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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 type of opioid drug that is partly manmade and partly natural. It is made from morphine, a psychoactive (mind-altering) substance that occurs naturally in the resin 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 becoming an increasing concern in areas where lots of people abuse prescription opioid painkillers, like OxyContin and Vicodin. They may turn to heroin since it produces a similar high but is cheaper and easier to obtain. Nearly half of young people who inject heroin surveyed in recent studies reported abusing prescription opioids before starting to use heroin.1

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

1Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. CBHSQ Data Review. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. Rockville, MD, August 2013. Available at:

How Is Heroin Used?

Heroin is mixed with water and injected with a needle. It can also be smoked or snorted.

How Does Heroin Affect the Brain?

When heroin enters the brain, it is converted back into morphine. It then binds 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.

Short-term effects of heroin include a rush of good feelings and clouded thinking. For the first several hours after taking heroin, people want to sleep, and their heart rate and breathing slow down. When the drug wears off, people may feel a strong urge to take more.

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 can’t stop using drugs even when they really want to and even after it causes terrible consequences to their health and other parts of their lives

What Are the Other Effects of Heroin?

The changes that take place in the brain from heroin use have effects on the rest of the body. Some of these effects are quite 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
  • Slowed (or even stopped) breathing
  • Increased risk of HIV and hepatitis (a liver disease) through shared needles
  • Coma—a deep state of unconsciousness

In addition to the effects of the drug itself, heroin bought on the street often contains a mix of substances, some of which 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.

2Substance 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:

Can You Get Addicted to Heroin?

Yes, heroin is very addictive. It enters the brain quickly, causing a fast, intense high. Because users can develop a tolerance, people who use heroin need to take more and more of it to get the same effect, and 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.3 For those who use heroin repeatedly (over and over again), addiction is very likely. Once a person becomes addicted to heroin, seeking and using the drug becomes their main goal in life.

The number of people addicted to heroin doubled from 214,000 in 2002 to 517,000 in 2013.4

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
  • Inability to sleep
  • 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.

3Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. CBHSQ Data Review. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. Rockville, MD, August 2013. Available at:

4Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. Available at [PDF - 3.2MB].

Can You Die if You Use Heroin?

Yes, heroin slows, and sometimes stops, breathing, and this can kill a person. Dying in this way is known as overdosing. Deaths from drug overdoses have been increasing since the early 1990s—fueled most recently by a surge in heroin use. In 2014, more than 10,000 people in the United States died from a heroin overdose. Compare that with 2001, when just 1,800 people overdosed on heroin and died.  For young people (ages 15 to 24), the increases are greater, with 1,300 young people dying from heroin overdose in 2014 as compared with 212 people who died in 2001 from a heroin overdose.5 Signs of a heroin overdose are slow breathing, blue lips and fingernails, cold damp skin, and shaking. People who might be overdosing should be taken to the emergency room right away.

5Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2014 on CDC WONDER Online Database, released 2015. Available at


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; 2015 (in percent)*
Drug Time Period 8th Graders 10th Graders 12th Graders
Heroin Lifetime [0.50] 0.70 0.80
Past Year [0.30] 0.50 0.50
Past Month 0.10 0.20 0.30

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


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.
Infographic - see text below for description

Abuse of Prescription Pain Medications Risks Heroin Use

Published: January 13, 2014
1 in 15 people who take non medical prescription pain relievers will try heroin within 10 years.