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  • Writer's pictureDr. Harold Pierre

What's the Difference Between Heroin vs Meth. Which is Worse?

Updated: Jan 17

Heroin vs Meth: Understanding the Key Differences Between These Powerful Addictive Substances

Heroin and methamphetamine are two of the most addictive and dangerous substances being abused today. Both can lead to devastating health effects and have a high potential for addiction and abuse. But what exactly are the differences between heroin and meth? How does each substance affect the body and brain? And what happens when they are combined? This in-depth guide examines heroin vs meth to uncover the similarities and key differences between these powerful drugs.

Paper cut Addiction to the drug icon isolated on black on purple backgrounbd. Heroin, narcotic, addiction, meth, illegal. Sick junkie with a syringe and medical pills. Paper art style copy

An Overview of Heroin and Methamphetamine

Heroin addiction continues to have a devastating impact on families and communities across the country. This harmful substance, derived from the opium poppy, can appear as a white powder or in shades of brown, presenting an illusion of harmlessness. However, when consumed—whether injected, inhaled, or snorted—it travels to the brain and binds to opioid receptors. This interaction leads to the release of dopamine, creating a sensation of euphoria and pain relief. Despite these temporary effects, heroin is dangerous and deceptive, often leading to severe health consequences. In emergency rooms, the reality of heroin’s harm is evident through symptoms like respiratory depression and constricted pupils.

However, heroin is highly addictive. Repeated use can quickly lead to tolerance and dependence as the brain adapts to the drug’s presence. When use is stopped, a heroin user will experience extremely uncomfortable withdrawal symptoms that drive them to continue using.

Methamphetamine, another harmful substance, is increasingly affecting communities. Its crystalline appearance may seem appealing, and it can initially produce a surge of energy. Methamphetamine, often consumed by swallowing, snorting, injecting, or smoking, rapidly affects the brain. It increases dopamine levels, which can lead to a feeling of heightened alertness and energy. However, this drug is highly dangerous and can cause serious health issues. Unlike opioids like heroin, which generally have sedative effects, methamphetamine is a stimulant that can lead to extreme agitation and overactivity.

The use of methamphetamine can result in severe consequences, including mental health issues like psychosis and aggressive behavior. Long-term use often leads to significant physical and psychological deterioration. Despite its destructive nature, methamphetamine is composed of common chemical elements and can be combated effectively.

How Do Heroin and Meth Enter and Affect the Body?

Heroin and methamphetamine take different paths to enter the body, but both cause short-term “highs” followed by hazardous side effects:


  • Injected - Injecting heroin sends it straight into the bloodstream for rapid onset of effects. This poses risks like vein damage and sharing needle infections.

  • Smoked - Heating heroin and inhaling the vapors causes a quicker high than snorting. It still lasts for several hours.

  • Snorted - Snorting heroin powder causes effects to begin in 5-10 minutes. But the high only lasts for a few hours.

Once administered, heroin is rapidly converted back into morphine in the brain. Morphine binds to opioid receptors, blocking pain signals and triggering a flood of dopamine and euphoria. It also depresses breathing and the cough reflex.


  • Smoked - Smoking crystal meth sends it quickly to the brain. Effects like euphoria, energy, and alertness begin immediately.

  • Injected - Injecting meth causes the fastest, most intense high. But it also comes with the greatest risks.

  • Snorted - When insufflated, meth reaches the brain in just 3 to 5 minutes. But the high may only last an hour.

  • Swallowed - Orally ingested meth has slower onset and lower bioavailability. But the high can persist for 4 to 6 hours.

Once in the body, meth causes a massive dopamine surge by reversing the transport of dopamine from the synaptic space back into neurons. This leads to a prolonged dopamine signal and intense stimulation.

How Does Heroin Alter Brain Chemistry?

Heroin’s effects stem from binding to mu-opioid receptors in the brain. This has several effects on brain chemistry and functioning:

  • Blocks pain signals

  • Suppresses the cough reflex

  • Slows breathing and heart rate

  • Triggers dopamine release and sensations of pleasure and reward

With repeated heroin use, the brain will adapt by making less dopamine and becoming less responsive to it. This leads to tolerance, needing more heroin to feel its effects. It also causes dependence when the brain is deprived of heroin.

What Changes Does Meth Cause in the Brain?

In contrast, meth’s stimulating qualities come from its interaction with dopamine and other neurotransmitters:

  • Reverses the dopamine transporter to increase dopamine signaling.

  • Boosts norepinephrine and epinephrine levels.

  • Raises serotonin initially, then depletes it with chronic use.

  • Activates the sympathetic nervous system, raising heart rate, blood pressure, and body temperature.

