Heroin addiction signs: what families notice, the harms and the risks of injecting

What are the signs of heroin addiction, and how can you tell if your son or husband is using?

The most common heroin addiction signs families notice are heavy drowsiness at the wrong times, as if the person keeps "nodding off" while sitting up, very small pupils, and slow, foggy thinking. Over time come withdrawal from the family, secrecy, repeated requests for money and things going missing from the house. When the person goes too long without the drug, they may look as if they have a bad flu: runny nose, watery eyes, yawning, sweating, aching muscles, poor sleep and diarrhea. No single sign is enough to be sure, but several signs together, again and again, are a good enough reason to worry and to ask for help.

Heroin is a drug from the opioid family. In Egypt it is often called "el-bodra" (the powder), while in Lebanon, Morocco and Iraq people simply call it heroin. But street names are not precise: "el-bodr" may also be used for other drugs, and a name does not tell you what a drug really contains. The US National Institute on Drug Abuse (NIDA) describes it as a highly addictive opioid. Families often feel its effects before the person is ready to admit anything.

What might a mother or wife notice at home?

Very often a mother or a wife is the first to sense that something has changed. These are signs listed by NIDA and the MedlinePlus medical encyclopedia, grouped the way you might see them:

Signs in the body and face

• Drowsiness lasting for hours after use, heavy arms and legs, slow movement and clouded thinking.
• Very small, pinpoint pupils.
• Flushed or warm skin, a dry mouth, severe itching, and sometimes nausea or vomiting.
• Ongoing constipation, poor or broken sleep, and neglecting food and appearance.
• If he injects: scarred veins, or abscesses and skin infections.

Signs in behavior and daily life

• Isolating and keeping away from the family, with new friends he does not introduce to you.
• Secrecy and lots of excuses, and irritability or aggression when you ask about drug use.
• Slipping at work or in studies, frequent absences, and losing interest in things he used to enjoy.
• Constantly asking for money, new debts, or cash and valuables disappearing from the house.

Signs of physical dependence

Once the body depends on opioids, withdrawal symptoms appear whenever the next dose is late: anxiety and restlessness, aching muscles, a runny nose and watery eyes, yawning and sweating, then stomach cramps, diarrhea, nausea, goosebumps and wide pupils. MedlinePlus notes that heroin withdrawal usually starts within 12 hours of the last use. If you notice he gets "sick" and then suddenly seems fine again after a short trip out, this may be a repeating pattern of withdrawal and use. You can read more in our article on heroin withdrawal symptoms and medically supervised treatment.

Is heroin addictive the first time, and why does overdose risk grow?

Not everyone who tries heroin once becomes addicted that same day, but it is one of the most addictive drugs, and the danger starts with the very first use: it slows breathing and heart rate, and NIDA explains that this slowing can become life-threatening.

With repeated use comes tolerance: the body gets used to the drug, so the person needs more to feel the same effect. Then comes physical dependence, so withdrawal appears when they stop. Addiction goes further still: MedlinePlus describes it as a chronic brain disease that drives a person to seek and use the drug compulsively despite the harm it causes them.

Heroin health risks: harms to the body and the dangers of injecting

NIDA lists harms that affect people who use heroin over a long time, whatever the way they take it: insomnia and constipation, lung problems including pneumonia and tuberculosis, depression and other mental health problems, sexual problems in men and irregular periods in women, and damage to the tissue inside the nose when it is sniffed.

Injecting adds its own dangers, described here only so you understand the harm:

• Blood-borne infections: hepatitis B, hepatitis C and HIV when injecting equipment is shared, and these can be passed on to a wife or children.
• Vein damage: scarred and collapsed veins.
• Bacterial infections: of the blood vessels and heart valves, plus abscesses and infections of the skin and soft tissue.
• Blocked small blood vessels: caused by substances mixed into the drug that do not dissolve, which can damage parts of the lungs, liver, kidneys or brain.

If your relative has ever injected, it matters that he tells the doctor without fear, so the right infection tests can be done. Finding hepatitis C or another infection early opens the door to treatment.

