Heroin

How is heroin used?

Heroin is usually injected into a vein, but it’s also smoked (‘chasing the dragon’), and added to cigarettes and cannabis.²

Effects of heroin

There is no safe level of drug use. Use of any drug always carries some risk. It’s important to be careful when taking any type of drug.

Heroin affects everyone differently, based on:

• the person’s size, weight and health
• whether the person is used to taking it
• whether other drugs are taken around the same time
• the amount taken
• the strength of the drug (it varies from batch to batch).

Onset and duration

How fast a drug takes effect and how long it lasts can vary depending on how it's taken - for example, whether it's snorted or injected.³

Effects are usually felt within seconds of injecting or smoking heroin, but will take around 10 to 15 minutes if snorted.⁴

The main effects of heroin usually last between 3 and 7 hours.²

Effects

Effects can include:

• intense pleasure and pain relief
• relaxation and drowsiness 
• confusion and clumsiness 
• feelings of detachment
• slurred and slow speech
• slow breathing and heartbeat
• dry mouth
• tiny pupils
• reduced appetite and vomiting
• decreased sex drive.^{1, 4, 5}

When injecting drugs, there is an increased risk of:

• tetanus
• infection
• vein damage.⁶

If sharing needles, there is an increased risk of:

• hepatitis B
• hepatitis C
• HIV and AIDS.⁶

Impact of mood and environment

Drugs that affect a person’s mental state (psychoactive drugs) can also have varied effects depending on a person’s mood (often called the ‘set’) or the environment they are in (the ‘setting’): 

• Set: a person’s state of mind, previous encounters with the drug, and expectations of what’s going to happen. For example, feelings of stress or anxiety before using heroin may result in an unpleasant experience and make those feelings worse.
• Setting: the physical and social environment where you take heroin – whether it’s known and familiar, who you're with, if you're indoors or outdoors, the type of music or sounds, and lighting. The ideal setting to take heroin will vary based on the individual and drug they’re using.⁷

Being in a good state of mind, with trusted friends and a safe environment before taking heroin reduces the risk of having a bad experience.⁷

Overdose

If you take a large amount of heroin or use a strong batch, you could overdose. 

Your risk of overdose can also increase if you mix heroin with alcohol or other drugs, including medications.

Heroin overdose can cause death.²

Call triple zero (000) and request an ambulance if you or someone else has any of the following symptoms (emergency services are there to help and can provide more instructions).

Signs of heroin overdose can include:

• extreme drowsiness or falling asleep (‘going on the nod’)
• unconscious or non-responsive
• slow breathing, abnormal breathing, or not breathing at all
• slow or no heartbeat and pulse
• choking or gurgling sounds
• skin colour changes, especially lips and fingernails
• bluish-purple skin for people with lighter complexions
• greyish or ashen skin for people with darker complexions
• vomiting
• cool or clammy (wet and sweaty) skin
• small ‘pinpoint’ pupils.^{8, 9}

Learn more on overdose and drug-related emergencies.

Naloxone

Naloxone (also known as Nyxoid®/Narcan®) temporarily reverses the effects of opioid overdose (including heroin). It’s available for free over the counter from most local pharmacies and can be administered by anyone, including family or friends and bystanders.¹⁰

If a person does not respond to the first dose after 3 minutes, give them a second dose. This can be repeated until the ambulance arrives.^{11, 12}

Mixing with other drugs

Mixing heroin with other drugs can have unpredictable effects and increase the risk of harm.

Mixing includes using more than one drug (including alcohol or medications) at the same time, or one after another. You should also consider what drugs you’ve taken in the last 24 hours.

• Heroin and ice/speed/cocaine: heroin lowers your heart rate and methamphetamine speeds it up, masking the effects of each other. Depending on how much you take, you could overdose on either drug if one wears off before the other. 
• Heroin and alcohol/GHB/benzos: high risk of overdose, may feel clumsy or uncoordinated, nausea and vomiting, slowed breathing, memory loss, passing out, and possible death.¹³

Using more than one drug or type of drug at the same time is called polydrug use.⁹

Reducing harm

There are ways you can reduce the risk of harm when using heroin.

• Learn about carrying naloxone (reverses an opioid overdose) and encourage family and friends to do the same
• avoid mixing heroin with other depressant drugs such as alcohol or benzodiazepines – this can greatly increase the risk of overdose
• use around people you trust and somewhere you feel safe
• if using illicit opioids such as heroin, test with a small amount to reduce overdose risk
• do not drive or operate machinery after use
• if injecting, always use clean needles, never share injecting equipment and always wash your hands
• safely dispose of used injecting equipment.

