How Heroin Can Kill You
(Hint: It’s Not What You Think)

Heroin syringe investigation

Since drug overdose deaths have been making national headlines for at least the last decade, it’s a pretty sure bet that nearly every American understands that heroin use can easily be deadly. They know that people can overdose on this or a similar drug like OxyContin, but they might not really understand what this means. And it’s very likely that most people don’t know that heroin can kill in many other ways than just through an overdose.

First, let’s clarify one thing. When we talk about heroin or a drug like oxycodone, we are basically talking about a single class of drugs called opioids. This kind of drug has a pain-deadening effect so it is often used as a painkiller. Types of opioids include:

  • Heroin
  • Opium
  • Morphine
  • Codeine
  • Oxycodone (may be purchased as OxyContin or Percocet)
  • Hydrocodone (Vicodin, Norco or Lortab)
  • Hydromorphone (Dilaudid)
  • Oxymorphone
  • Meperidine (Demerol)
  • Methadone
  • Buprenorphine (Butrans, Suboxone)

Most of these drugs are manufactured by pharmaceutical companies. Heroin and opium are manufactured and sold illicitly.

The other drug in this category deserves a little attention: Fentanyl. This is actually a family of dozens of drugs. Fentanyl is 50 to 100 times more powerful than morphine and 25 to 40 times more powerful than heroin. This makes it extremely easy for a user to overdose. Here are some of the many forms of fentanyl:

  • Fentanyl
  • Sufentanil
  • Remifentanil
  • Alfentanil
  • Acetyl fentanyl
  • Isofentanyl
  • Cyclopropyl fentanyl
  • Furanyl fentanyl
  • Oxtfentanil
  • Methoxyacetyl fentanyl
  • And the most powerful one on the list, Carfentanil.

Some of these drugs are manufactured by legitimate pharmaceutical companies and distributed to medical facilities. Carfentanil is so powerful that it isn’t even used on humans. It’s used to sedate large animals like elephants and giraffes.

But in the last four years, outlaw chemical companies mostly located in Asia have begun to supply the illicit market with large quantities of fentanyl and its analogs (chemically similar drugs). So now many of these drugs are found on the illicit market. They may be pressed into pills that look like they come from a pharmaceutical company, or added to heroin, cocaine or methamphetamine supplies or may be sold directly to a user who wants to consume fentanyl. These drugs are so powerful that many drug users avoid them whenever possible.

Some of the ailments we’re going to talk about in a moment can occur with the misuse of any of these opioids but others are particularly related to the use of illicitly manufactured drugs like heroin or illicit fentanyl. That’s because the illicit drug supply is much more likely to be contaminated with chemicals, unwanted drugs, bacteria or mold. Those substances trigger certain deadly health conditions as you will soon see.

How an Overdose Happens

As I mentioned, most people know that heroin or opioid overdoses can easily be deadly. These drugs kill by suppressing the person’s breathing. The overdosing person may be snoring loudly and raggedly or they may be unconscious. Eventually, their breathing stops and the person dies.

They may be able to be roused by causing pain. First responders try rubbing very hard on the person’s sternum with their knuckles. This pain will wake the person up if he’s not too far gone.

If there’s no response, the first responder will normally administer naloxone, an antidote to the opioids the person consumed. Usually, in just a minute, the person will wake up and begin to breathe normally.

The Other Ways Heroin or Opioids Kill

It’s a sad fact that even if a person survives overdoses or never experiences one, they can still die from their heroin or opioid use. Here’s what can happen.

Heroin effects on the body.

Infective endocarditis

Infective endocarditis is an infection in the valves or the interior lining of the heart. This condition is rare among people with healthy hearts. An intravenous drug user is 300 times more likely to die from this cause than a non-intravenous drug user. Among heroin users, this condition can have an 85% mortality rate.


Heroin or other opioids may cause a problem with the rate or rhythm of the heartbeat. Atrial fibrillation is a possibility, The heart may then become unable to pump enough blood to the body which can interfere with the function of the brain, the heart itself or other organs.

Pulmonary Edema

When a person survives the initial phase of a heroin or opioid overdose, they could still succumb to pulmonary edema. This condition could be missed in the rush to bring the person back from the overdose or it may not show up for as long as 24 hours after the overdose.

Kidney Failure

Heroin use can damage the kidneys, often after users inject the drug directly into their muscles. Users might make this choice after their regular injection sites have developed widespread scarring which can happen when the person injects black tar heroin.

Injecting heroin into muscles can stimulate the production of certain proteins that are subsequently deposited in the kidneys, making them unable to do their jobs. There is no cure. If the individual doesn’t receive dialysis, they will die.


Heroin and any illicitly manufactured drug can be contaminated with mold which will also contaminate needles or other tools to prepare the drug for use. This mold travels to the brain and creates inflammation that increases the pressure inside the skull and that can cause death.

Wound Botulism

A recent discovery is that wound botulism related to heroin use can cause death. As announced by the Centers for Disease Control and Prevention, the greatest risk occurs when injecting black tar heroin under the skin or into a muscle. A germ called Clostridium botulinum invades the body, attacking the nervous system. This can cause muscle weakness and difficulty breathing which can be fatal.

Transmission of Infections

Of course, it’s well known that drug users who share needles can also share dangerous infections such as hepatitis or HIV. If not treated, these diseases can kill. Risky sexual practices resulting from a poor lifestyle related to drug use can also result in the transmission of infections that can kill.

Transmission of infections is not limited to hepatitis or HIV. Bacterial contaminants like Staphylococcus aureus, A Streptococcus, Brucella or Listeria can be transmitted among injecting drug users. These bacteria can damage the heart valves as discussed above or cause abscesses in the brain or arterial aneurysms that rupture, resulting in strokes.

Families who have a loved one using heroin or another opioid should remember that no one wants to remain addicted, no matter what they say. The best solution is always to help a loved one find effective treatment for their heroin addiction. Every day, an opioid user risks their life. Hopefully, this clarification of the risks will help families take the often difficult steps to get their loved one to break free from their use of these deadly substances.

Reviewed by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP


Karen Hadley

For more than a decade, Karen has been researching and writing about drug trafficking, drug abuse, addiction and recovery. She has also studied and written about policy issues related to drug treatment.