Chronic use may cause collapsed veins, infection of heart lining and valves, abscesses, liver disease, pulmonary complications, and various types of pneumonia. Heroin causes depression of central nervous system (CNS), cloudy mental functioning and slowed breathing to the point of possible respiratory failure. A heroin overdose may cause slow and shallow breathing, convulsions, coma, and possibly death.

Heroin abuserstypically report feeling a surge of pleasurable sensation, a "rush." The intensity of the rush is a function of how much of the drug is injected and how rapidly the drug enters the brain and binds to the brains natural opioid receptors. Heroin is particularly addictive because it enters the brain so rapidly. With heroin , the rush is usually accompanied by a warm flushing of the skin, intense euphoria, dry mouth, and a heavy feeling in the extremities, which may be accompanied by nausea, vomiting, and severe itching.

There are a number of ways to ingest heroin. Heroin can be injected intravenously, intramuscularly, and it can be smoked or snorted. Black tar heroin, if snorted, is usually mixed with water and then snorted (referred to as “monkey-water).

Obvious indication of heroin use would be track marks (puncture marks from injections), slurred speech, nodding off, weight loss, bags under eyes, a pale appearance, pinned pupils (when pupils completely contract), and an obvious change in mood and health.

The potency of heroin seems to be a factor based on location. States closer to either border have higher grade (more heroin per 1/10 gram) heroin then those that are not. Heroin usually comes in two forms. A black tar like substance (named after its appearance) is usually available in states closer to the Mexican border and the white or slightly yellow powder form that is more readily available nationally. The difference between the two types of heroin is the potency. Black tar heroin usually consists of closer to 90% pure heroin while powdered heroin is, on average, 5-20% pure.

While heroin is socially stigmatized as one of the more dangerous and damaging drugs, it is actually safer then alcohol. The dangers involving heroin lie in the possibility of an overdose, hot-shots (bad batches that cause fatalities), intravenous drug use dangers (disease transmission, infection at injection site, abscesses), and gastrointestinal problems as a result of constipation caused by the heroin . An additional problem with street grade heroin is what is referred to as “cut” or “filler.” An accompanying chemical that is used to sell less heroin for more money. These “fillers” usually consist of baby laxatives and/or fentanyl. But, each heroin dealer decides what the heroin is “cut” with, which has resulted in numerous deaths. Although less physically damaging then alcohol, heroin is far more addictive and as a result usually leads to a quicker adoption of habitual use and the resulting penalties.

Detoxification from heroin can be extremely uncomfortable. Symptoms of withdrawal consist of: nausea, vomiting, diarrhea, low blood pressure, fever, runny nose, repeated yawning, bone pain, skin crawls, rotational thinking, depression and anxiety. While most heroin users seek a detoxification unit to come off the drug, the risk of death from an unaided heroin detox is very low and is usually caused by additional health problems.

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