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Signs of heroin use: What to look for
Published November 15, 2025 · 8 min read · Updated April 2026
Reviewed for accuracy by licensed clinical professionals.
Physical signs
Pinpoint pupils even in dim light, drowsiness and nodding off, track marks on arms, dry mouth, flushed skin, itching, constipation, weight loss, and neglected hygiene.
Behavioral signs
Wearing long sleeves in warm weather, social withdrawal, new unknown friends, missing money or valuables, finding paraphernalia (burnt spoons, bags, syringes, foil), mood swings, and declining performance.
What to do
Wait for a sober moment. Express specific observations without accusations. Lead with concern. Have treatment options ready. Consider professional intervention if direct conversation fails.
Frequently asked questions
What are the first signs of heroin use?
Pinpoint pupils, unusual drowsiness, runny nose, and mood changes. Track marks appear only with injection use.
What does heroin paraphernalia look like?
Burnt spoons, small bags, syringes, cotton balls, rubber tubing, and aluminum foil with burn marks.
How do I confront someone about heroin?
Choose a sober private moment, use specific observations not accusations, and have treatment options researched.
Disclaimer: Informational only. Not medical advice. SAMHSA: 1-800-662-4357.