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Track Mark Signs, Causes, and Addiction Treatment Options 

Scar tissue that traces the course of veins leaves track markings. These scars are the result of long-term intravenous drug usage. In most cases, the marks appear in the forearms but can appear anywhere on the body where repeated injections of heroin or meth occur.

What are Track Marks?

Intravenous (IV) drug use, such as heroin, may leave visual evidence such as bruising, scarring, discoloration, and scabs—known as track marks at the injection site [1]. Track marks are caused by blunt, dirty, or repeatedly using needles on the same vein. Track marks may indicate a collapsed or blown vein or infection. While stopping IV drug use is better, there are ways to minimize or avoid track marks and the damage they cause.

Injecting drug users (IDU) are at increased risk of a number of harms associated with their drug use, including blood-borne viral infections (BBVI) such as HIV, hepatitis C (HCV) and hepatitis B (HBV); drug overdosedrug dependence and abuse; and psychiatric disorders. Even the most experienced, careful intravenous drug user is not immune to the damage that needles can physically cause to veins and blood flow. Even the most experienced, careful intravenous drug user is not immune to the damage that needles can physically cause to veins and blood flow.

Track Mark

What Causes Track Marks?

Track marks are caused by the puncturing of the needle into the skin, leading to bruising and slight surface-level contusions.The side effects of track marks, at least on the surface, are far less terrifying than drug abuse’s internal physical and mental side effects.

A classic indicative sign of IV drug abuse is track marks on arms. These scars are most common in heroin users, but any drug that a person routinely injects can cause these marks. Old needles, those who share needles and contaminated drugs, can also increase the risk of these track marks.

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What Do Track Marks Look Like?

Most track marks look like fresh bruising. When the wound is fresh, dried blood might be present around the injection site. As intravenous drug use continues, marks will have cracked skin around them and skin infections. Veins around the injection area will also look more raised and darker. 

They are easy to identify by their brusing and dark pigmentation. Their appearances can vary, depending on:

  • The frequency people use injection drugs
  • How recently
  • How sensitive their skin is
  • Any underlying health conditions that cause bruising

Where Do Track Marks Appear?

Track marks can appear on any area of the body where an individual injects drugs. For example, many people inject drugs into their arms. They will usually use their dominant arm to easily inject the drug into their non-dominant arm. However, some may ask another person to inject the drug into their dominant arm. Other injection sites may include:

  • Legs
  • Hands
  • Feet
  • Ankles
  • Neck
  • Groin

Because track marks can signify drug abuse, most people try to hide them. For instance, a person with track marks on their forearms might wear long sleeves all the time, even in hot weather. Other people hide track marks with makeup or even tattoos.

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How To Spot Track Marks

There are some familiar ways to identify heroin track marks, but many prolonged intravenous drug users have developed explanations and other methods of hiding their drug use. If an individual is constantly covering up their arms, ankles, or legs with tall socks or long sleeves, even in warm weather, this may be a tell-tale sign of IV drug use.

Likewise, intravenous drug users may cover up their track marks with tattoos, as any track mark or bruised portion of skin is conveniently hidden under the ink. Lasting financial problems also affect many drug users, so they may construct a web of convenient lies or alibis to cover up their monetary issues.

What is Intravenous IV Drug Use?

Intravenous (IV) drug use involves injecting chemicals into the body through a hypodermic needle into a vein. Drugs can also be injected under the skin (also called “skin popping”) or directly into the muscle (intramuscular injection). For example, heroin is an illegal drug most commonly administered by intravenous injection, but other drugs such as amphetamines, methamphetamines, and cocaine can be helped by IV injection.

By injecting a drug, it enters the bloodstream immediately, accelerating its delivery to the brain. Due to the rapid onset of the habit-forming drug’s intensely rewarding effects, injecting drugs increases the user’s risk of developing an addiction and the likelihood of experiencing an overdose.

What is Needle Fixation?

Needle fixation is when people become addicted not only to the drug, but also to the ritual of drawing their drug up into a needle, and the act of injecting it. Such a user will divide the ‘fix’ into as many shots as possible, craving the actual injection and associated ‘rush’ into the veins. The user may also resort to other substances just to satisfy this urge, quite often collapsing veins and leaving track marks in the process.

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What Types Of Drugs Are Injected?

