The Risks of Snorting Heroin


Heroin is a narcotic opiate. It comes as either a white or brownish powder as well as a black sticky substance referred to as “black tar heroin.”1,2 The drug can be administered many ways and is typically injected, but it’s also smoked and snorted.3

Heroin binds to the body’s opioid receptors after it enters the brain. It blocks pain signals and affects the body’s rewards pathway, producing a sense of immediate euphoria and reinforcing the pleasurable effects of the highly addictive drug.1

How Snorting Heroin Affects the Brain

Injecting heroin is a quick and efficient delivery method, with users experiencing effects within 5 minutes.4 Injecting heroin, however, greatly increases the likelihood of blood-borne infection such as hepatitis C and HIV, as well as other infections like endocarditis and skin abscesses.5 Injection drug use is also heavily stigmatized and increases the likelihood of social discrimination.5

Snorting or smoking heroin is an alternative to using needles, eliminating the stigma associated with injection drug use.6 Powdered heroin can be snorted dry or misted as a solution. Black tar heroin can be dissolved in water and placed into a medical spray bottle and “snorted” (i.e., insufflated).8

Intranasal inhalation requires minimal equipment and the onset of action is rapid enough to produce the desired euphoria.7 Snorting heroin may help users to avoid some of the medical consequences of chronic injectors of heroin, such as collapsed veins, bacterial infections of the blood and heart valves.8 Heroin isn’t a commercially produced pharmaceutical drug, but rather one people must buy on the street, there’s never any guarantee that the substance someone is snorting is just heroin. Additives are commonly used as fillers and even other drugs that can further increase the risk of adverse effects.8

Although snorting heroin may reduce long-term health risks associated with injecting heroin, repeatedly snorting heroin carries its own risks, such as damage the mucosal tissues in the nose as well as perforate the nasal septum—the tissue that separates the nasal passages.8,9

Snorting heroin, however, is about half as potent when heroin is administered via intramuscular injection.4 It’s a noticeable difference and those who snort heroin risk switching to injecting as their drug use progresses.5,10

Overdose is another big risk that comes with snorting heroin.11,12 An overdose can occur after taking just one dose. 11,12 It’s difficult for heroin users to be certain of the actual strength of what they purchase on the street, as heroin is increasingly being cut with fentanyl and other highly potent synthetic opioids.13,14 Between 2010 and 2017, the rate of heroin-related overdose deaths increased by almost 400%.13

Signs of overdose include extremely slow and shallow breathing, pinpoint pupils, and confusion or unconsciousness.12

Signs of Snorting Heroin

Following the initial high of using heroin, a person will go “on the nod” for several hours—a period of alternating between a drowsy and wakeful state.1 Breathing is often slow and shallow.1 Dry mouth, nausea, vomiting and severe itching can also be noticeable short-term effects.1

Snorting involves using a straw or rolled piece of paper (e.g., a dollar bill) to inhale powdered heroin through the nose.15 Razor blades may also be used to separate lines from a portion of powder.15 Snorting heroin may result in nosebleeds and irritation of the nasal passage. A chronically runny nose can indicate that snorting is occurring on a regular basis. Bacterial infections sometimes result as a consequence of exposing the mucous membranes in the nasal passage to the toxins in heroin.9

Getting Help

Heroin is a dangerous, deadly substance that claimed the lives of 14,996 people who overdosed on the drug in 2018.16 The treatment process is sometimes intimidating to individuals who are apprehensive about going through withdrawal. They may have heard horror stories from others. While they might contemplate getting help, the minute their latest dose starts wearing off and they start feeling sick or jittery as they crave another dose, they might not be able to fathom the idea of making it through withdrawal. Addiction treatment professionals can help make withdrawal more comfortable and can lead you down the path of sobriety and show you that recovery is possible.

References

  1. National Institute on Drug Abuse. (2019). DrugFacts: Heroin.
  2. U.S. Drug Enforcement Administration. (2017). Drug Fact Sheet: Heroin.
  3. Centers for Diesase Control and Prevention. (2018). Opioid Overdose: Opioid Basics: Heroin.
  4. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  5. Syvertsen, J. L., Paquette, C. E., & Pollini, R. A. (2017). Down in the valley: Trajectories of injection initiation among young injectors in California’s Central Valley. The International Journal on Drug Policy, 44, 41–
  6. National Institute on Drug Abuse. (2018). What is heroin and how is it used?
  7. Strain, E. (2019.) UpToDate: Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis.
  8. National Institute on Drug Abuse. (2018.) What are the medical complications of chronic heroin use?
  9. Peyrière, H., Léglise, Y., Rousseau, A., Cartier, C., Gibaja, V., & Galland, P. (2013). Necrosis of the intranasal structures and soft palate as a result of heroin snorting: A case series. Substance Abuse, 34(4), 409–414.
  10. Mathias, R. (1999). Heroin Snorters Risk Transition to Injection Drug Use and Infectious Disease.
  11. American Society of Addiction Medicine. (2015). The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
  12. Substance Abuse and Mental Health Services Administration. (2018). Opioid Overdose Prevention Toolkit.
  13. Hedegaard, H., Miniño, A. M., & Warner, M. (2018). Drug Overdose Deaths in the United States, 1999–2017.
  14. U.S. Drug Enforcement Administration. (2019). 2019 National Drug Threat Assessment.
  15. Center for Substance Abuse Research. (n.d.). Heroin.
  16. Hedegaard, H., Miniño, A. M., & Warner, M. (2020). Drug Overdose Deaths in the United States, 1999–2018.


About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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