Heroin use in the United States has seen a steady decline since the 1980s and is less of a concern today than it has been in past decades. Unfortunately, it is important for pediatricians to be familiar with the manifestations and management of heroin abuse if it presents in their patients.

Depending on the route of delivery, heroin’s affects on the body will be different. Heroin induces euphoria, blunts pain, and results in pinpoint pupils. A lowered body temperature is suggested as a sign of heroin’s affect on the hypothalamus. Vasodilation is a major cardiovascular manifestation, and alveolar hypoventilation is a characteristic of respiratory depression. “Track marks,” which are hypertrophic linear scars that follow the course of large veins, are a frequently occurring dermatologic lesion associated with chronic heroin use; however, more easily overlooked are the smaller peripheral scars that occur from injection into smaller veins. If injected subcutaneously, heroin causes fat necrosis, lipodystrophy, and atrophy. Not surprisingly, abscesses secondary to unsterile drug administration techniques are a common occurrence. In addition, endocarditis with Staphylococcus aureus, cerebral microabscesses, and viral infections with hepatitis B and human immunodeficiency virus can all result from unsterile drug administration. Although its cause is unknown, a loss of libido is also a characteristic of heroin use. Addicted children may often find themselves in difficult circumstances to support a drug habit and prostitution is not an uncommon means of supporting these addictions. Constipation results from decreased smooth muscle propulsive contractions and increased anal sphincter tone. Finally, abnormal serologic reactions are frequent with heroin abuse, which include false-positive Venereal Disease Research Laboratory (VDRL) and latex fixation tests.