Drug and Alcohol - Opioid Addiction

Track Marks: What They Are, and Why They’re a Sign of Drug Abuse

What are Track Marks?

Track marks are the reddest of red flags when it comes to addiction. Track marks are a sign of IV drug use, the deadliest form of substance abuse.

Written by

brian-mooreBrian Moore

Content Writer

Reviewed by

jeremy-arztJeremy Arzt

Chief Clinical Officer

Drug and Alcohol

Opioid Addiction

March 2, 2023

Track marks, the sores and scares caused by IV drug use, are one of the most recognized and infamous signs of addiction.

Drugs can be consumed in a huge variety of ways: inhalation, smoking, vaping, or even eating. But there is perhaps no method of drug consumption as infamous as injecting addictive drugs with needles.

There is a strong stigma associated with injecting a drug. A person using injections is more exposed to serious medical risks ... and these risks can extend to those around them. This is why injectable drug users seek isolation and cannot risk syringes being found out by anybody.

Secondly, injection drug users also deal with an increased risk of infectious diseases associated with sharing syringes. Indeed, the entire act of arranging the injectable drug has always been depicted as the worst form of addiction in movies and other media, and when you listen to testimonies of people caught up in addiction, they often mention the time they started injecting their drug was like crossing a major line.

This is why injection drug users are most likely to be highly secretive about their addiction, reducing their chances of seeking help. The most lethal drugs on the street, such as cocaine, fentanyl, and methamphetamines, are often injected with needles. If your loved one seems to be using any injected drugs, you need to do the groundwork to understand the depth of the addiction and how to intervene and get the help required to prevent a fatal drug overdose.

Read ahead to understand how track marks are the most commonly understood sign of someone abusing injected drugs.

Track Marks: A Tell-Tale Sign of IV Drug Abuse

To understand track marks, you need to know a bit more about injecting drugs and what type of drugs bring this about.

What Are Track Marks?

Track marks are visible signs of skin damage, such as small holes along the areas that a person is repeatedly using to inject a drug. When the person is slamming, jacking up, or shooting up a drug, some places on the body are preferred for repeatedly injecting the drug. These are usually found on the arms, although it's possible to find track marks and associated injuries like abscesses anywhere on the body.

With time, these areas develop a distinctive look due to repeated wear & tear to the skin and tissues in that spot. Track marks can look rather ugly and might persist for some time, even after the person has stopped injecting. It takes some time for the tissues to heal properly and around the track marks and for the marks to go away completely.

In severe cases of chronic injected drug use, track marks might maintain some visibility forever, whereas they might fade away over a period in some people.

Noticing Track Marks

People tend to take notice of track marks when there is some significant scarring, or there is inflammation at the injection site. In more severe cases, the person might develop damaged veins or lesions might form at the site. No matter how careful the person is when injecting, there is every chance of some bruising and other damage to the skin.

How Do Track Marks Form?

It's important to remember that injecting drugs is common in medical care, where a drug is administered through a needle or syringe. People who have donated blood or have had an IV installed in them will show signs of damage, although it's rarely as severe as IV drug use. Professionals administering injections are careful to minimize harm, and track marks and other IV drug trauma are caused by dull needles and impurities in the injected drugs.

The method that someone with a drug addiction commonly uses is IV drug injection, where the drug is injected directly into the vein. It is found across all injectable drug users, called intravenous or IV drug use.

The preferred injection site here is often the crook of the forearm. The person is likely to prefer the less dominant arm. A right-handed person is most likely to inject the drug along the vein of the left hand, for example. This makes it easier to maintain control when using the syringe. People who have used the injection site too much might ask for assistance, asking someone who also has a drug addiction to inject the drug.

More caution is needed when injecting the drug in the dominant arm because an infection or soreness could really limit the person's mobility.

Similarly, not every drug is injected into veins. Some people addicted to drugs might inject a drug into their muscles. This, too, is borrowed from the healthcare setting where intramuscular injections are common. Others might inject just below the skin: this is called "skin-popping."

Track Mark Patterns

IV drug users often inject drugs in areas all over their bodies. Regular injection sites can get overused and might become too painful. Here, a person is likely to move to hand or foot or might even inject in the groin or leg. Some people tend to move around with the injection site, developing track marks along the feet and hands. They do this assuming that using one site less frequently makes the track marks less visible. This might not be entirely true if someone pays attention, as track marks tend to stand out no matter how smartly they are hidden.

Yes, there is always a primary site for injecting an IV drug. The scarring from repeatedly injecting can become severe enough to need treatment using antibiotics and other prescription medications. However, some people might not seek medical care fearing that their track marks will easily give away the fact that they use drugs. Many users might make a mistake when selecting a vein to inject.

This can cause bleeding or injecting improperly—this is a common issue among people who are still new to injecting drugs and those with a less alert state of mind due to abusing drugs. The "tie off" along the injection site is essential, and for this, the person might use anything from a medically approved tie to a regular belt or rubber tubing. The strapping of the arm is necessary to tourniquet the site. Referred to as banding a tie, it helps to swell up the vein a bit, making it easier to inject. 

Track Marks: Common IV Drugs

Not every drug is injectable, and not every person injects drugs. However, there are some drugs that are commonly associated with IV use. Heroin and other opioids are probably the most famous. Cocaine is another injected drug, and some users inject it along with heroin, called a "speedball."

