Signs of Heroin Overdose

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Overdose of heroin is a life-threatening emergency. According to the Centers for Disease Control and Prevention (CDC), opioid-involved overdose deaths rose from 21,088 in 2010 to nearly 47000 in 2018 in the U.S. 

Recent improvements in death certificate reporting, including drug overdose deaths, have publicized that the number of deaths is significantly higher than expected, representing an alarming situation.

As a family member, spouse, bystander, or friend, can the signs of a heroin overdose be spotted? According to the National Institute on Drugs, as more and more Americans are moving from overdosing and misusing prescription drugs to heroin, the chances of seeing a live drug overdose are increasing. Hence, it is essential to familiarize yourself with the signs of heroin overdose so that you can play your role in saving a life if the need arises.

Heroin Overdose Statistics

Heroin overdose in the U.S. rose sharply, but since 2016 the number of deaths has trended down by almost 7% between 2019 and 2020. Statistics from 2020 represents that:

  • There were almost 20% of fatal opioid overdoses involved heroin
  • Heroin was responsible for more than 13,000 fatal overdoses

What is a Heroin Overdose?

Overdose (OD) is when someone takes too much substance, usually a drug. An overdose of heroin may cause harmful, serious symptoms or even death of a person. Opioid toxicity occurs when someone consumes opioids in large quantities than are physically tolerated. Heroin and other opioids slow down many of the body’s vital functions and affect many areas of the brain, such as central nervous system communication and difficulty in regulating respiratory rate. Also, high enough doses can result in dangerously slowed breathing if taken too quickly. 

Opioid-induced respiratory depression is the primary cause of overdose death, accounting for the current global opioid crisis. When a person consumes heroin or other opioids together with certain other substances, including benzodiazepines and alcohol, the risk of toxicity and overdose may rise.

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Additionally, heroin is an illicitly manufactured drug and is highly addictive in nature. Even if heroin becomes easier to obtain, the purity can vary depending on the source. Manufacturers may include the impurities, cut or lace heroin with other substances, including fentanyl, to increase the potency or cut production costs. Consuming this type of illicit opioid combination can cause significant risk to anyone who thinks they are merely using heroin.

Symptoms of Heroin Overdose

Heroin, being a depressant, makes a person sleepy. Medical professionals suggest the more prominent signs of a heroin overdose as the opioid overdose triad. The typical symptoms seen in opioid overdose include decreased level of consciousness, respiratory depression, and pinpoint-sized pupils. However, a heroin overdose may also show other signs and symptoms in different parts of the body.

Airways and lungs

  • Shallow breathing
  • Slow and difficult breathing
  • No breathing

Eyes, Ears, Nose, and Throat 

  • Extremely small pupils, sometimes as small as the head of a pin (pinpoint pupils)
  • Dehydrated mouth
  • Tongue discoloration

Heart and Blood

  • Weakness of pulse
  • Hypotension or low blood pressure

Stomach and intestines 

  • Spasms of the stomach and intestines
  • Constipation


  • Bluish discoloration of the nails and lips

Nervous System 

  • Delirium (confusion)
  • Coma (lack of responsiveness)
  • Disorientation
  • Uncontrolled muscle movements
  • Drowsiness

Heroin Overdose Causes & Risk Factors

Heroin overdose can happen to those who are using it for the first time and may also occur among certain people in specific situations. The following are some common examples of people who are at high risk: 

  • Male gender.
  • Those in the relatively younger age (i.e., between the ages of 20 and 40).
  • Those having severe medical and/or mental health conditions, including HIV, depression, kidney or liver problems, and breathing issues.
  • Those who have experienced prior overdoses.
  • Using heroin with one or more other drugs.
  • Those who use heroin intravenously.
  • Those who escalate their doses of heroin.
  • Those who use heroin after a period of abstinence when opioid tolerance has declined significantly.

People who are addicted to heroin also use other drugs, and these kinds of combos increase the risk of an overdose in them. While heroin poses a danger on its own, mixing it with other CNS depressant substances such as alcohol or benzodiazepines can increase the risk of an overdose and serious health issues.

Heroin Overdose Treatment

Heroin overdoses pose a significant risk to people in the U.S., which is why many face grave consequences and even death. In these situations, medical professionals work hard to stabilize the condition of a person with supportive care; therefore, if an individual comes into the ER suffering from a heroin overdose, they are treated immediately on the highest priority.  First of all, professionals note breathing since an overdose is characterized by slow breathing. Assisted ventilation and assiduous airway management might be necessary for those who are not breathing and need enough air to survive. In the emergency room, blood tests are essential to gain information about other substances in a person’s system as well since it helps doctors to rule out other issues that may be disturbing their current condition.

Overdose symptoms can return if naloxone has already been given and its effect wore off, and in such situations, more naloxone can be administered. When administered during an opioid overdose, naloxone knocks opioids off their receptors to reverse overdose symptoms. As opioid overdose symptoms fade, specialists monitor them for at least 6-12 hours in the hospital to maintain stable vital signs.