With prolonged abuse, meth can damage dopamine and serotonin-releasing neurons. This leads to reduced dopamine activity and a lack of interest or pleasure in normal rewards or activities. It contributes heavily to meth addiction.

What are the Short-Term Effects of Heroin vs Meth?

While they work differently, heroin and meth both produce feelings of euphoria and pleasure in the short term. However, they have some differing effects as well:

Short-Term Effects of Heroin

  • Euphoria and intense pleasure

  • Pain relief

  • Drowsiness and lethargy

  • Slowed breathing

  • Nausea and vomiting

  • Itching and flushing

  • Clouded mental state

  • Constipation

Short-Term Effects of Meth

  • Euphoria, elation

  • Increased alertness and attention

  • Bursts of energy, restlessness

  • Decreased appetite

  • Increased respiration and heart rate

  • Increased blood pressure, body temperature

  • Dilated pupils

So in summary, heroin tends to sedate and dissociate while meth stimulates and activates. But both provide sought-after euphoria.

What are the Long-Term Effects of Heroin and Meth Use?

Over time, heroin and meth abuse can severely impact both physical and mental health:

Long-Term Effects of Heroin

Physical effects:

  • Weight loss, poor hygiene

  • Skin infections, abscesses, and scarring from injection drug use

  • Heart infections like endocarditis

  • Liver and kidney disease

  • Weakened immune system

Mental effects:

  • Depression, anxiety, isolation

  • Impaired decision-making and self-control

  • Reduced quality of life and functioning

Long-Term Effects of Meth

Physical effects:

  • Severe weight loss and tooth decay (“meth mouth”)

  • Sleep deprivation and fatigue

  • Skin damage and aging from scratching

  • Heart damage, stroke, seizures

Mental effects:

Psychosis-like paranoia, hallucinations, delusions

  • Violent mood swings and aggressive behavior

  • Memory loss, impaired cognition and motor skills

So as you can see, both drugs can severely impact health, appearance, functioning, and mental wellbeing over months and years of abuse.

Heroin vs Methamphetamine: Which Cause Addiction Faster?

Handcuffed person with syringe and colorful pills. Presentation of a person addicted to illegal drugs copy

Both heroin and methamphetamine are highly addictive substances that can quickly lead to dependence and compulsive use. However, research suggests that heroin may cause addiction sooner than methamphetamine in several key ways:

  • Heroin binds rapidly and tightly to opioid receptors in the brain, triggering a massive release of dopamine that causes intense euphoria and reinforcement of continued use. In contrast, methamphetamine works by slowly reversing dopamine transporters, leading to a more gradual high.

  • Studies show it takes fewer administrations of heroin for dependent users to transition through stages of addiction, like developing cravings, escalating to regular use, and experiencing withdrawal when use stops.

  • In one study surveying heroin and meth users entering treatment, heroin users reported transitioning to compulsive use after around 50 days and 20 administrations. Meth users took longer - around 85 days and 15 administrations - to become compulsive users.

  • Heroin is more likely to be used daily or multiple times per day as tolerance quickly builds. Methamphetamine has a longer-lasting high so it tends to be used in more episodic binges separated by several days. This factor alone can accelerate heroin dependence.

  • The withdrawal syndrome for heroin also sets in more rapidly as the short-acting opioid leaves the system. Methamphetamine has a much longer half-life so withdrawal signs emerge slowly. Abrupt heroin withdrawal promotes re-use and a cycle of addiction.

So in summary, while both heroin and methamphetamine are highly addictive after prolonged abuse, heroin appears to trigger addiction, tolerance, and compulsive use more quickly thanks to its rapid and intense effects on brain opioid receptors and dopamine. However, no illicit drug causes guaranteed or immediate addiction after just a single use. Multiple factors always contribute to the development of substance use disorders.

How Does Heroin Withdrawal Differ From Meth Withdrawal?

The body adapts to the long-term presence of heroin and methamphetamine. When drugs are stopped, this triggers an often agonizing set of withdrawal symptoms:

Heroin Withdrawal Symptoms

  • Restlessness, insomnia

  • Muscle and bone pain

  • Cold flashes with goosebumps

  • Leg movements or kicking

  • Diarrhea and vomiting

  • Dilated pupils, watery eyes

  • Runny nose, yawning

  • Anxiety, dysphoria (unease)

  • Cravings for the drug

Meth Withdrawal Symptoms

  • Excessive fatigue

  • Increased appetite

  • Depression, anxiety, suicidal thoughts

  • Disturbing dreams or nightmares

  • Slowed thinking and movements

  • Lack of motivation and energy

  • Strong meth cravings

So in general, heroin withdrawal causes more physical effects while meth withdrawal has greater mental and emotional symptoms. Both can be very difficult to endure without a slow opioid or stimulant taper.