While heroin is the most infamous drug used this way, you may be surprised to know that drug users administer a wide variety of other drugs by this method. Cocaine (including crack), methamphetamine (including crystal meth), and morphine are also frequently used this way. Mixing heroin and cocaine, or “speedballing, or speedball drug” is a common practice with recreational drug users.

Morphine IV Dosage

Morphine delivered into the body intravenously is a rapid process, which eliminates inconsistencies with other variants like issues with absorption. The approach often requires a doctor or registered nurse to be present. The recommended dosage amount for IV morphine varies depending on the patient’s needs. The average starting dose is between 2.5 and 5mg every 4 hours, but patients with previous opioid exposure may require higher doses.

IV morphine use has a high abuse potential and can cause side effects such as sedation, loss of appetite, constipation, respiratory depression, and collapsed veins. The pleasurable effects of morphine, such as sedation, euphoria, and analgesia, make it an appealing target of drug abuse which may lead to a morphine overdose. Morphine tablets and pills can also form a solution when crushed and mixed with water. This is also a form of IV morphine addiction.

IV Cocaine Use

There are many damaging side effects of shooting cocaine. When cocaine is used intravenously (IV), also referred to as shooting, it is dispensed into a vein and directly introduced into the bloodstream. Injecting cocaine is dangerous because each time someone uses the drug they are increasing the risk of contracting an infection and developing a condition called sepsis. Sepsis, sometimes incorrectly called blood poisoning, is the body’s natural response to infection. Some of the expected complications from intravenous cocaine use start with the injection process, sometimes referred to as “skin-popping.” Someone who regularly inject cocaine may experience injection wounds, cuts or other breaks in the skin.

Cocaine use produces many cardiac problems due to the extra stress put on the cardiovascular system during each use. It is possible for people who have used cocaine by repeated injection to develop a condition called venous sclerosis, wherein the vein becomes so inflamed that blood is no longer able to flow through it. The risks to your heart and cardiovascular system don’t only come after years of cocaine use; the effects of cocaine are so immediate on your body that you could experience a heart attack with your first dose.

IV Amphetamine Use

Quite dangerously, a variety of amphetamine drugs are also used this way. Most of these medications come in a pill or tablet form, which requires users to crush and liquefy the drug. Amphetamines, such as those used to treat ADHD, are frequently used this way, including:

Amphetamine/dextroamphetamine (Adderall) 

Adderall is an addictive prescription stimulant with effects similar to meth. Although not everyone who uses Adderall will develop an addiction, people regularly taking Adderall at higher than prescribed doses are at an increased risk of becoming addicted. This is because Adderall works by increasing dopamine and norepinephrine levels in the central nervous system. 

In addition, taking psychoactive drugs like Adderall and mixing them with alcohol poses a great risk. Not only is mixing Adderall and alcohol bad, but it’s also deadly. Whether an Adderall and alcohol overdose happens accidentally or on purpose, it can lead to death.

Methylphenidate (Concerta, Ritalin, Quillivant)

Ritalin. or Methylphenidate hydrochloride—the generic for Ritalin, is a stimulant prescribed for attention deficit hyperactivity disorder (ADHD) treatment and to manage symptoms of narcolepsy (sleep disorder), but this prescription drug is also prone to abuse — begging the question, “can you inject Ritalin?” and “can you snort Ritalin?” 

It is also often abused as a party drug just like Adderall and considered a rave energy pill because it increases users’ focus and energy, producing bursts of activity and talkativeness — begging the questions, “can you mix Ritalin and alcohol?” and “how long does for Ritalin to leave your system?” 

IV Meth Use

Both crystal meth and meth powder can be dissolved into a liquid and injected directly into the bloodstream, causing more potent effects than other methods. Illicit methamphetamine is highly addictive. Many dealers or manufacturers cut it with other substances to stretch the supply. Cutting agents lower the quality of the drug and make it even more dangerous since you don’t know what’s in it. Methamphetamine can kill you. High doses can cause the body to overheat to dangerous levels.

Methamphetamine overdose nearly tripled from 2015 to 2019 among people ages 18-64 in the United States. What does meth feel like? Meth gives the user a rush of energy and intense feelings of pleasure. Meth releases a surge of chemicals known as serotonin and dopamine into the body. This is why most people who are “high” can’t sleep after meth use.

