The Symptoms, Signs, and Dangers of a Heroin Overdose

What Happens During a Heroin Overdose?

Overdose is one of the greatest risks of drug use, particularly with opioid drugs. If someone consumes enough heroin, the effects can overwhelm the body and poison it. The medical term for heroin overdose is heroin toxicity, or opioid toxicity.[3]

Opioids like heroin may cause a high, but they are depressant drugs that impact the area of the brain responsible for regulating breathing.[4] During a heroin overdose, breathing slows to a dangerous level, leading to full respiratory arrest and death.

Heroin has a high risk of overdose on its own, but when combined with other opioids or depressants like alcohol or benzodiazepines, the risks are staggering.

In addition, heroin has been illegal since 1924.[5] The only available heroin comes from illicit sources, which brings the purity into question. Manufacturers may cut or lace heroin with other substances, including potent and deadly fentanyl, leading to unpredictable effects.[6]

Fentanyl and Heroin Overdose

Heroin carries the risk of overdose on its own, but it’s often mixed with fentanyl – a synthetic opioid that’s up to 50 times more potent.[7]

Fentanyl is available in pharmaceutical and illicit forms, the latter of which is related to overdoses and the opioid epidemic. The drug is often added to other drugs like heroin to produce more intense effects. The result is that the drugs are cheap, powerful, and more addictive.[8]

People may abuse fentanyl, but it’s also laced into heroin and other drugs without the user knowing. Even small doses can be deadly.

A new threat is emerging with fentanyl-laced drugs as well. Xylazine, a livestock tranquilizer, is being discovered in illicit drug supplies in the US.[9] Combining xylazine with fentanyl – then with a drug like heroin – compounds the risks of overdose considerably.

Heroin Overdose Symptoms and Signs

Heroin overdose signs and symptoms can vary, but the telltale indicators are collectively referred to as the opioid overdose triad: respiratory depression, decreased level of consciousness, and pinpoint pupils.[10]

These aren’t the only signs of heroin overdose, however. Other symptoms may include:[11]

• Uncontrollable vomiting
• Limpness
• Drowsiness
• Loss of consciousness
• Choking or gurgling
• Labored breathing
• Slowed pulse
• Low blood pressure
• Pale or blue skin (cyanosis)
• Respiratory arrest
• Unresponsiveness, even with painful stimuli like a sternal rub

Heroin Overdose Risk Factors

Overdose is a risk anytime you use heroin – even for the first time. Heroin overdose is more likely to occur in certain groups or situations, however, such as:

• Young adults
• Males
• People with a history of overdoses
• People with medical conditions like depression, HIV, cardiovascular issues, liver problems, or respiratory problems
• IV heroin use
• Polydrug use (using heroin with other substances)
• Escalating the dose of heroin
• Using heroin after a period of abstinence[12]

Heroin combined with other drugs increases the risk of overdose in general, but overdose is more likely – and complex to treat – when heroin is combined with depressants like alcohol or benzodiazepines.[13]

How to Respond to a Heroin Overdose

A drug overdose is a medical emergency. If you suspect someone is overdosing, call 911 immediately to get emergency services. Wait with the person until medical personnel arrive and try to keep them awake, monitoring their breathing and providing naloxone if available. If they’re unconscious, turn them on their side to avoid choking if they vomit.

If you’re concerned about legal issues, virtually all US states have Good Samaritan laws that protect the person reporting the overdose and the person overdosing from prosecution.[14]

Naloxone is also widely available without a prescription in many states, which can reverse an opioid overdose.[15] If you have naloxone on hand, administer it immediately. It may take more than one dose of naloxone, especially if heroin is mixed with other opioids like fentanyl.[16]

Heroin Addiction Treatment

Heroin is a highly addictive substance that produces intense euphoria followed by a severe crash, compelling repeated use. Over time, people develop a tolerance and increase their dose or frequency, and addiction occurs.

The official term for heroin addiction in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is opioid use disorder (OUD), which includes the following criteria:

• Using heroin in higher doses or for longer periods than intended
• Spending time sourcing, using, or recovering from heroin use
• Trying to cut back or stop heroin use without success
• Experiencing strong cravings for heroin
• Continuing to use heroin despite problems with work, home, or school
• Failing at responsibilities in day-to-day life
• Giving up activities or hobbies once enjoyed
• Gaining a tolerance to the effects of heroin
• Experiencing withdrawal when cutting back or stopping heroin use[17]

Heroin abuse or addiction increases the risk of overdose, but withdrawal can be an extremely uncomfortable experience. People who go through opioid withdrawal may relapse just to relieve the effects.

Because of the risks and discomfort of heroin withdrawal, medical detox is often the best start to seeking help for heroin addiction. Medical detox allows you to withdraw from heroin under the supervision of a medical team to keep you safe and comfortable.

Detox is just one part of the process, however. Once detox is complete, you can enter an inpatient or outpatient treatment program with therapies like group and individual counseling, peer groups, and behavioral therapies.

Heroin addiction treatment is effective when it includes behavioral and medication therapy. Medications such as methadone, buprenorphine, and naltrexone are ideal for treating withdrawal symptoms and cravings, aiding in the treatment of physical addiction. [18]

Behavioral therapies like cognitive behavioral therapy (CBT) and contingency management are evidence-based approaches that focus on the motivations and behaviors involved in drug use.[19] CBT modifies behavior by helping you identify the thoughts and patterns that influence drug use while contingency management encourages abstinence with a rewards-based system.