When someone uses heroin and experiences psychotic symptoms, they may wonder, “Can heroin cause psychosis?” The answer is that heroin-induced psychosis is rare but can occur under specific conditions.

Using opiates for relief from painful psychological symptoms has many negative effects, including potential addiction, medical problems and intensification of mental health symptoms during withdrawal periods. People with co-occurring heroin use and psychotic disorders have more severe functional impairment than people who only have one of the two conditions.

When people with psychotic disorders use heroin or other opiates, it is usually because these pain-killing drugs reduce psychotic symptoms rather than trigger or worsen them. Only in rare cases does heroin become the cause of psychotic symptoms. However, the withdrawal effects of heroin can sometimes cause the symptoms of an underlying psychotic disorder to return with greater force.

Even for people who do not have schizophrenia or another psychotic disorder, heroin withdrawal symptoms can sometimes develop into heroin-induced psychosis.

Heroin Withdrawal Psychosis

Psychosis is a break from reality during which a person has difficulty distinguishing internal perceptions from external stimuli. The most severe symptoms of psychosis are delusions and hallucinations. People with psychotic disorders are particularly prone to auditory hallucinations of disembodied voices with threatening or disparaging messages. They may also develop paranoid delusions that people are plotting to harm or kill them.

People with schizophrenia aren’t the only ones who experience these symptoms. Psychosis can be triggered by adverse reactions to medication, periods of heightened stress, sleep deprivation and delirium secondary to medical conditions. The active or withdrawal effects of some substances have the potential to induce psychosis.

Substances can induce psychotic symptoms in people who have never experienced psychosis before. Research shows that this has to do with levels of two essential brain chemicals. Glutamate and dopamine levels can be affected by stressors that activate the sympathetic nervous system and trigger the release of adrenaline, which sensitizes the brain’s response to dopamine.

Anything that causes severe stress can trigger the same changes in the brain as a psychotic disorder, though usually only when the sympathetic nervous system is active. These effects are more likely when the source of stress is something that directly affects brain chemistry, such as medication, drugs or a head injury.

Heroin withdrawal is physically and psychologically stressful. Withdrawal effects often include uncomfortable flu-like symptoms that can make people feel overwhelmed and hopeless. During the heroin withdrawal period, people may suffer from anxiety, agitation, depression, paranoia and other unpleasant psychological symptoms.

These effects can provoke psychosis when they are severe and may overwhelm the brain’s normal abilities to cope with stress. As agitation and physical discomfort intensify, people can enter a state of delirium in which they are no longer able to perceive environmental details or events accurately. Passing thoughts and fears can take on unnecessary importance, causing people to become paranoid or even to experience auditory or visual hallucinations.

Factors that increase the chances a person will experience heroin-induced psychosis include the following:

  • Mixing heroin and other substances
  • Having a medical condition that affects cognition
  • Suffering from acute or chronic sleep deprivation
  • Using heroin during a period of increased stress or trauma

Psychosis distorts judgment and can provoke dangerous behavior. Drug-induced psychosis frequently causes people to go to hospitals for emergency evaluations or to recovery centers for inpatient psychiatric treatment. Some people may be misdiagnosed with a psychotic disorder when they present with symptoms of heroin-induced psychosis. In other cases, people may act on hallucinations or delusional thoughts in ways that cause them to suffer accidental injury or other complications.

Co-Occurring Heroin Abuse and Psychosis Treatment

Sometimes, all a person needs to recover from substance-induced psychosis is time under clinical supervision in a safe environment. As the active or withdrawal effects of a substance wear off, clinicians determine whether a person can be released without further treatment or needs further care.

In cases when someone is extremely agitated, benzodiazepines or other sedative medications may be used to calm them and keep them safe. Opiate agonists or other medications are sometimes given to people experiencing heroin withdrawal symptoms and are slowly tapered as the withdrawal period ends.

When someone who experiences heroin-induced psychosis also has an underlying psychotic disorder, treatment is more complex. Research over the past few decades has shown that people with dual disorders have better outcomes when they participate in integrated treatment programs. The right treatment can effectively control symptoms of psychosis while promoting recovery from a substance use disorder.

People who have psychotic disorders don’t need to complete mental health treatment to benefit from substance abuse treatment or have a certain amount of time free from substance use before they begin to receive psychiatric care. Instead, people are less likely to resume using substances when their mental health disorder is treated. They are also more likely to experience a reduction in psychiatric symptoms when they are supported in their recovery from addiction.

In integrated programs, people can immediately enroll in multiple interventions that often include group therapy, individual counseling, medication management and complementary therapies. A main component of integrated programs is regular communication between treating professionals so that progress in one area doesn’t cause regression in another.

For people who are dependent on heroin, treatment often begins with admission to inpatient detoxification. In detox, people can receive support and treatment that helps them get through the withdrawal period safely and more comfortably.

Interventions provided in the inpatient detox setting can prevent or manage heroin withdrawal psychosis. Depending on someone’s needs, the severity of their disorders and program availability, they may proceed from detox to either inpatient or outpatient treatment.

Key Points: Heroin-Induced Psychosis

Some relevant facts to remember about heroin-induced psychosis include:

  • Heroin-induced psychosis is rare but can occur under certain conditions.
  • When people use heroin during a period of heightened stress, mix it with other substances or have an underlying mental health condition, heroin intoxication can cause delirium that progresses to psychosis.
  • Heroin-induced psychosis is most common in the form of heroin withdrawal psychosis. The physical and psychological stress of heroin withdrawal can trigger psychosis in people who are sensitive to pain or discomfort.
  • Substance-induced psychosis usually recedes quickly after the effects of substance intoxication or withdrawal wear off.
  • For people with chronic mental health conditions, longer-term mental health treatment may be required for psychotic symptoms to go into remission.

If you are concerned that you or someone you know may be addicted to heroin, you can take this self-assessment to learn more about the severity of your addiction and what kind of help is available. If you are struggling with co-occurring heroin use and a psychotic disorder and need help, contact The Recovery Village to learn about treatment options that can meet your needs.

Drug and Alcohol Services of South Australia. “Comorbidity of Mental Disorders and Substance Use: A Brief Guide for the Primary Care Clinician.” Published 2008. Retrieved December 9, 2018.

Rettner, Rachel. “Brain Chemicals Cooperate to Cause Psychosis, Study Suggests.” Live Science. Published October 1, 2010. Retrieved December 9, 2018.

Winkel, Ruud van, Stefanis, Nicholas C., and Myin-Germeys, Inez. “Psychosocial Stress and Psychosis: A Review of the Neurobiological Mechanisms and the Evidence for Gene-Stress Interaction.” Schizophrenia Bulletin, 34(6): 1095-1105. Published November 2008. Retrieved December 9, 2018.

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. “Integrated Treatment for Co-Occurring Disorders: The Evidence.” Published 2009. Retrieved December 9, 2018.

Heroin-Induced Psychosis
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