Other opioids people slip into: strong painkillers and codeine cough syrups

Heroin is not the only road into opioid addiction. MedlinePlus explains that strong opioid painkillers, including tramadol, can be misused: taking more than the doctor prescribed or more often than usual, taking them to get high, or taking someone else's medicine. It also notes that some people move from painkillers to heroin because it may be cheaper or easier to get.

Cough medicines that contain codeine are opioids too. A case report published in BMJ Case Reports in 2015 describes codeine dependence as a common problem among adults that has also been recorded in teenagers. So if your son drinks a lot of cough syrup for no clear reason, or you keep finding empty painkiller packs, take these signs just as seriously. To learn more about tramadol, read the signs of tramadol addiction.

What does an overdose look like, and what should you do right away?

The World Health Organization sums up the signs of an opioid overdose in three: very small pupils, loss of consciousness and difficulty breathing. MedlinePlus and Cleveland Clinic add other signs:

• He does not wake up or respond when you call his name or shake him.
• Very slow, shallow or stopped breathing, or snoring or gurgling sounds.
• Blue, purple or pale lips and fingernails, and cold, clammy skin.
• A limp body, a weak pulse, and possibly vomiting.

These are not theoretical fears: the World Health Organization estimates that about 600,000 deaths worldwide in 2019 were linked to drug use, and close to 80% of them were related to opioids.

When should you ask for help?

Do not wait for him to "confess" or to hit rock bottom. Ask for help now if you notice:

• Any sign of an overdose: then you call the ambulance on 123 straight away.
• Repeated signs of use, or withdrawal symptoms whenever the drug is late.
• Injection marks on his body, or that he has shared equipment with others.
• Severe depression, or talk of death or of hurting himself: ask him calmly and clearly whether he is thinking of harming himself; asking does not put the idea in his head. If he is in danger right now, do not leave him alone, and call the ambulance on 123 straight away. If the danger is not immediate, or once the ambulance has been called, you can also call the Ministry of Health's 24/7 mental-health line on 16328 or the center's emergencies line on +20 100 006 6752. This crisis can be overcome with the right help.
• That he has tried to stop on his own and gone back, which means he needs medical support, not blame.
• That you yourself, as a mother or a wife, have become exhausted and frightened and do not know what to do.

If the person you are worried about is your husband, you may find it helpful to read what to do if your husband is using drugs.

Opioid addiction is treatable: how does treatment work?

Opioid addiction is a treatable medical condition, not a moral weakness. The World Health Organization recommends treatment that combines medicines a doctor decides on, such as buprenorphine, methadone and naltrexone depending on the case and on what is available in each country, with psychological and social support. The WHO also notes that fewer than 10% of people who need this treatment receive it, which means many people never reach treatment at all.

1. Appointment and assessment: the doctor checks his physical and mental health, asks about what he uses and about injecting and infections, and may request a drug test and other tests as needed.
2. Detox under medical supervision, when the doctor decides on it: opioid withdrawal is painful and can be dangerous for someone who tries it alone, and MedlinePlus cautions that stopping without supervision can be difficult and dangerous. That is why detox at the center is done with medical follow-up, and the person does not change any medicine by himself. But detox alone is not complete treatment: MedlinePlus notes that most people need long-term treatment afterward, and the doctor may decide that ongoing medicine such as methadone or buprenorphine suits some people best, depending on what is available in each country.
3. Rehabilitation and relapse prevention: therapy sessions help him understand what drives his use and cope with cravings, with family counseling and follow-up after he leaves, as part of the rehabilitation program.
4. Treating what comes with addiction: such as depression or anxiety, because leaving them untreated makes going back more likely.

At Oxygen Center we see people aged 15 and over (under 18 with a guardian's consent). Inpatient stays for detox and rehabilitation are for males only, while doctor appointments, therapy sessions and drug tests are open to men and women. The first step is simple: a call on +20 101 687 0711 or on the landline +20 45 320 0011, and the family can come alone first to find out what suits their relative's situation.