Street names: Brown Sugar, Horse, Smack

What is heroin?

teen looking troubled, synringe and lighter with heroine on a table

Also known as: Smack, Junk, H, Black tar, Ska, and Horse

Heroin is a highly addictive drug made from morphine, a psychoactive (mind-altering) substance that is extracted from the resin of the seed pod of  the opium poppy plant. Heroin’s color and look depend on how it is made and what else it may be mixed with. It can be white or brown powder or a black, sticky substance called “black tar heroin.”

Heroin is part of a class of drugs called opioids. Other opioids include codeine, oxycodone (OxyContin), and hydrocodone (e.g. Vicodin). These drugs are chemically similar to endorphins, which are opioid chemicals that the body makes naturally to relieve pain (such as after exercise).

Because of where opioid receptors are located in the brain, heroin and other opioid drugs also activate the brain’s reward center, causing the “high” that puts the user at risk for addiction. In an overdose, it can also cause a person to stop breathing, which is often fatal. 

Heroin use and overdose deaths have dramatically increased over the last decade. This increase is related to the growing number of people misusing prescription opioid pain relievers like OxyContin and Vicodin; many who become addicted to those drugs switch to heroin because it produces similar effects but is cheaper and easier to get. 

In fact, nearly 80 percent of people who use heroin report having first misused prescription opioids.

To learn more about the different types of opioids, visit our Prescription Opioids Drug Facts page.

1 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. CBHSQ Report. Trends in Heroin Use in the United States: 2002 to 2013. Rockville, MD, April 2015. Available at: http://www.samhsa.gov/data/sites/default/files/report_1943/ShortReport-1943.html.

How is heroin used?

Heroin is mixed with water and injected with a needle. It can also be smoked or snorted. Users sometimes combine it with other drugs, such as alcohol or cocaine (a “speedball”), which can be particularly dangerous and raise the risk of overdose.

How does heroin affect the brain?

When heroin enters the brain, it attaches to molecules on cells known as opioid receptors. These receptors are located in many areas of the brain and body, especially areas involved in the perception of pain and pleasure, as well as a part of the brain that regulates breathing.

Short-term effects of heroin include a rush of good feelings and clouded thinking. These effects can last for a few hours, and during this time people feel drowsy, and their heart rate and breathing slow down. When the drug wears off, people experience a depressed mood and often crave the drug to regain the good feelings.

Regular heroin use changes the functioning of the brain. Using heroin repeatedly can result in:

  • tolerance: more of the drug is needed to achieve the same “high”
  • dependence: the need to continue use of the drug to avoid withdrawal symptoms
  • addiction: a devastating brain disease where, without proper treatment, people have trouble stopping using drugs even when they really want to and even after it causes terrible consequences to their health and other parts of their lives. Because of changes to how the brain functions after repeated drug use, people that are addicted crave the drug just to feel “normal.”

Learn more about how the brain works and what happens when a person uses drugs. And, check out how the brain responds to natural rewards and to drugs.

What are the other effects of heroin?

Opioid receptors are located not only in the brain, but also in the brain stem, which controls breathing and other basic life functions, as well as the spinal cord, lungs, and intestines.  Thus, using heroin can result in a wide variety of physical problems, some of which may be very serious. In 2011, more than 250,000 visits to a hospital emergency department involved heroin.2

Heroin use can cause:

  • feeling sick to the stomach and throwing up
  • severe itching
  • constipation
  • coma—a deep state of unconsciousness
  • dangerously slowed (or even stopped) breathing that can lead to overdose death
  • increased risk of HIV and hepatitis (a liver disease) through shared needles

In addition to the effects of the drug itself, heroin bought on the street often contains a mix of substances. Some of these substances can be toxic and can clog the blood vessels leading to the lungs, liver, kidney, or brain. This can cause permanent damage to those organs.

2 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The DAWN Report, Highlights of the 2011 Drug Abuse Warning Network (DAWN): Findings on Drug-Related Emergency Department Visits. Rockville, MD, February 22, 2013. Available at: http://media.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm.

Can you get addicted to heroin?

