Risks of Snorting, Smoking, and Injecting Heroin


Heroin is a very addictive drug made from morphine that is sold either as a white powder or as a brown sticky substance (black tar heroin). An illicit opioid drug, heroin enters the brain quickly and binds to opioid receptors to cause an immediate and intensely euphoric high.1 Heroin’s action on the body’s opioid receptors also reduces feelings of pain and slows vital functions like breathing and the heart rate.

Effects of Heroin

Drug high

Someone who is high on heroin may experience and/or exhibit many short-term many short-term effects, including:1

  • Nodding the head and switching between a conscious and semi-conscious state (being “on the nod”).
  • Heaviness in the extremities.
  • Problems thinking clearly.
  • Dry mouth.
  • Itching.
  • Nausea/vomiting.
  • Warm, flushed skin.

How Is Heroin Used?

Most users of this powerful illegal opioid will snort, smoke, or inject the drug.1 Black tar heroin is typically injected, whereas white powder heroin is often snorted or smoked. New users will often seek out the white powder heroin to avoid injection use, which is very stigmatized.1

People who use heroin may, over time, switch their preferred methods of use—for example, they may move from snorting or smoking to injecting—as their dependence grows and their addiction progresses.2–4

Heroin use by any means is dangerous. In 2018, almost 15,000 people died in a heroin-related overdose in the United States.5

What Happens if You Snort Heroin?

People often snort heroin because it isn’t as scary as injecting or even smoking the drug.4  Some heroin users also believe they won’t become addicted to heroin if they stick to this method. This is a myth, of course; any heroin use, regardless of the method, may result in addiction. 4

Snorting or sniffing (intranasal delivery) may alleviate the fears of some heroin users over contracting HIV and other bloodborne diseases, a very serious risk of injection drug use.6 However, snorting the drug does not fully eliminate this risk because heroin use by any means is linked to a greater likelihood of engaging in risky behaviors, including unsafe sex.

Snorting the drug also has its own inherent health risks. Regular intranasal use of this drug can result in damage to the nasal tissues.1 Those who snort heroin may experience:8

  • Red and/or runny nose.
  • Nasal pain.
  • Sores in the nose.
  • Holes in the nasal septum.
  • Problems swallowing.
  • Damage to the hard or soft palate.

Snorting may quickly progress to injection use as a user gains a greater tolerance to the effects of the drug and looks for a better high.4,6 Some users will engage in both snorting and injection use. For example, some individuals may snort their heroin prior to injecting it as a way of informally testing it to determine its strength or ingredients. 6

Signs a Person is Snorting Heroin

While snorting heroin doesn’t leave telltale track marks on the arms, there are still ways to tell if a person has been using heroin intranasally. Apart from the general signs of heroin abuse, regularly snorting heroin may lead to noticeable physical changes including:9

  • Chronic runny nose.
  • Redness of the nose.
  • Constant sniffing.
  • Nosebleeds.
  • Sores on the nostrils.

While little paraphernalia is needed to snort heroin, there are some items that may indicate a person is engaging in the practice, including:9,10

  • Short/cut-off plastic straws.
  • Rolled-up papers or dollar bills.
  • Empty plastic pen cases.
  • Nasal spray bottles (used to snort a heroin/water mixture).
  • Items heroin may have been sold in, such as empty drug capsules or small plastic bags.

What Happens if You Smoke Heroin?

Man smoking heroin

Smoking, like snorting, is a method of use often chosen by new heroin users to avoid injection use.4 While some people believe smoking to be less dangerous or addictive, smoking delivers heroin to the brain rapidly, can result in addiction, and is associated with many health risks.11

Smoking heroin is linked to respiratory health problems. One study of more than 750 heroin smokers found that most suffered from chronic obstructive pulmonary disease (COPD) or a combination of COPD and asthma.12 The prevalence of COPD in heroin smokers is also much higher than the COPD prevalence among regular tobacco smokers.13

Other respiratory issues that may arise from consistent inhalation (smoking) of heroin include:12,14

  • Mucosal inflammation and injury.
  • Chronic bronchitis.
  • Acute bacterial bronchitis.
  • Airway reactivity (inflammatory changes in the airways after exposure to irritants that can result in coughing, wheezing, shortness of breath, etc.).
  • Early onset of severe emphysema.
  • Hypersensitivity pneumonitis (a disease that causes swelling and sensitivity of the lung tissue, makes breathing difficult, and may cause lung scarring).
  • Barotrauma (e.g., pneumothorax, a life-threatening condition involving air or gas between the lungs and chest wall).

Signs Someone is Smoking Heroin

A person who smokes heroin may show physical signs such as sores on their lips or burn marks on their mouth and/or fingers. They may also cough or hack persistently.9

Heroin smokers may also leave certain paraphernalia lying around. You may find one or more of the following in places they spend time:9

  • Spoons with burn marks.
  • Aluminum foil and/or gum wrappers that have burn marks.
  • Straws with burn marks on them.
  • Empty plastic pen cases.

Risks of Shooting Heroin

Injecting, or shooting, heroin often represents a serious progression of drug use, since a large portion of new heroin users start with snorting or smoking.4 Injection is a very efficient way to deliver the drug into the system, so users chasing a high they can no longer achieve via other means may “graduate” to shooting up—a practice rife with risks.4

Research indicates that, compared to other methods of use, injection drug use is linked to more severe substance abuse-related problems including higher rates of:2

  • Drug abuse and dependence.
  • Unemployment.
  • Physical health issues.
  • Co-occurring mental health disorders.

