearing
• Insomnia
• Intense cravings and a desire to use

6. Paraphernalia

Individuals who are abusing heroin often require the use of paraphernalia such as:

• Hypodermic needles
• Small cotton balls
• Spoons
• Bottle caps
• Razor blades
• Straws
• Rolled dollar bills
• Pipes
• Balloons
• Syringe caps
• Eyedroppers
• Rubber tubing or “tie-offs”
• Matches
• Foil
• Bloody tissues

7. Mood Swings

Mood swings are another indicator that someone is on heroin. There is an obvious and very dramatic difference in behavior when they are high and when the drug wears off. When someone is high, they may act happy, laid back or drowsy. When the drug wears off, they may become severely depressed, be very apathetic towards their life, even towards things that once made them happy. Furthermore, if someone asks them about their potential drug abuse, they may become angry, even hostile. 

8. Itchiness

Another sign of heroin abuse is itching. This is due to an immune system response to the drug. The body identifies the heroin as a foreign invader, so it produces high levels of histamine.  As well, itching may be due to an inflamed or infected injection site if they are using heroin intravenously or if they are experiencing intense skin picking. Another reason for itching is dermatillomania, which is a mental illness that is often seen in people who abuse heroin.  

9. Strange, Secretive Behavior

The  National Institute on Drug Abuse (NIDA) reports that “Heroin… produces profound degrees of tolerance and physical dependence” which can also lead to addiction. Because of this, the more heroin someone abuses, the more erratic their behavior will seem. Many heroin abusers stop spending time with their old friends and only want to hang out with other heroin users.

They may also stop going to school or work and do dangerous things to obtain more of the drug. The person may also become very secretive and likely hide their drugs or drug paraphernalia in places they don’t think others will look. Additionally, they may not be straightforward about where they are going or why. The longer this behavior keeps up, the more likely it is that the individual is addicted to heroin and desperately needs help.

10. Changes in Self-Care

According to the NLM, some of the clearest signs of drug abuse include “neglecting to eat,” “not caring about physical appearance,” and no longer taking care of one’s personal hygiene. If someone you know is showing these signs, heroin use may be to blame. As addiction takes hold, many people become focused almost entirely on getting and using the drug, often losing interest in their appearance, hygiene, health and daily responsibilities. They may lose weight, appear tired or unwell and stop taking care of themselves the way they once did. Wearing the same clothes repeatedly or choosing long sleeves to high track marks can also be common warning signs of heroin use. 

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