IV Prescription Pill Use

Xanax is used to treat anxiety disorders and panic disorder (sudden, unexpected attacks of extreme fear and worry about these attacks). Xanax is in a class of medications called benzodiazepines. Xanax may be habit-forming or may cause drug addiction.

Can you inject Xanax? Yes, but it doesn’t mean you have to. Anecdotally, injection of Xanax has been reported, causing dangerous damage to blood vessels, closure of blood vessels (embolization), and decay of muscle tissue (rhabdomyolysis). Xanax is not very soluble in water—when crushed in water, it does not fully dissolve.

Oxycodone is a common opioid pain killer sold under the brand name OxyContin, among others. The extremely addictive nature of oxycodone and other opioids has created an opioid crisis across the US. In 2019, nearly 50,000 people in the United States died from opioid overdoses.

Can you inject oxycodone? Yes, you can. Generally, when people want to shoot up oxycodone, they will crush and dissolve the tablets in water, creating a solution that can be intravenously injected. Some people learn how to shoot oxycodone because it provides them with a faster effect. When any drug is injected, and this includes shooing up narcotics, it reaches the brain more quickly, and the high people feel may also be more powerful.

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Arm Track Marks

Track marks on the arms are the most common. They are usually found in the crook of the elbow because new users will learn how to inject heroin there. Alternate injection sites may be located on the wrist or the back of a user’s hand. Track marks on the legs are often found on the inner thigh, and some heroin users will inject into large veins on their feet or the back of their hands. It is a painful process, but often, veins disappear in the more common areas and force them to find other places on the body.

Many users have found that shooting between their toes is a good spot because they can better mask their heroin addiction. Unfortunately, when users run out of options to shoot heroin into, they will go to great lengths and shoot into their neck, breasts, or penis. When a user has reached this point, it shows how deep they are into a substance use disorder and need help.

Drug Track Marks

The vast majority of drug users do not start their drug use by shooting or injecting drugs, instead it usually takes some time for them to reach that point.Part of the reason is that drug users do not need to get that high that fast when they first start using or even near the peak of their use. They can still get high and be satisfied with that high by smoking, snorting, or swallowing drugs.

As tolerance and dependence increase, shdooting drugs starts to be more appealing because of how powerful this form of transmission is. It is rare for someone who begins injecting drugs to stop and return to other methods of consumption, making it likely for physical health and addiction issues to develop.

It is a common misconception that track marks only appear on the arms. Unfortunately, drug users tend to frequent several different veins in various areas of the body, such as those veins in the hands, between the toes and the groin, to name a few. Track marks can be present in those areas, too. Looking for the paraphernalia of heroin and drug users is the quickest way to find out if someone is abusing substances.

Do Track Marks Go Away?

Track marks do not just automatically go away when you stop using drugs intravenously. In some cases, it can take up to 5 years for bad track marks to no longer be visible. It is important to get checked out by a doctor so that they can evaluate your damaged veins to make sure there is no infection or open wounds. Infection can cause the track marks to get worse.

Track Marks Medical Term 

Track marks can become infected and this can sometimes lead to serious bloodstream infections which require immediate medical treatment. There are several risks associated with track marks, including:


The risk of infection is associated with any injection, especially when used, dirty or dull needles are used. Moreover, if the drug is not prepared with sterile water, the drug solution itself may be contaminated with bacteria or fungi, which may cause infections. 

Collapsed Veins

Veins may collapse with repeated punctures. Collapsed veins often occur because of multiple punctures, which don’t allow the vein walls to stay open to allow normal blood flow. Collapsed veins are difficult to puncture. Continuing to try injecting a drug into a collapsed vein will likely be unsuccessful, painful and cause inflammation or swelling.


Scar tissue may form with regular intravenous injections, especially if injection locations are not allowed to heal before further injections are performed. Scarring can be extensive and some veins develop so much scar tissue that they cannot be used for intravenous access again.


An abscess is a swollen, tender mass that is usually caused by an underlying infection. Generally, they are caused by bacterial infections and can be quite painful and warm to the touch. Abscesses usually need to be opened surgically and drained to release the buildup of pus and debris. Often antibiotics are necessary to rid the body of infection.

Fresh Track Marks

The appearance of track marks may vary. They can be fresh or old. Depending on the stage of healing, the appearance of track marks may look different.