A drug user might inject back-to-back within a short period or maintain an injecting schedule. Across the US, people have overdosed due to opioids mixed with cocaine or heroin and the concoction being injected. Injected alone or in combination with a drug, using IV injections remains a dangerous proposition, and the outcome can be fatal. 

What Drugs Cause Track Marks?

Some of the more regularly used IV injection abused drugs are:

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Track Marks: Other Causes

Track marks can be understood as the scarring that forms due to a person repeatedly shooting up a drug along a particular spot. These track marks can be caused by:

  • Using old needles is another common reason for track marks. Since the tip of the same needle is more likely to get blunted and dull with repeated usage, the person will pressurize and press upon the needle more. This is when the extra pressure is passed on to the vein and there is a chance of making the damage worse.

  • Prolonged and excessive use of the same injection site. The vein and the skin’s surface around that spot become damaged, clearly showing the track marks that don’t heal soon 

  • Using impure drugs is a lesser-understood cause of track marks. Drugs on the street come laced with many synthetics and fillers. Often, these are toxic. This can cause contamination along the injection site. Due to this, infections can surface. When the person repeatedly uses such drugs, there is a build-up of such contaminants. This makes the track marks infected and prevents them from healing in time.

A Closer Look at Identifying Track Marks 

If you have been wondering about what track marks look like or how to recognize them, understand that sometimes it is impossible to spot them as a person doing drugs is more likely to conceal them. Some people might wear long sleeves or ensure they layer up with an extra piece of clothing to hide the injection spots. Some people might get tattoos done all over the injection site that conceals multiple track marks.

The chronic type of IV drug use means that these scars remain visible for many years even after going through detox and regaining sobriety via drug rehab. For such people, with a history of IV drug injection, track marks can be embarrassing. One glance at these marks works like a tell-tale sign that the person is either doing drugs or once had a severe addiction.

For an IV drug user, different track marks might look different depending on how much time has elapsed since injecting again at the same spot. Usually, people with a serious addiction cannot provide a substantial gap between using again and not allowing the track marks to fully heal. This means a person is likely to have different types of track marks, including old and fresh marks along with some marks with a layer of healing tissue. The coloration of the track marks can also vary differently.

  • New or recent track marks: the lesions don’t have an overlying, hardened layer. The look is more of a bruise or a small puncture mark. 

  • Older track marks: the spot develops a typical coloration that is the result of repeatedly reusing, bleeding, healing, and using again. If the site is infected, the track marks could show pronounced scarring. Older track marks are more likely to be discolored and have a slightly darker coloration.

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Common Risks Associated with IV Drug Use Track Marks

Not just discoloring or scarring the injection sites, track marks come with many other complications, such as:

  • Cellulitis

  • Abscesses

  • Collapsed vein

  • Clotting in the veins

  • Fungal or bacterial infections

  • Inflammation of skin along the entire length of the arm

Needle-Sharing Risks Associated with Track Marks

Injectable drugs with an increased risk of blood-borne and skin infections. The seriously addicted are likely to use different drug injection equipment, including needles, tie-up bands, and syringes, apart from some other paraphernalia. IV drug abuse patterns suggest that people seldom sterilize such injection equipment.

A more significant threat is sharing needles. When people exchange or swap drug injecting needs, they risk getting infected, including exposure to fatal viral infections such as Hepatitis. Needle sharing helps people save money and time, and it is a bit practical for people who don't want to carry their own drug-injecting gear. Sometimes, access to sterile needles is not easy, and the person might not be ready to wait as the craving to use them again can be overwhelming.

Some places in the United States don't allow syringes to be bought with a prescription. This further raises the chances of people injecting IV drugs via shared syringes. Seldom stopping to check out the state of the equipment, such people are more likely not to complain about sharing a needle since it helps to conceal the addiction. Among drug traders and gangs, sharing the needle might also be a cultural thing, where gang initiations might involve using shared needles to underline trust and camaraderie.

Diseases linked to needle-sharing risks:

  • Human Immunodeficiency Virus (HIV)

  • Hepatitis B Virus (HBV)

  • Hepatitis C Virus (HCV)

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Track Marks: Hope for Overcoming IV Drug Addiction

No matter how serious drug addiction is, there is a chance to turn things around with proper care and compassion. Even if the person is addicted to the most lethal drugs like heroin or is increasingly finding ways to experiment with prescription opioids, a timely intervention followed by comprehensive detoxification and a stay at a nearby drug rehab center can help.

Every drug addiction center has different modalities for handling other drug addiction cases. It is up to the affected family to choose a facility that caters to their drug addiction challenges.

Tired of Track Marks? The Edge Treatment Center Will Help You Leave IV Drug Abuse Behind

Track marks are a serious, serious sign of drug addiction. Whether they're caused by opioids, methamphetamines, or other drugs, IV drug use is the riskiest form of substance abuse. Track marks are a sign of immediate intervention.

The Edge Treatment Center provides expert, evidence-based care for IV drug use. Our programs have helped many leave IV drugs behind. We'll start by matching you with a drug detox center where track marks will be treated by medical professionals as you detox from IV drugs. When you come to The Edge, our outpatient drug rehab will help you continue to build a life where IV drug use is in the past.


Track marks fade with time. At The Edge Treatment Center, you'll have time to heal. Reach out to us today to learn more.

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If you or a loved one is struggling with addiction, there is hope. Our team can guide you on your journey to recovery. Call us today.