In 2020 over 900,000 people in the United States of America used heroin, up from 745,000 in 2019.1 Additionally, over 47,600 people died from an opioid overdose, which includes heroin overdose, in 2017.2 It is plausible this number is even higher, given that many people don’t report overdoses. Knowing the signs and symptoms of a heroin overdose can empower you to seek emergency medical care for yourself or someone else as well as use naloxone (Narcan) if available.
In this article:
- Signs of Heroin Overdose
- Risk Factors for Heroin Overdose
- How to Prevent a Fatal Heroin Overdose
- Treatment for Someone Who Has Overdosed on Heroin
- Transitioning into Rehab After an Overdose
Signs of Heroin Overdose
A heroin overdose involves taking a toxic amount of heroin that your body and brain cannot handle, leading to dangerous and potentially life-threatening consequences. When someone overdoses on heroin or another opioid, they will experience profound respiratory depression, characterized by slowed, stopped, or irregular breathing and heart rate.
The signs and symptoms of a heroin overdose may include:<sup.3,4
- Pale face
- Clammy skin
- Limp body
- Blue/purple fingernails or lips
- Gurgling or choking noises
- Unable to be awakened
- Unable to speak
- Shallow or stopped breathing
- Slowed or stopped heartbeat
Overmedication, a state that can occur before an overdose, can be an early sign of a heroin overdose. But recognizing these early signs could help you get help for your or someone else before the situation worsens.
Symptoms you could experience before a heroin overdose include:3
- Unusual drowsiness or sleepiness
- Slurred speech
- Behavior consistent with intoxication
- Extremely small or “pinpoint” pupils
- Slower than normal heartbeat and breathing
- Lower than average blood pressure
- Difficulty waking
Call 911 immediately if you suspect you or someone else has overdosed on heroin or another opioid like fentanyl.
Risk Factors for Heroin Overdose
Although an overdose on heroin can happen any time someone uses heroin, many things can increase your risk of experiencing a heroin overdose, including:4
- Long-term use of heroin or misuse of opioid painkillers
- Reduced tolerance due to a period of abstinence (such as incarceration or detox)
- Change in quality or purity of heroin
- Mixing heroin with other opioids, alcohol, or benzodiazepines
- Mixing heroin with stimulants like cocaine
- Comorbid health conditions, such as poor nutrition, a weak immune system, heart problems
- History of surviving a past overdose
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You may develop a tolerance when you take heroin regularly. This is because as your body becomes used to heroin, it may need a larger amount or more frequent use to receive the same effect.3 However, your tolerance may decrease after a period of abstinence, such as going to rehab or prison/jail. When this happens, the same amount of heroin that used to be effective becomes too much, and an overdose can happen.
Change in Quality or Purity of Heroin
Given that heroin is man-made, there are natural differences between each batch. Frequently, heroin is cut with other substances, a common substance being fentanyl. Fentanyl is an extremely potent and dangerous opioid, increasing the risk of overdose.4
Additionally, cocaine or pressed pills are added to heroin, which can change the quality and purity of heroin.4
Mixing Heroin with Other Drugs
Heroin is typically mixed with other substances, and adding more substances can increase the effects of the heroin. Also, heroin is a depressant drug, so adding other depressants, such as alcohol, benzodiazepines, and other opioids, intensifies respiratory depression and the risk of overdose.
Comorbid Health Conditions
When you or your loved one has an existing health condition, the impact of heroin can be even more detrimental. If your body is not performing to the best of its ability, it may not be able to properly metabolize the substance leading to adverse reactions, such as increased intoxication.
How to Prevent a Fatal Heroin Overdose
Although you have a risk of overdose each time you use heroin, you can apply multiple strategies to prevent a fatal overdose, like:1
- Carrying naloxone
- Using while someone else is around
- Calling or letting someone know before you use
- Using in a semi-public location
- Starting low and going slow
- Using heroin without mixing with other opioids or substances
Naloxone, also known as Narcan, is a medication that temporarily reverses the life-threatening effects of opioids. In many states, it is available at any pharmacy without a prescription.5 Naloxone is covered by most insurances, so it may cost you little to nothing. Start by asking a pharmacist near you, your primary care physician, needle exchange programs, or other community organizations that specialize in opioid treatment.