Yes, heroin can be very addictive. The number of people receiving treatment for heroin use more than doubled from 277,000 in 2002 to 526,000 in 2013. Of the people who received treatment in 2013, 6,000 were teens and 128,000 were young adults.3

Heroin enters the brain quickly, causing a fast, intense high. Using heroin repeatedly can cause people to develop tolerance to the drug. This means they need to take more and more of it to get the same effect. Eventually they may need to keep taking the drug just to feel normal. It is estimated that about 23 percent of individuals who use heroin become addicted.4 For those who use heroin over and over again, addiction is more likely. Once a person becomes addicted to heroin, seeking and using the drug often becomes the main goal guiding their day to day behavior.

When someone is addicted to heroin and stops using it, he or she may experience:

  • muscle and bone pain
  • cold flashes with chills
  • throwing up
  • diarrhea
  • trouble sleeping
  • restlessness
  • kicking movements
  • strong craving for the drug

Fortunately, treatment can help an addicted person stop using and stay off heroin. Medicines can help with cravings that occur after quitting, helping a person to take control of their health and their lives.

3 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. .The CBHSQ Report. Trends in Heroin Use in the United States: 2002 to 2013. Rockville, MD, April 2015. Available at: http://www.samhsa.gov/data/sites/default/files/report_1943/ShortReport-1943.html.

4 Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD. 2014. Available at http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf [PDF - 3.2MB].

Can you die if you use heroin?

Yes, heroin slows, and sometimes stops, breathing, and this can kill a person—what is called a fatal overdose. Deaths from drug overdoses have been increasing since the early 1990s, fueled by increases in misuse of prescription opioids and, more recently, by a surge in heroin use. In 2015, close to 13,000 people in the United States died from a heroin overdose—more than seven times as many as in 2001 (nearly 1,800).

For young people (ages 15 to 24), the increases are greater. More than 1,600 young people died from heroin overdose in 2015 as compared with just over 200 people who died in 2001 from a heroin overdose.5

Signs of a possible heroin overdose are:

  • slow breathing
  • blue lips and fingernails
  • cold damp skin
  • shaking
  • vomiting or gurgling noise

People who are showing symptoms of overdose need medical assistance immediately. A drug called naloxone can be used to reverse the effects of heroin overdose and prevent death if it is given in time.  Naloxone is an opioid antagonist, which means that it binds to the opioid receptors and reverses/blocks the effects of the heroin (or other opioid drug). It is available in an easy-to-use nasal spray or autoinjector.  It is often carried by emergency first responders, including police officers and EMTs. In many states, doctors can now prescribe naloxone to people who use heroin or prescription opioids and to their family members, so that in the event of an overdose, it can be given immediately without waiting for emergency personnel (who may not arrive in time). Read more about how Naloxone Saves Lives.

5 Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. Available at http://wonder.cdc.gov.


How many teens use heroin?

For the most recent statistics on heroin use among teens, see the results below from NIDA’s Monitoring the Future study.

Swipe left or right to scroll.

Monitoring the Future Study: Trends in Prevalence of Heroin for 8th Graders, 10th Graders, and 12th Graders; 2016 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Heroin Lifetime 0.50 0.60 0.70
Past Year 0.30 0.30 0.30
Past Month 0.20 0.20 0.20

Source: University of Michigan, Monitoring the Future Study

For more statistics on teen drug use, see NIDA’s Monitoring the Future study.

What should I do if someone I know needs help?

If you, or a friend, are in crisis and need to speak with someone now, please call:

  • National Suicide Prevention Lifeline at 1-800-273-TALK (they don't just talk about suicide—they cover a lot of issues and will help put you in touch with someone close by).

If you need information on treatment and where you can find it, you can call:

For more information on how to help a friend or loved one, visit our Have a Drug Problem, Need Help? page.

For more information on heroin

Drug Facts


Statistics and Trends


Centers for Disease Control and Prevention

Monitoring the Future (University of Michigan):

Substance Abuse and Mental Health Services Administration:

Blog Posts

Chat Day Transcripts


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Monitoring the Future 2015 Survey Results

Published: December 16, 2015
NIH’s 2015 Monitoring the Future survey shows long term decline in illicit drug use, prescription opioid abuse, cigarette and alcohol use among the nation’s youth.