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How Does Heroin Affect the Brain Long Term?

Heroin is a powerful illegal opiate drug that changes the structure, chemical makeup, and physiology of the brain, the National Institute on Drug Abuse (NIDA) explains.

How Heroin Works

When heroin enters the bloodstream, it quickly binds to opioid receptors in the brain. This depresses some of the functions of the central nervous system that are autonomic, such as body temperature, respiration, blood pressure, and heart rate.
This alters the chemical makeup of the brain, as the transmission, production, and reabsorption of neurotransmitters like dopamine are impacted.

The flood of dopamine is what produces the euphoric rush or high that heroin use creates. Dopamine is not only responsible for feelings of pleasure and mood regulation but also for sleep and movement functions. Parts of the brain that help a person to make rational decisions and think clearly are impacted by heroin use. While under the influence of heroin, a person is likely to act irrationally, impulsively, or in ways that are out of character.
Heroin wears off relatively quickly. When it processes out of the brain, dopamine levels can take some time to regulate and get back to normal. Low levels of dopamine can cause depression, anxiety, irritability, trouble concentrating, agitation, and sleep difficulties.
The more regularly heroin is used, the more imbalanced the brain can become. With more use, the brain will struggle more to normalize without the drug, and the process will take longer.
Heroin use greatly impacts the brain and multiple other bodily functions and organs. It is also extremely addictive.

Brain Damage Related to Heroin Use

White matter is found in the subcortical part of the brain, which is in the deeper tissues and contains nerve fibers surrounded by myelin. The integrity of the brain’s white matter is compromised by chronic heroin use, which then leads to problems with decision-making abilities, the journal PLoS ONE reports.

The journal Applied Radiology publishes that regular heroin use has been shown to lead to toxic leukoencephalopathy, which is a progressive deterioration of the brain’s white matter and myelin. Side effects can include forgetfulness, problems with paying attention, changes in personality, dementia, uncontrollable body movements (ataxia), speech difficulties, coma, and even death.
Heroin is a toxic substance that wreaks havoc on the brain in many ways. Not only can heroin use damage parts of the brain that make it harder to think clearly and remember things well, but it can also influence sleep and movement functions as well as cause complete shifts in personality.
Heroin use can be related to the onset of mental health disorders, such as depression and antisocial personality disorder, NIDA warns. People who struggle with an antisocial personality disorder often have difficulties understanding and recognizing the difference between right and wrong as well as problems feeling and expressing empathy.

Heart, Lung, and Additional Complications 

The U.S. National Library of Medicine (NLM) publishes that heroin use can lead to serious health concerns, including infections of the heart, an increased risk of contracting an infectious disease such as hepatitis or HIV/AIDS from injection drug use, and miscarriages.
NIDA explains that further long-term side effects of heroin use can include sexual dysfunction in men, irregular menstruation in women, insomnia, constipation, abscesses, heart valve infections, lung infections and complications including pneumonia, and kidney and liver disease.

Snorting heroin can damage one’s nasal and sinus cavities, and lead to a lost sense of smell, chronic runny nose or nosebleeds, and respiratory issues. Smoking it can cause chronic cough and other lung problems. Injecting heroin raises the risk of contracting blood-borne diseases through the sharing of dirty needles, and it can also lead to collapsed veins and scarring at the injection site, called “track marks.”
Heroin often contains additives. These substances can be toxic and may not be metabolized well, which can lead to additional health problems.

MRI of a brain affected by heroin

Heroin use also affects one’s appetite levels. It can, therefore, lead to significant and unhealthy weight loss and even potentially anorexia.

Chronic Heroin Use: Tolerance, Dependence, Withdrawal, and Addiction

The U.S. Drug Enforcement Administration (DEA) warns that one of the biggest side effects of heroin use is addiction. With just a few uses, a person can become tolerant to the powerful opiate drug and, therefore, needs to take more next time to get the same high.
Repeated heroin use creates a physical and psychological dependence, as the brain can no longer stabilize and balance itself without the drug. At this point, when heroin wears off, challenging and uncomfortable withdrawal symptoms can occur. Among these are:

  • Sleep issues
  • Agitation
  • Tremors
  • Anxiety
  • Depression
  • Stomach pain
  • Nausea and vomiting
  • Diarrhea
  • Appetite loss
  • Irritability
  • Yawning
  • Watery eyes and runny nose
  • Concentration issues
  • Dizziness
  • Joint and bone pain
  • Intense mood swings
  • Cravings

These withdrawal symptoms generally start within 12 hours of the last dose of heroin and can be intense.
The American Society of Addiction Medicine (ASAM) reports that close to a quarter of people who use heroin will battle addiction involving the potent opioid. Addiction involves a loss of control over drug use and is classified as a brain disease. In addition being a compulsive and chronic disorder, it is also related to the changes in brain structure and chemical makeup that are induced by repeated heroin use.
The National Survey on Drug Use and Health (NSDUH) publishes that more than 600,000 people in the United States struggled with heroin addiction in 2016.

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Reversing Heroin-Related Damage

To prevent heroin-related damage from progressing, heroin use has to be stopped.
Since heroin is so highly addictive, and the drug cravings and withdrawal side effects can be significant, heroin is generally not a drug that can be easily stopped cold turkey. In fact, suddenly stopping heroin use after a dependence has built up can shock the brain, as the chemical balance will be significantly impacted.

Medical detox is considered the safest way to allow heroin to process out the brain while using medications (commonly opioid replacement drugs like methadone or buprenorphine) to regulate brain chemistry.
Generally, acute withdrawal symptoms persist for about a week or so. They then start to taper off as the brain begins to balance itself. Medications can help with this process, stabilizing the brain’s chemical makeup until it can normalize again. 

Sleep and mood disturbances can take a little longer to regulate, but therapeutic, supportive, and pharmacological interventions can help to manage this. Stress, anxiety, depression, sleep difficulties, and trouble feeling pleasure without heroin can all be side effects of changes the drug made to the structure and chemistry of the brain. These issues can be addressed through behavioral therapies and other medications, such as antidepressants, on an as-needed basis.

The journal Addiction Biology reports that some of the damage to the brain’s structure and white matter caused by heroin use may be reversible with prolonged abstinence. While some of the damage may be irreversible, stopping heroin use and remaining abstinence can prevent further damage to the brain.

A comprehensive addiction treatment program can provide tools for healing the brain as much as possible, creating healthy habits, and promoting long-term recovery.


(June 2018). What are the Long-Term Effects of Heroin Use? National Institute on Drug Abuse. Retrieved January 2019 from

(May 2013). Progressive White Matter Microstructure Damage in Male Chronic Heroin-Dependant Individuals: A DTI and TBSS Study. PLoS ONE. Retrieved January 2019 from

(March 2016). Heroin-Induced Leukoencephalopathy. Applied Radiology. Retrieved January 2019 from

(June 2018). What are the Medical Complications of Chronic Heroin Use? National Institute on Drug Abuse. Retrieved January 2019 from

(July 2018). Heroin. U.S. National Library of Medicine. Retrieved January 2019 from

(June 2018). What is Heroin? National Institute on Drug Abuse. Retrieved January 2019 from

(2017). Drugs of Abuse A DEA Resource Guide. Drug Enforcement Administration. Retrieved January 2019 from

(2016). Opioid Addiction 2016 Facts & Figures. American Society of Addiction Medicine. Retrieved January 2019 from

(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved January 2019 from

(July 2013). Reversible Brain White Matter Microstructure Changes in Heroin Addicts: A Longitudinal Study. Addiction Biology. Retrieved January 2019 from

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