HIV and Other Disease Transmission

One of the most well-known, and most frightening, risks of injecting heroin is the risk of contracting HIV or viral hepatitis. Sharing needles or other injection equipment may result in the transfer of blood (and the diseases it carries) to another user.15 The risky behaviors associated with drug use and addiction, such as unsafe sex, only add to this danger.15

Per the Centers for Disease Control and Prevention (CDC), an HIV-negative person has a 1 in 160 chance of getting HIV each time they share a needle with an HIV-positive person.15 One in every 10 new HIV diagnoses occurs in an injection drug user.15

Injection heroin may also result in life-threatening bacterial and fungal infections.16

Did You Know?

HIV can live in a used syringe for up to 42 days.15

Other Health Effects of Injecting Heroin

The risks of injection drug use go beyond the risk of bloodborne disease transmission. Shooting heroin may cause:1,17–20

  • Infection of the veins.
  • Collapsed veins.
  • Varicose veins.
  • Clogged blood vessels from additives (e.g., sugar or powdered milk) in the heroin.
  • Hematoma (bleeding outside of blood vessels).
  • Track marks and other scarring.
  • Leg ulcers.
  • Abscesses (swollen, pus-filled tissue).
  • Cellulitis.
  • Deep vein thrombosis.
  • Tetanus.
  • Wound botulism, a potentially deadly injection.
  • Endocarditis (injection of the heart lining and valves).
  • Necrotizing fasciitis (death of the soft tissue).
  • Bone infections.

Injecting heroin may also increase the risk of deadly overdose, though overdose is a risk any time a person uses heroin, regardless of the method.21,22 The risk of overdose is very high when the drug is cut with another substance such as fentanyl, which often occurs without the user’s knowledge.15,23

Signs a Person is Injection Heroin

If you suspect someone you love may be shooting up, watch for the following:9

  • Needles or syringes.
  • Small orange syringe caps lying around.
  • Burnt spoons.
  • Errant shoelaces or rubber straps/bands (used to tie off injection sites).
  • Small cotton balls, Q-tips, or bits of cigarette filters.
  • Needle marks and/or track marks.
  • Skin infections or sores.

Also be on the lookout for odd behaviors such as wearing long sleeves even in very hot weather.9

Heroin Addiction Treatment

Heroin use disorder is a serious and progressive disease that can lead to early disease or death. Getting help can save your life or the life of someone you love.

Recovery First Treatment Center offers the programs needed to begin building a life in recovery. We offer various levels of care from medical detox to help alleviate the discomfort of withdrawal to inpatient rehab and outpatient programs. To learn about our treatment offerings and all of our facility’s features and amenities, call us at 954-526-5776 to speak to an admissions navigator today.

References

  1. National Institute on Drug Abuse. (2019). Heroin Drug Facts.
  2. Novak, S. P., & Kral, A. H. (2011). Comparing injection and non-injection routes of administration for heroin, methamphetamine, and cocaine users in the United StatesJournal of addictive diseases30(3), 248–257.
  3. Genetic Science Learning Center. (n.d.). Drug Delivery Methods.
  4. National Drug Intelligence Center. (2003). Heroin Fast Facts: Questions and Answers.
  5. Centers for Disease Control and Prevention. (2020). Heroin Overdose Data.
  6. Mars, S. G., Ondocsin, J., & Ciccarone, D. (2018). Toots, tastes and tester shots: user accounts of drug sampling methods for gauging heroin potencyHarm reduction journal15(1), 26.
  7. National Institute on Drug Abuse. (2018). Why does heroin use create special risk for contracting HIV/AIDS and hepatitis B and C?
  8. Peyrière, H., Léglise, Y., Rousseau, A., Cartier, C., Gibaja, V., & Galland, P. (2013). Necrosis of the intranasal structures and soft palate as a result of heroin snorting: A case seriesSubstance Abuse, 34(4), 409–414.
  9. Nationwide Children’s. (2011). Warning Signs That a Person Might be Using Heroin.
  10. Drug Enforcement Administration. (n.d.). Straw or Tube.
  11. National Institute on Drug Abuse. (2018). What are the long-term effects of heroin use?
  12. Burhan H, Young R, Byrne T, et al. (2019). Screening Heroin Smokers Attending Community Drug Services for COPD. Chest, 155(2), 279-287.
  13. Tashkin, D. (2019). Heroin Smoking and COPD: A Case for Targeted Screening Spirometry. Chest, 155(2), 247–248.
  14. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  15. Centers for Disease Control and Prevention. (2020). Injection Drug Use and HIV Risk.
  16. Centers for Disease Control and Prevention. (2018). People Who Inject Drugs (PWID).
  17. Centers for Disease Control and Prevention. (2018). Injection Drug Use and Wound Botulism.
  18. Irish, C., Maxwell, R., Dancox, M., Brown, P., Trotter, C., Verne, J., & Shaw, M. (2007). Skin and soft tissue infections and vascular disease among drug users, EnglandEmerging infectious diseases13(10), 1510–1511.
  19. Coull, A.F., Atherton, I., Taylor, A. et al. (2014). Prevalence of skin problems and leg ulceration in a sample of young injecting drug usersHarm Reduct J, 11, 22.
  20. Cornford, C., & Close, H. (2016). The physical health of people who inject drugs: complexities, challenges, and continuityThe British journal of general practice : the journal of the Royal College of General Practitioners66(647), 286–287.
  21. Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide.
  22. Liebling, E. J., Green, T. C., Hadland, S. E., & Marshall, B. (2018). Injection drug use and overdose among young adults who use prescription opioids non-medicallyAddictive behaviors76, 20–26.
  23. Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide.



About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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