What Parents Need to Know About Teen Heroin Use

Drug paraphernalia with blurred teen sitting in background

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Heroin is a growing problem among adults. According to the National Survey on Drug Use and Health (NSDUH), heroin use has been on the rise since 2007. In 2020, 907,000 people reported using heroin in the past year. The greatest increase in use was in 18- to 25-year-olds. In teens, heroin use has been on the decline. Less than 1% of teens in eighth, 10th, and 12th grades reported recent use.

The effects of heroin are grave. Though use of heroin among youth is less than other illicit drugs, because of the uptick in young adult usage, parents need to be aware of it.

What Is Heroin?

Heroin is also called by the slang terms "smack," "skunk," "junk," "H," "horse," "skag," "brown sugar," and "white horse." It is an addictive opioid drug that comes from morphine, a drug derived from Asian opium poppy seed pods. It is usually in the form of a black tar-like substance (giving rise to the "black tar heroin" name), or a brown or white powder.

Heroin is sometimes mixed with other substances, like cocaine or alcohol (known as a "speedball"). These combinations increase the risk of overdose.


Traces of Fentanyl have been found in heroin. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. The presence of Fentanyl in heroin makes overdosing more likely. Unfortunately, it is not always possible to know if the drug is laced with Fentanyl.

How Heroin Is Used

Heroin can be injected, smoked, and snorted for a high. Most commonly, it is mixed with water and injected into a vein with a needle. Because it goes directly into the bloodstream when injected, or to the brain when snorted, the effects of heroin are felt almost instantly.

Because there are opioid receptors in the brain, spinal cord, lungs, and intestines, heroin use can result in a myriad of physical sensations in the body. These receptor locations are also what makes heroin use so dangerous.

Mu-opioid receptors are naturally present in the body. They work by binding to natural pain-killers called endogenous endorphins and enkephalins. Drugs that act on these receptors, like heroin and other opioids, can cause addiction, drowsiness, and breathing difficulty.

Some of the physical effects of heroin include:

  • Feelings of euphoria
  • Drowsiness and lethargy
  • Dry mouth
  • Warm, flushed skin
  • Nausea and vomiting
  • Itching
  • Moving in and out of consciousness

Regular heroin use impacts the functioning of the brain. The drug is highly addictive. When a person uses heroin regularly, their tolerance of the drug increases, and they depend on the drug to avoid withdrawal.

Signs of Heroin Use

When someone is using heroin, there are telltale signs to watch for. One of the most obvious is "track marks"—marks on the skin where the needle went in. Teens who use heroin may begin wearing long sleeves all the time to cover up these marks, even when it's warm. Other signs of heroin use can include:

  • Thinking and moving slowly
  • Extreme sleepiness
  • Feeling very happy
  • Very small pupils

These signs indicate being actively affected by the drug. Other signs can indicate withdrawal, such as:

  • Pain in bones and muscles
  • Chills
  • Vomiting
  • Insomnia
  • Anxiety
  • Itchiness

Signs of Overdose

Heroin can reduce a person's respiratory rate. Sometimes it may cause a person to stop breathing completely. Heroin overdoses happen because people are unable to tell the strength of the drug until they have taken it. It can also happen because, as a person's tolerance increases, they need to increase their dose to attain the same high.

Call 911 immediately if you notice the following signs:

  • Slow breathing
  • Unable to wake
  • Slow or stopped heart rate
  • Blue lips and fingernails
  • Clammy skin
  • Unable to speak
  • Shaking

Risk Factors for Heroin Use

Heroin is not just a problem in urban communities—it is an increasing issue in suburban and rural communities, as well. No matter who you are or where you live, using heroin just one time puts you at risk for heroin addiction. Researchers have also noted that there are some things that put people at greater risk of heroin addiction.