Coming down

Heroin is not known to cause comedown effects.

Long-term effects

Long-term effects can vary depending on how much, how often and how heroin is consumed. Regular use may eventually contribute to:

• intense sadness
• irregular periods and difficulty having children
• no sex drive, erectile dysfunction and infertility in men
• constipation
• dental issues
• damaged heart, lungs, liver and brain
• vein damage and skin, heart and lung infections from injecting
• needing to use more to get the same effect
• dependence on heroin.^{1, 4, 5}

Heroin and mental health

Experiencing a dependence on heroin is likely to have a serious impact on mental health due to its effects on physical health, relationships, work/financial situation and general day-to-day functioning. Many people who use heroin regularly also have a history of mental health issues, including major depression, anxiety disorders, suicidal ideation, PTSD, personality disorders and experiences of trauma.^{14, 15}

Tolerance

Regularly taking heroin can lead to developing a tolerance, which means you need to take larger amounts to get the same effects.^{2, 16}

Tolerance to heroin also affects other opioids (known as cross-tolerance). For example, tolerance to heroin will also result in a higher tolerance to oxycodone or fentanyl.^{2, 17}

Tolerance should return to normal within 1 – 2 weeks of not using opioids^.2

Dependence

People who regularly use heroin may become dependent. They may feel they need to use heroin to go about usual activities like working, studying and socialising, or just to get through the day.²

Withdrawal

Withdrawal refers to the symptoms that can occur when someone who is dependent on a drug, or who has been using it regularly over time, stops or reduces their use.¹⁸

Withdrawal can include physical symptoms (such as headaches, or nausea) and psychological symptoms (such as anxiety, or depressed mood).¹⁸

Symptoms - including how strong they are and how long they last - will vary depending on the type of drug and a person’s history of use.¹⁸

Withdrawal from heroin can be potentially life-threatening.¹⁹

If you, or someone you care about, is planning to stop taking opium after using it for a long time, it’s important to speak with a medical professional for guidance and supervision.

Withdrawal symptoms

Reducing, or stopping using heroin after a period of regular use can lead to withdrawal symptoms, including:

• cravings for heroin
• restlessness and irritability
• anxiety
• depression
• diarrhoea
• restless sleep and yawning
• stomach and leg cramps
• muscle spasms
• vomiting and no appetite
• goosebumps
• hot and cold flushes
• sweating
• runny nose and watery eyes
• insomnia, disturbed sleep
• fast heartbeat.^{1, 4, 5}

Withdrawal symptoms usually start within 6-24 hours after the last dose and usually last about a week - but can sometimes last up to ten days. Days one to three will be the worst.

Reduced tolerance and overdose risk

After withdrawing from heroin, your body is no longer used to it and your tolerance drops.²⁰

This means if you use the same amount as before, it can be too much for your body and cause an overdose.²⁰

Always start with a lower dose after a break from heroin.²⁰

Pregnancy and breastfeeding

Before pregnancy

There is research that shows opioid drugs, including heroin, can impact fertility.

They can:

• affect menstrual cycles
• lower sex drive.
• lower testosterone levels
• reduce sperm quality and movement
• cause erectile dysfunction.^21-23

During pregnancy

Opioid use during pregnancy can harm the baby’s development.^{24, 25}

Opioids can pass to your baby via the placenta. This can affect the baby’s growth and result in a premature (early) birth, which has other health impacts on the baby.²⁴

Heroin or other chemicals may also be present in illegal or counterfeit (fake) opioid medication, and there is no way to know exactly how these will impact the baby or the pregnancy.²⁶

If you’re injecting opioids, it’s important to not share injecting equipment with other people. This protects you and the baby from bloodborne viruses such as HIV and hepatitis C.²⁷

After pregnancy

Opioid use during pregnancy can sometimes cause withdrawal symptoms in babies after birth. This is known as neonatal opioid withdrawal syndrome (NOWS).^{25, 28}

NOWS is easily diagnosed and treated, and not all babies will experience symptoms.²⁸

Breastfeeding your baby while using opioids in high doses is not recommended, as the drugs can be present in breastmilk and affect the baby.^{24, 27, 29, 30}

If you’re planning to breastfeed, make sure you talk with your midwife or doctor about your use of opioids.²⁵

Getting help

If your use of heroin is affecting your health, family, relationships, work, school, financial or other life situations, or you’re concerned about someone, there is help and support. 

• Call the National Alcohol and Other Drug Hotline on 1800 250 015 for free and confidential advice, information and counselling about alcohol and other drugs.
• Search our Help and Support directory to find your preferred support, by adding your location or postcode and filtering by service type.