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Nasal Damage from Heroin Use

Nasal damage from drug use is most often associated with snorting cocaine. Short-term cocaine use often results in nosebleeds and an altered sense of smell. Progressive damage from chronic cocaine use can lead to necrosis (tissue death) in the septal cartilage and perforation (hole or fissure) in the nasal septum. Nasal tissue damage is attributed to the irritant side effects of adulterants in the drug (most notably levamisole), the traumatic impact on the mucosa caused by cocaine crystals snorted at high velocity and recurrent nasal infections.1

What Happens If You Snort Heroin?

The considerable risks of injecting heroin are well-documented. Many heroin users believe snorting heroin is a “safer” alternative. Snorting heroin eliminates the risk of contracting HIV and hepatitis, although this practice is associated with many side effects and dangers. The risk of developing an addiction, tolerance, withdrawal symptoms and overdose are essentially the same regardless of method of consumption. Moreover, snorting can be unpredictable and not as consistent in producing euphoria (the high), which can easily lead to an overdose. While the nasal side effects of heroin are not as widely studied as cocaine, heroin also contains additives and impurities, which can lead to sinus irritations. With chronic inflammation of the delicate nasal tissue, the risk of serious tissue damage increases, including perforations inside the nasal septum. People with asthma-related conditions who snort heroin face greater risks of suffering more frequent and severe asthma attacks that may require hospitalization.2

Adulterated Heroin

When it comes to adulterants, heroin is far more dangerous than cocaine due to the recent trend of fentanyl and carfentanil-laced heroin batches. In terms of nasal damage, this is the least of the issues one has to worry about with this deadly combination. Called gray death, this drug resembles a concrete mix and varies in consistency from a hard, chunky material to a fine powder. Experts blame thousands of opioid deaths across the country on this deadly combo. Moreover, fentanyl powder alone can be deadly just to the touch, without snorting or injecting it.3

Signs of Nose Damage from Drugs

A French study published in 2013 indicated snorting heroin can lead to similar nasal damage as cocaine inhalation. In this study, investigators analyzed side effects in 24 individuals with a history of chronic nasal inhalation of heroin (average daily consumption 5 g). The participants snorted heroin anywhere from two months to more than 10 years. Six individuals also had a history of co-occurring cocaine abuse. The following common clinical symptoms were noted.4,5

  • Nasal pain
  • Purulent sputum (yellow or green phlegm – sign of possible bacterial infection)
  • Dysphagia (swallowing difficulties)
  • Rhinitis: Stuffy or runny nose

The following complications occurred, with a varying number of individuals impacted by each condition.4,5

  • Nasal septum necrosis (five individuals): Dead skin tissue in the cartilage dividing the nostrils.
  • Nasal perforation (11 individuals): A hole or fissure, typically in the septum.
  • Nasal erythema or ulceration (five individuals): Superficial, patchy reddening of the skin, resulting from dilatation of the blood capillaries caused by irritation/injury or open wound/sore.
  • Palate damage (five individuals): Tissue damage on the roof of the mouth, which separates the cavities of the nose and the mouth.
  • Pharyngeal ulceration (three individuals): Open sores in the part of the throat behind the mouth and nasal cavity and above the esophagus and larynx.
  1. Berman M, Paran D, Elkayam O. Cocaine-Induced Vasculitis. Balbir-Gurman A, ed. Rambam Maimonides Med J. 2016;7(4):e0036. doi:10.5041/RMMJ.10263.
  2. Side Effects and Dangers of Snorting Heroin. Using website. http://using.com/side-effects-dangers-snorting-heroin Accessed June 5, 2017.
  3. ‘Gray death’ is the latest opioid street mix causing worry. WGN-TV website. http://wgntv.com/2017/05/07/gray-death-is-the-latest-opioid-street-mix-causing-worry/ Published May 7, 2017. Accessed June 5, 2017.
  4. Septal Perforation – Medical Aspects Clinical Presentation. Medscape website. http://emedicine.medscape.com/article/863325-clinical Published February 24, 2016. Accessed June 5, 2017.
  5. Peyrière H, Léglise Y, Rousseau A, Cartier C, Gibaja V, Galland P. Necrosis of the intranasal structures and soft palate as a result of heroin snorting: a case series. Subst Abus. 2013;34(4):409-14. doi: 10.1080/08897077.2013.781565.
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