The University of Arizona

Health Consequences of Illicit Drug Use
Health Effects of Heroin :
Medical Complications

As with other drugs, the medical complications of heroin may vary depending on the individual, frequency of use, amount of dosage, and/or prior medical attributes.


Heroin use can lead to addiction, a chronic relapsing problem attendant to repeated drug use that has the potential for causing neurochemical and molecular changes in the brain as well as instigating behavior change.[1]


Withdrawal symptoms are most noticeable between 24 and 48 hours after the last dose of heroin and can include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and leg movements.  Users sometimes describe withdrawal as being similar to a bad case of the flu.  The symptoms usually subside after a week but there has been evidence showing that the symptoms may be persistent for many months.[1,2]  Heroin users rarely die from withdrawal.

Cognitive Functioning

Chronic use or abuse of heroin can lead to long lasting and deleterious impairments on intellectual functioning.[3-5]  The negative effects on brain functioning may include a decrease in working memory, episodic memory, and decision making.[3,4]  In addition, active heroin addicts may exhibit poor impulse control, planning, decision making, verbal functioning, and visual-spatial analysis.[3,5]

Injecting-Related Problems

Injecting is a particularly common route of administration among heroin users.  This is a concern because additives in street heroin may not dissolve readily.  As a result, injecting heroin can contribute to the clogging of the blood vessels that lead to the lungs, liver, kidneys, and brain.[2]  Collapsed veins, cellulitis, and abscesses are common problems among chronic injection heroin users.[6]  In Arizona, most of the heroin used is a dark gummy form of the drug called black tar heroin.  This form of the drug may be especially problematic because it is less refined and cheaper than white powder heroin and is frequently mixed with different adulterants such as dextrose, burned cornstarch, instant coffee, and sometimes dirt.  As a result of the mixing process, bacterial spores may be introduced to the final product.[7]  In addition, since black tar heroin is predominantly injected, repeated IV injections can cause vascular sclerosis and lead the injectors to inject subcutaneously or intramuscularly.  As a result, a series of infections grouped as necrotizing fasciitis can form and become lethal.[6]

Smoking-Related Problems

Some short term effects associated with heroin smoking (inhaling heroin vapors) may include leukoencephalopathy, reduced pulmonary function, dyspnea, and status asthmaticus.[8]


Poor health of heroin users and the depressing effects heroin causes on respiration are contributing factors to pulmonary complications including various types of pneumonia.[2]

Immune System

Recent studies have reported that peripheral immunomodulatory functions are influenced by opiates.  Exogenous opiates, such as heroin, tend to repress diverse immune functions.  The depression of the immune system along with poor nutritional status, intravenous drug use, poly drug use, and unsanitary housing can lead to the problems of cutaneous and systemic infections often seen in heroin users.[9]


Along with abscesses and cellulitis, endocarditis is also reported in injection drug users (IDUs) abusing heroin.  Endocarditis predominantly appears on the right side, often involving the lungs.[9]

Infections of the Liver

The risks for acquiring hepatitis B, C, and A are increased in heroin users who administer the drug intravenously.  In general, hepatitis B and C may occur due to sharing of contaminated drug injecting equipment.  Hepatitis A, which is typically transmitted in the general population by the normal fecal-oral route, may be transmitted among heroin users due to poor hygiene in the preparation of the drug.[9]

Blood born viruses

HIV is also a serious concern, particularly among injection drug users.  Sharing of needles, along with other injecting equipment and an increase in risky sexual behaviors (e.g. prostitution) contribute to the transmission of HIV.[9]



  • (1) NIDA. Heroin: Abuse and Addiction. Rockville, MD: NIH; 2005 May.
  • (2) NIDA. Heroin. Rockville, MD: NIH; 2006 May.
  • (3) Wang JH, Liu XF, Chen YM, Sun HY, Fu Y, Ma MX, et al. Heroin impairs map-picture-following and memory tasks dependent on gender and orientation of the tasks. Behavioral Neuroscience 2007 Aug;121(4):653-64.
  • (4) Ornstein TJ, Iddon JL, Baldacchino AM, Sahakian BJ, London M, Everitt BJ, et al. Profiles of Cognitive Dysfunction in Chronic Amphetamine and Heroin Abusers. Neuropsychopharmacology 2000 Aug;23(2):113-26.
  • (5) Prosser J, Cohen LJ, Steinfeld M, Eisenberg D, London ED, Galynker II. Neuropsychological functioning in opiate-dependent subjects receiving and following methadone maintenance treatment. Drug and Alcohol Dependence 2006 Oct 1;84(3):240-7.
  • (6) Dunbar NM, Harruff RC. Necrotizing fasciitis: manifestations, microbiology and connection with black tar heroin. Journal of Forensic Science 2007 Jul;52(4):920-3.
  • (7) Kimura AC, Higa JI, Levin RM, Simpson G, Vargas Y, Vugia DJ. Outbreak of necrotizing fasciitis due to Clostridium sordellii among black-tar heroin users. Clinical Infectious Diseases 2004;38:87-91.
  • (8) Darke S, Kaye S, Duflou J. Cocaine-related fatalities in New South Wales, Australia 1993-2002. Drug and Alcohol Dependence 2005 Feb 14;77(2):107-14.
  • (9) Theodorou S, Haber PS. The medical complications of heroin use. Current Opinion in Psychiatry 2005;18(3):257-63.


  • ="Health
    Health Effects of Heroin
  • ="Long-
    Long- and Short-Term Effects of Heroin
  • ="Opiates
    Opiates in the Brain