Heroin is a well-known opioid drug commonly associated with IV (intravenous) use, a technique that introduces drugs directly into the bloodstream. However, some heroin users snort the drug through their nostrils instead of injecting it into a vein. In a study published in late 2013 in the journal Substance Abuse, researchers from four French universities sought to determine if heroin snorters experience the same damaging changes in nasal health found in people who snort the stimulant drug cocaine. Heroin vs. Cocaine Illicit drug manufacturers make heroin from morphine, a substance naturally found in the parent opioid plant called the opium poppy. Once it reaches the brain, the drug produces several powerful effects. First, it alters the normal ability to sense pain. It also triggers a powerful, pleasurable sensation called euphoria by altering the brain\u2019s usual levels of a key chemical. In addition, the presence of heroin slows down the function of several body systems by reducing the rate of nerve cell communication inside the brain. In addition to nasal inhalation (snorting) or IV injection, heroin users can introduce the drug into their bodies by smoking it. Cocaine, one of the classic stimulant drugs of abuse, comes from the processing of coca, the common name for several related species of South American plants. The basic processing of coca plants produces powdered cocaine, a substance that contains both cocaine and an inactive, secondary ingredient called hydrochloride. Additional processing of powdered cocaine strips away the hydrochloride and leaves behind the pebble-like substance typically known in the U.S. as \u201ccrack\u201d cocaine. Powdered cocaine is commonly introduced into the body through nasal inhalation; users can also inject this form of the drug into their veins. Crack users must inhale the smoke produced by burning the drug. Known Nasal Harms of Snorting Cocaine Powdered cocaine has a firmly established ability to damage the nasal health of people who habitually snort the drug. Relatively minor forms of this damage include nosebleeds and a reduced ability to detect smells. More serious forms of cocaine-related nasal damage revolve around the death of tissues that form the nose\u2019s soft and hard surfaces. Specific examples of the tissue death associated with snorting cocaine include death of the mucous membranes that line the nose, death of the tissue that separates the right nostril from the left nostril, death of the main nasal bones and death of the bone in the hard palate, which separates the floor of the nose from the roof of the mouth. People affected by cocaine-related nasal tissue death can develop sores and lesions that severely disfigure their normal appearance. Nasal Harms of Snorting Heroin In the study published in Substance Abuse, the French researchers compared the nasal damage produced by chronic snorting of heroin to the known nasal damage caused by chronic snorting of cocaine. Their project included 24 young adults and middle-aged adults between the ages of 24 and 42. These individuals had regularly engaged in heroin snorting for a minimum of two months and a maximum of over 10 years. Some of study participants snorted a relatively modest 0.5 g of the drug per day, while others snorted as much as 20 times this amount; the average rate of use was 5 g per day. Six of the participants were also known users of cocaine. Out of the 24 study participants, 11 developed a hole in the outer surfaces of one or both nostrils. Five participants developed ulcerating sores somewhere in their nasal tissues, and another five participants experienced tissue death in the wall separating their nostrils. In addition, five study participants experienced significant damage in their hard palates. The people who developed these destructive changes also experienced a number of associated symptoms, including pain, swallowing difficulties and a form of mucous membrane irritation called rhinitis. Significance and Considerations The authors of the study published in Substance Abuse concluded that habitual heroin snorters are clearly subject to the same types of nasal damage found in people who habitually snort cocaine. In line with this finding, they believe that doctors should consider the presence of heroin abuse as well as the presence of cocaine abuse when they observe certain destructive nasal changes in their patients. On a related note, one-third of the study participants saw improvements in their nasal health when they stopped actively using heroin and switched to use of the replacement opioid medication methadone or the replacement opioid medication buprenorphine. Neither of these medications involves nasal inhalation during use.