Drug abuse or addiction is not always obvious. Many people are ashamed of it and will deny it if confronted, or they may genuinely not know they are addicted. Individuals who abuse heroin may exhibit a number of signs and symptoms. However, not all abusers will react to the drug in the same way. While signs and symptoms may vary, in general signs of heroin abuse include:

• Behavioral changes
• Hyperactivity followed by fatigue
• Disorientation
• Irresponsibility at work or school
• Lying
• Wearing long shirts and pants even during warm weather
• Increased sleeping
• Slurred speech
• Needle marks on arms or legs
• Weight loss
• Constant runny nose
• Scabs or bruises due to picking at the skin
• Dry mouth
• Skin will flush
• Pupils constricted
• Appear dopy and may fade in and out of wakefulness
• May nod off suddenly
• Breathing will be slowed, which is how an overdose kills
• Loss of memory
• Itching
• Nausea and vomiting
• Constipation requiring laxatives
• Lowered immunity making them more susceptible to illness
• High tolerance for pain
• Reckless behavior, such as stealing from loved-ones, shoplifting and pawning items
• Hostility towards others
• Skin infections
• Distancing from family and friends, spending more time “out” without reason
• Lack of personal hygiene
• Unexplained expenses
• Possession of drug paraphernalia
• Restlessness, especially during withdrawal
• Depending on the method of administration, you might find remnants of the drug or paraphernalia left behind. Heroin may be a powdery or crumbly substance ranging from off-white to dark brown. Black tar heroin is nearly black and is sticky instead of powdery.
• Syringes or small glass or metal pipes might be left behind.
• A person dissolving the drug to inject it might leave dirty spoons, rubber tubing, a belt or lighters around.

Signs of heroin use should be taken very seriously as heroin symptoms can be lethal. Even if unsure about heroin use or addiction, the heroin user should still be counseled to seek help for heroin use, or any other issue that might be causing the concerning behavior.