Treatment for Someone Who Has Overdosed on Heroin
Although a heroin overdose can be life-threatening, receiving emergency medical care make the difference in saving a life. For those experiencing symptoms of a heroin overdose, naloxone can buy them much-needed time while waiting for first responders to arrive. When this medication is administered, it counteracts the effects of the heroin, placing them into immediate withdrawal. The administration of naloxone quickly restores normal respiration. Naloxone is administered either through injection or nasal spray.6
If you have administered naloxone, call 911 immediately, as naloxone is typically only active within someone’s body for approximately 30 to 90 minutes. The effects of naloxone can wear off, and the individual who received the naloxone may begin to overdose again. You should continue to monitor this person until emergency responders have arrived.2
Another key factor for administering naloxone is that it may require more than one dose. If you have administered naloxone and do not see improvement, additional doses can be repeated every two to three minutes.2
Dos and Don’ts of Treating an Opioid Overdose
If you suspect someone is in the midst of an overdose, call 911 immediately.
Things to do are:3
- Attend to their breathing
- Provide rescue breaths and/or chest compressions as needed
- Administer naloxone if available, and administer additional doses as needed
- Help the person into a “recovery position” on their side
- Stay with the person and keep them warm
- Shout, rub your knuckles on the center of their chest, lightly pinch if they are not easily waking
Things not to do are:3
- Leave the person alone
- Slap or forcefully try to stimulate the person
- Put them in a cold shower or bath
- Inject or give them anything other than naloxone
- Try to make them vomit, as they can choke or inhale the vomit into their lungs
Treatment, including detox and rehab, is an excellent option after a heroin overdose. If someone you love has overdosed and received services at a hospital, it is a great place to begin their treatment journey, as they can likely transition straight from the hospital to a treatment facility.
Transitioning into Rehab After an Overdose
While everyone who experience a heroin overdose is not necessarily addicted to this opioid, it can be a strong indicator of addiction. At the hospital, once the person who has overdosed has been stabilized, the treatment team may conduct an assessment to see if they could benefit from heroin addiction treatment. If they diagnose a heroin addiction, they will refer to the patient to an appropriate level of care.
Treatment will likely begin with detox, which will likely include medications to help manage your discomfort as your body adjusts to no longer having heroin. These medications include:7
- Methadone: A full opioid agonist that relieves heroin withdrawal symptoms and cravings without producing a high
- Buprenorphine: A partial opioid agonist that alleviates withdrawal and cravings without causing a euphoric rush
- Clonidine: An adjunctive medication that can treat rapid heart rate and sweating
After you have gone through detox, you will likely begin inpatient treatment. During inpatient treatment, you may be given relapse prevention medications (e.g., methadone, buprenorphine, naltrexone). In addition to medications, inpatient treatment will include:
- Individual therapy
- Group therapy
- Family therapy
During these various therapy sessions, you will:8
- Learn more about heroin addiction
- Learn about your triggers
- Be able to solely focus on recovery
- Form new habits and practices that do not involve substance use
- Learn new coping and stress management skills
- Learn new skills to cope with cravings
- Develop techniques to improve communication and relationships
- Learn ways to prevent relapse
Types of Therapy
Your therapy will include various techniques to assist you with your goals. These addiction therapies include:
- Cognitive Behavioral Therapy (i.e., focused on addressing thoughts, emotions, and behaviors and their influence on each other)
- Contingency Management Interventions (i.e., receiving a momentary award for achieving a goal)
- 12-Step Facilitation Therapy (e.g., Narcotics anonymous)
Once inpatient rehab has been completed, treatment does not stop. Your treatment provider will help develop an aftercare plan. This aftercare plan can include:
- Intensive outpatient treatment (i.e., multiple hours multiple days a week)
- Outpatient treatment (i.e., individual and/or group therapy 1-2 times a week)
- Sober living facility (e.g., living with other individuals who are in recovery)
- Community-based treatment (i.e., support groups like narcotics anonymous or SMART Recovery)
- Substance Abuse and Mental Health Services Administration. (2020). Opioid overdose.
- National Institute on Drug Abuse. (2021) Naloxone for opioid overdose: Life-saving science.
- Substance Abuse and Mental Health Services Administration. (2018). Opioid overdose prevention toolkit: Opioid use disorder facts.
- Commonwealth of Massachusetts. (2022). Opioid overdose risk factors.
- Prevent and Protect. (2022). Where to get naloxone.
- Substance Abuse and Mental Health Services Administration. (2018). Opioid overdose prevention toolkit: Recovering from opioid overdose.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment.
- National Institute on Drug Abuse. (2020). Principles of drug addiction treatment: A research-based guide (Third edition)