Since naloxone only provides temporary treatment, withdrawal symptoms may begin immediately when naloxone is administered to those physically dependent on opioids. Sometimes, the unpleasant nature of acute opioid withdrawal can bring aggression and anxiety in some, while others may experience a wide range of emotions like embarrassment, anger, shame, gratitude, and guilt. Along with the medical providers, the support of family and friends can help their loved ones to deal with such situations. Recovery and support resources are available for those with substance use disorder that can help people get the support they need to live healthier lives.

Outlook (Prognosis)

People can recover from an acute overdose within 24 to 48 hours by giving a specific antidote. However, adulterants are deliberately added to heroin to increase the bulk and enhance the pharmacological effect which can result in more significant health risks and organ damage. A hospital stay and consultation with doctors are essential to get the proper treatment.

In addition, some people may inhale or breathe fluids into their lungs if their breathing has been affected for a long time, which can lead to coughing, discomfort, pneumonia, and other lung complications. Individuals can also develop crush injuries to their skin and underlying tissue by remaining unconscious for long periods, and lying on hard surfaces may lead to infection, skin ulcers, and deep scarring. Injecting drugs through a needle can cause systemic complications and severe infections and can lead to abscesses of the brain, kidneys, lungs, or even heart valve infection. As heroin users might share needles with others, they are also prone to developing issues that can lead to HIV infection, hepatitis, and AIDS. (People usually inject heroin in their veins to get the desired results.) 

Heroin Addiction Treatment

Heroin is a very dangerous, addictive, and illicit opioid drug that acts as a depressant. This is why, after a sustained period, a person may develop significant opioid dependence. When an individual has been physically dependent on any substance, their brain is adjusted to regularly having a certain level of this substance in their system.  Since opioid use disorder is commonly linked with dependence and heroin is a highly addictive substance, treatment often begins with professional medical detox. 

Medically supervised detox, also referred to as withdrawal management, helps people withdraw from heroin under the care and guidance of medical specialists.  Detox is usually safe and comfortable and is typically completed through medications such as methadone or buprenorphine.  These medications minimize and eliminate withdrawal symptoms and cravings and help in completing the detox process.

However, detox should be followed up with an additional treatment to achieve long-term recovery, as it alone would not create long-term change. After discharge from detox, different types of treatments are available that help people on the path to recovery. These treatments consist of the following.

Inpatient rehab

An inpatient or residential rehab setting requires patients to admit themselves for several weeks to months in a controlled environment to address substance use disorder that may be causing them difficulty. During this time, patients stay in a residential treatment center, receiving behavioral therapy in both group and individual settings with complete medical care and emotional support. In inpatient treatment, patients heal their minds and bodies and are not allowed to contact the outside world unnecessarily. Inpatient rehab helps patients focus on getting well without the distraction of everyday life and readjust their lives without heroin or other substances.

Outpatient rehab

Outpatient treatment is generally considered to be less restrictive than an inpatient program. Different levels of outpatient care allow the freedom to continue working and caring for the family while recovering. An outpatient rehab program offers treatment sessions for a severe addiction to certain substances like heroin and support groups that can be attended throughout the week. Scheduled and clinic-based group and individual counseling sessions are introduced to patients to allow them to practice the learned session outside the world and live a happy and healthy life.

Behavioral therapy

Group, family, and individual therapy sessions can help patients identify and change potentially self-destructive and unhealthy behaviors. People learn to address underlying issues and communicate more effectively and understand how to strengthen their sobriety, prevent relapse and cope with stressors and triggers.

Medication-assisted treatment (MAT)

MAT is the use of medications such as buprenorphine, methadone, and naltrexone in combination with behavioral and counseling therapies, which is effective in treating opioid use disorders and can help people manage cravings, sustain recovery and reduce their likelihood of relapse. These medications can be used for long periods or even indefinitely to help individuals maintain their hard-earned recovery.


What is the role of fentanyl in heroin overdose?

Heroin is usually adulterated with fentanyl since it is 30-40 times more potent than heroin. Those who OD on fentanyl start feeling sleepy at first, but after a few minutes, they become so lost in their sleep that it’s nearly impossible to wake them up. Since fentanyl is easier and cheaper to manufacture, many people sell fentanyl-laced heroin or even pure fentanyl by disguising it as ‘strong heroin.’ This is why the number of deaths due to fentanyl OD has been rising sharply since 2014.

It’s gnarly impossible to differentiate between pure heroin or heroin that has been mixed with fentanyl, making it easier for people to take enough fentanyl to experience a deadly overdose. Also, owing to its rapid-onset and potent effects, it can be pretty difficult to manage this kind of overdose rather than others and may even require intensive care.

What information should you have ready before calling for medical help?

To seek medical help for people who have overdosed on heroin, the following information is necessary:

  • The amount of heroin a person took if known
  • The time of overdose
  • The age, weight, and condition of the individual

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