Heroin overdose | signs and emergency care

Heroin overdose occurs when heroin suppresses essential brain functions, particularly the automatic drive to breathe. You may become extremely drowsy and then unresponsive as your breathing slows or stops. If a person cannot be woken, makes gurgling sounds or develops blue or grey lips after possible heroin use, call an ambulance immediately.

How does a heroin overdose kill you?

Heroin activates opioid receptors and can cause respiratory depression. Falling oxygen levels can damage the brain and heart. Pinpoint pupils, unconsciousness and difficulty breathing are the three characteristic signs of an opioid overdose. Emergency treatment given in time can prevent death.

Heroin overdose symptoms may develop within minutes. The most important heroin overdose signs involve consciousness and breathing:

• being unable to wake or respond
• slow, shallow or irregular breathing
• choking, gurgling or unusual snoring sounds
• pinpoint pupils and a limp body
• blue, grey or very pale lips and nails
• vomiting, collapse or loss of consciousness

When “nodding” becomes an emergency

Heroin can make you drift in and out of consciousness, which is sometimes called nodding. This can make an overdose easier to miss. If you are with someone who cannot be woken easily, or whose breathing becomes slow, irregular or noisy, they are not simply drowsy. Do not wait for complete unconsciousness before calling an ambulance.

What does a heroin overdose feel like?

There may be very little warning. You might feel a sudden heaviness, be confused or be unable to keep your eyes open, without realising that your breathing has slowed. Someone beside you may see the danger before you understand what is happening.

Smoking heroin can still cause a fatal overdose because the drug continues to suppress the brain's control of breathing. Although smoking avoids some injection-related injuries, it does not make heroin safe. The purity and effect of each dose remain completely unpredictable regardless of how you take the drug, and continuing despite these risks may indicate heroin addiction.

Why the route does not remove the risk

You may have heard that smoking heroin is not “as bad” as injecting it. Smoking carries its own danger, because you can keep inhaling without realising how sedated you are. Heroin is increasingly cut with synthetic opioids such as fentanyl or nitazenes, which are far stronger than heroin itself. Drug markets differ between countries, but appearance alone cannot tell you what a powder contains. Smoking changes how heroin enters your body, but it can still stop your breathing.

When heroin overdose risk rises

The risk rises after a detox or any other period without heroin because your tolerance has fallen. Alcohol, benzodiazepines and other sedatives intensify breathing suppression. If you use alone, nobody is there to notice your breathing change or call an ambulance. An amount you have used before may then cause an overdose.

How much heroin causes an overdose?

There is no reliable answer to how much heroin it takes to overdose. Purity varies, fentanyl or nitazenes may be present, and your tolerance can change rapidly. Health, route and other substances also affect the outcome. An amount that seemed fine before can be fatal on another occasion.

Call an ambulance when a person is unresponsive or breathing abnormally after possible heroin use. Follow the instructions from the call handler and the paramedics. Connection Mental Healthcare is not an emergency service, so urgent medical care must come first. Going through a heroin overdose, or seeing someone else go through one, can be very distressing. If you would like to talk to someone about it afterwards, you can call us on +27 21 541 0643.

Heroin overdose treatment

Heroin overdose treatment focuses on restoring breathing and reversing opioid effects. Naloxone acts quickly, but its effect is temporary and further doses may be needed. Emergency teams may provide oxygen, ventilation and monitoring. Treatment may also deal with inhaled vomit or injuries sustained while unconscious.

After surviving an overdose

After the emergency, you may wake to withdrawal, cravings and difficulty stopping heroin. Reduced tolerance can increase the risk of another overdose. Medical detoxification may be appropriate when withdrawal needs clinical care. Continuing treatment can address triggers, mental health problems and relapse risk.

At Connection Mental Healthcare, we provide private inpatient treatment for opioid addiction and co-occurring mental health conditions at our rehabilitation centre in South Africa. An addiction assessment considers your opioid use, overdose history and previous attempts to stop before we discuss a suitable treatment plan. You can call +27 21 541 0643 to discuss treatment after a heroin overdose.