  • Existing addiction to painkillers
  • Existing addiction to other illicit drugs or alcohol
  • Uninsured or on Medicaid
  • Non-Hispanic White people
  • Males
  • Living in a metropolitan area
  • Ages 18 to 25

The number of 12th-grade students who say that heroin is easy to obtain is declining. In 2019, 16% of students said that they could easily obtain heroin, compared to 35% in the mid-1990s.


Heroin can cause immediate and long-term complications. How heroin affects the body depends on a number of factors, including how the drug is taken, how much is taken, what is mixed with the drug, and how rapidly the drug binds to opioid receptors.

In the short term, the biggest risk with heroin use is overdose. Opioids change neurochemical activity in the brainstem that controls breathing and heart rate. These changes can be deadly. Immediate complications from heroin can include:

  • Addiction
  • Slowed heart function
  • Severely slowed breathing
  • Coma
  • Brain damage
  • Death

According to National Survey Results on Drug Use 1975-2020, 81% of 12th-graders believe that heroin poses a great risk of harm from regular use. Fewer—63%—believe it poses a great risk if used once or twice.

When asked about whether they approved of heroin use, 96% of high school seniors said they disapproved of experimental use.

In the long term, the most profound risk with heroin is dependency. Heroin activates the reward center of the brain, releasing dopamine. Dopamine reinforces the drug-taking behavior. Over time, a person's tolerance to the drug builds and they must take more of it to feel the same effects. When someone tries to stop using, their body may experience withdrawal symptoms that are so severe that obtaining and taking the drug takes over their life. Long-term complications from heroin include:

  • Changes in the brain
  • Impaired decision-making abilities
  • Impaired behavior-regulation
  • Tolerance to the drug
  • Dependency on the drug
  • Withdrawal
  • Heroin use disorder, characterized by chronic relapsing and drug-seeking no matter the consequence

Heroin Withdrawal

Heroin withdrawal symptoms include body pain, insomnia, chills, restlessness, vomiting, and diarrhea. Severe symptoms peak within a day or two after the last dose and usually subside within a week. However, some people experience symptoms of withdrawal for months.

In addition to overdose and dependency, heroin can lead to the following health complications:

  • Insomnia
  • Constipation
  • Lung problems
  • Mental illness
  • Sexual and menstrual disorders
  • Collapsed veins
  • Infections of blood vessels and soft tissues
  • Hepatitis B and C
  • HIV

If your teen has an addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.


Opioid overdoses are treated by administering a medication, Naloxone, that reverses the effects of opioids. Naloxone works by binding to opioid receptors, preventing the opioid from activating them. Naloxone is very effective and you do not need to be a medical professional to administer it. The use of this medication can buy time until medical assistance can arrive.

Heroin use disorder is treated with medication and behavioral therapies. Medications are aimed at easing withdrawal symptoms. These medications work through the same opioid receptors, but they are safer to use.

  • Methadone: Taken orally to reduce withdrawal symptoms
  • Buprenorphine: Taken orally, by implant, or by injection to reduce withdrawal symptoms
  • Naltrexone: Injected monthly to block opioids

Behavioral therapies may be done on an inpatient or outpatient basis. Cognitive-behavioral therapy teaches people coping skills and techniques to manage stress. Contingency management uses a reward-based system to reinforce healthy choices.

A Word From Verywell

If you suspect that your teen may be using heroin, you may be feeling scared. Try to stay calm as you do a little detective work. In addition to the physical signs of heroin use, pay attention to your child's behavior for other clues that may indicate drug use. Teens who use drugs often show other signs like a change in friends, mood swings, secrecy, depression, and poor hygiene.

Have a conversation with your child and recruit other people to support you. Don't ignore warning signs. Seek help from your child's doctor or mental health professional.

14 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  5. University of Michigan. Body’s natural pain killers can be enhanced.

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  8. Centers for Disease Control and Prevention. Today’s heroin epidemic.

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By Denise Witmer
Denise Witmer is a freelance writer and mother of three children, who has authored several books and countless articles on parenting teens since 1997.