What Factors Contribute to Heroin and Meth Addiction?

While highly addictive on their own, certain factors can increase someone’s risk of becoming addicted to heroin or meth:

Heroin addiction risk factors

  • Early age of first use

  • Childhood trauma or abuse

  • Mental health conditions like depression

  • Regular abuse of prescription opioids

Meth addiction risk factors

  • First use in the teen years

  • Underlying mental health disorder

  • Social isolation or lack of support

  • Earlier stimulant abuse

Genetic factors also play a role for both drugs. Those with family histories of addiction are more prone to developing one themselves.

Environmental factors like peer pressure and everyday availability of drugs in one’s community also impact addiction likelihood.

What are Signs of Heroin vs Meth Addiction and Dependence?

Repeated abuse of heroin and meth changes the brain, leading to escalating use patterns, mounting tolerance, and addiction characterized by:

Signs of heroin addiction

  • Taking more heroin to feel effects (“chasing the high”)

  • Using first thing in morning to relieve withdrawal

  • Spending money on heroin instead of necessities

  • Failed attempts to cut back or quit heroin use

  • Showing withdrawal when heroin use is stopped

Signs of meth addiction

  • Using meth in higher doses or more frequently

  • Spending excessive time and money to obtain meth

  • Taking more meth to combat fatigue as tolerance builds

  • Continuing meth use despite physical and mental harms

  • Powerful meth cravings make quitting very difficult

If someone shows physical dependence on heroin or meth along with compulsive use, loss of control, and harm without regard, it indicates addiction requiring professional treatment.

What are the Dangers of Mixing Meth and Heroin Together?

Many polysubstance users alternate between using meth and heroin or even combine them simultaneously:

  • Meth can provide energy to counteract heroin’s sedating effects

  • Heroin relieves irritability and agitation caused by meth

However, mixing these two potent and addictive drugs together can compound risks:

  • The opposing effects on heart rate and breathing may cause strain

  • Higher doses of heroin are often used, raising overdose risk

  • Meth masks heroin’s sedating effects so warning signs are missed

  • Meth extends opioid withdrawal symptoms when heroin runs out

  • There is a higher risk of infectious disease from two types of injection

  • One drug can easily lead to relapse of the other during recovery

Overall, combining meth and heroin magnifies the hazards of each individual drug. Those mixing both need comprehensive addiction treatment and harm reduction education.

How Does Heroin Addiction Treatment Differ from Meth Addiction Treatment?

Overcoming addiction to heroin or meth requires professional treatment tailored to the drug:

Heroin addiction treatment

  • Supervised medical heroin detox to ease withdrawal

  • Medications like methadone, buprenorphine to relieve cravings

  • Adjunct medications for depression, anxiety, or pain

  • Behavioral therapies like cognitive-behavioral and contingency management

  • Community support groups like Narcotics Anonymous

Meth addiction treatment

  • Monitored detox and medications to alleviate withdrawal

  • Contingency management rewards to encourage abstinence

  • Cognitive processing therapy for mood and behavior issues

  • Family education and community support programs

  • Treatment for co-occurring disorders like depression

While both benefit from counseling and social support during recovery, medications for opioid addiction play a larger role in heroin treatment. But comprehensive treatment for both drugs should address medical, psychological, and social factors.

Key Takeaways - Heroin vs Meth

Heroin and meth may seem quite different at first glance, but they share some key similarities:

  • Produce short-term euphoria and pleasure through effects on dopamine.

  • Highly addictive substances that quickly lead to escalating use and tolerance.

  • Change brain chemistry and functioning, making addiction difficult to overcome.

  • Can severely impact physical health, mental health, and daily functioning.

  • Pose dangers like overdose and infections, especially when injected.

  • Require professional treatment and support for long-term recovery.

  • These two drugs target the central nervous system.

However, there are also notable differences:

  • Heroin is an opioid and activates opioid receptors, meth stimulates the CNS.

  • Heroin sedates, meth activates and energizes.

  • Heroin has more physical withdrawal symptoms, meth has more mental effects.

  • Heroin use is being replaced by fentanyl use.

  • Medications are core to heroin recovery, not universally used in meth recovery.

So in summary, all addictive drugs share common principles of abuse and recovery. However, it’s vital to understand the unique actions, effects, risks, and treatments for specific substances like heroin and methamphetamine to best address each type of addiction. Being aware of both the similarities and differences will lead to better outcomes.

Wang, Z., Li, W.-X., & Zhi-Min, L. (2017). Similarity and Difference in Drug Addiction Process Between Heroin- and Methamphetamine-Dependent Users. Substance Use & Misuse, 52(4), 459–467.

About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.

This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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