Fresh track marks may look like a bruise, a scab or a puncture mark. They are often red and inflamed because they haven’t had time to heal. A person struggling with drug abuse showing a new track mark may be a sign that their drug use was recent.

Old Track Marks 

Older track marks tend to look like raised, white scars because they have had time to heal and form a permanent line or scar. They are less inflamed and may not be as noticeable as fresh track marks. Sometimes the skin may become thickened where the injection occurred.

Needle Marks

Needles and syringes are among the most dangerous means of drug administration. Intravenous routes of drug administration deliver the injected substance directly into your bloodstream, thereby creating an almost immediate effect which is usually intense. This is why it is a popular means of substance abuse.

If a person keep using the same needle over and over, it will eventually become blunt. This bluntness will mean you have to apply more pressure before the needle can pierce through your skin and vein. This increased pressure can cause increased damage to the skin and veins.

Are There Other Dangers Of IV Drug Use? 

What makes IV drug use so dangerous? And why is it that—despite the researched dangers—an estimated 11 million people worldwide inject drugs?

IV drug use increases the risk of developing physical and psychological addiction.

  • Physical Dependence: Tolerance happens when the body becomes dependent on a drug; you have to take more and more of that substance to achieve the same effects.
  • Psychological Dependence: Feeling like you can’t normally function without the use of a drug is a common symptom of psychological dependency. You experience withdrawal symptoms when you stop using it or use less.
  • Addiction: While dependence and tolerance are both unique, they often contribute to the development of addiction.

Wound Botulism

The disease wound botulism is caused by a germ that can get into the skin during IV drug use. This toxin attacks the body’s nerves. It causes breathing difficulties and muscle weakness. If wound botulism isn’t treated properly, it can cause death [2].

Heart Damage

Any drug injection method can cause heart problems. Specifically, bacteria may find their way to the heart and cause endocarditis (a life-threatening inflammation of the heart). Endocarditis increases the risk of stroke.

Blown Veins

Repeated IV drug use causes veins to malfunction and collapse. But by then, the user is addicted. So, to continue using the drug, the person often injects into other parts of the body. This is called injecting intramuscularly (in a muscle) or subcutaneously (under the skin). 

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How To Overcome IV Drug Addiction 

Most people who attempt to quit using intravenous drugs on their own are not successful. They typically can’t handle the intense withdrawal symptoms they experience. As a result, they go back to using. This is why going to a treatment center for intravenous drug addicts is the best plan. There, these individuals will receive unconditional support. There will be no opportunity to relapse in this type of setting either.

There is a strong link between mental health and substance abuse. Individuals who struggle with mood disorders like depression and anxiety are more susceptible to developing an addiction to drugs or alcohol, often to self-medicate symptoms of their underlying mental health condition. These co-occurring disorders can make each other worse without proper treatment.

Medically-Assisted Detox

Medical detox is often considered the first stage of treatment. It will help you navigate the complicated process of Ritalin withdrawal, but it doesn’t address patterns of thought and behavior that contribute to drug use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient drug rehab helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of Ritalin withdrawals.

Psychotherapy for Depression

Several different modalities of psychotherapy have been used in the treatment of mental health disorders along with addiction, including:

  • Cognitive Behavioral Therapy (CBT) – is an effective treatment that involves making changes in both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression.
  • Dialectical Behavioral Therapy – is a comprehensive mental health and substance abuse treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. The main goal of DBT is to help a person develop what is referred to as a “clear mind.” 
  • Person-Centered Therapy – is a strategy that allows and encourages clients to understand and resolve their concerns in a safe, supportive environment.
  • Solution Focused Therapy – is an approach interested in solutions that can be quickly implemented with a simple first step leading to further positive consequences.

Dual Diagnosis Treatment

Prescription drug abuse and mental health disorders often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. This strategy treats both the substance abuse problem and the mental disorder simultaneously. Regardless of which diagnosis (mental health or substance abuse problem)

Medication-Assisted Treatments

Medication-Assisted Treatments (MAT) for substance use and mental health disorders are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

Contact one of our helpful treatment specialists today if you or a loved one are struggling with long-term prescription drug abuse and a co-occurring mental health condition such as depression. We Level Up can provide information on dual diagnosis and detox programs that may fit your specific needs.

Track Mark

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