Track marks are linear scars that occur because of intravenous drug use. Learning what track marks look like can be the first step in getting professional help for a loved one.

Intravenous drug use carries specific risks, like being more likely to contract certain infectious diseases. One of the tell-tale signs of intravenous drug use is track marks. People who use drugs intravenously will often take precautions to try and hide track marks on arms, hands and elsewhere, but they aren’t always able to keep them out of sight.

Intravenous Drug Use

Using a drug intravenously means injecting a substance into a vein with a syringe. This type of drug use leads to rapid effects. The substance bypasses the first-pass metabolism process that oral drugs would go through. When someone uses drugs orally, they must first be absorbed into the intestines. Then, they’re carried to the liver and processed before they hit the bloodstream. With intravenous injection, drugs bypass the liver and immediately go to the bloodstream and brain. The high can often be felt within a minute of injection.

Intravenous drug use, also known as IV use, isn’t usually the first route of administration. As someone’s dependence on a substance increases, they might want a faster and stronger high, leading to intravenous use. The rapid and intense euphoria tends to dissipate quickly as well. That can make people who inject drugs more prone to binging. Binging behaviors mean taking doses one after another immediately after a high wears off.

Almost all drugs can be injected, including:

What Are Track Marks?

Track marks on arms and hands from other drugs are one of the characteristic signs of intravenous drug use. Track marks are linear scars and areas of increased pigmentation. As people continue to inject themselves, scarring makes it difficult to inject in the same place, causing them to inject above the previous location. As this process repeats, linear marks over injection sites develop. The most common place to see needle track marks is on the forearms, where they can be hidden and easily accessed.

What Causes Track Marks?

The main causes of track marks include:

  • Prolonged, chronic use at the same site of injection. If you’re repeatedly injecting substances into the same spot, there’s damage to the vein. Scars can build up.
  • A blunted or dull needle tip if it’s old. When someone uses an old needle for IV drug use, it puts more pressure on the vein, causing further damage.
  • The drugs or needles are contaminated. it’s highly unlikely that someone is using pure drugs when they buy them off the streets. Nearly all street drugs are contaminated in some way. These toxins in drugs can worsen track marks and make them appear darker.

Where Can Track Marks Be Found?

While they’re most common on the inside part where the upper and lower arm meet, track marks can be found anywhere someone injects drugs. Along with track marks on arms and hands, track marks on legs, ankles, and feet are also common.

The veins in the hands and arms are easy to see and inject into. These veins are often close to the surface, and it’s easy to cover track marks on the arms with long sleeves. Veins in the lower extremities are common sites for injection, especially after the veins in the arm and hands get too damaged or collapse. Leg veins are deeper under the skin, making them harder to access.

What Do Track Marks Look Like?

Along with scars, track marks can look like multiple linear bruises, scabs or punctures at injection sites. A new puncture wound may appear pink or bright red. The skin might be covered by a scab or newly formed scar tissue for newer sites. Older track marks are light pink or white once they’re healed. The vein itself may also become scarred. When the vein is scarred, it may look darker and very noticeable.

Other Signs of IV Drug Use

Along with needle track marks, other signs of drug use can include:

  • Irritability
  • Weight loss
  • Declining personal hygiene
  • Changes in sleep habits
  • Changes in energy levels
  • Social isolation
  • Neglecting responsibilities
  • Financial issues
  • Risky behaviors
  • Being increasingly secretive

Dangers of IV Use

Using drugs intravenously introduces new risks and the dangers that come with using the drug itself. Dangers and complications of intravenous drug use include:

  • Skin infections and abscesses: in one study, an estimated 89% of injectable substances sold on the street are contaminated with at least one pathogen.
  • Endocarditis: the heart’s interior lining can be infected by bacteria that can enter the blood when using IV drugs. Most people who use drugs intravenously inject substances into the vein that drains into the right side of the heart, damaging the valves. 
  • Blood-related disease: Sharing needles or not sanitizing items used for IV drug use can transmit blood-related diseases and conditions like HIV and hepatitis.
  • Fatal overdose: this risk increases significantly when someone injects drugs directly into their body compared to using the same dose another way.

Get Treatment for Addiction in Colorado

Addiction is a disease that can overtake every area of someone’s life, but it doesn’t have to stay that way. Treatment programs at The Recovery Village at Palmer Lake are evidence-based and personalized to begin the recovery journey in a safe, comfortable environment. Reach out to learn more about our Colorado addiction treatment programs.

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Editor – Melissa Carmona
As the content manager at Advanced Recovery Systems, Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more
Benjamin-Caleb-Williams
Medically Reviewed By – Benjamin Caleb Williams, RN
Benjamin Caleb Williams is a board-certified Emergency Nurse with several years of clinical experience, including supervisory roles within the ICU and ER settings. Read more
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Levitt, Alexandra, Mermin, Jonathan, Jones, Christopher M., See, Isaac, Butler, Jay C. “Infectious diseases and injection drug u[…] and response.” The Journal of Infectious Diseases, September 2020. Accessed July 15, 2022.

UCLA Resnick Neuropsychiatric Hospital. “Potential Complications of IV Drug Use”&[…]f IV Drug Use.” Accessed July 15, 2022.

Medical Disclaimer

The Recovery Village at Palmer Lake aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.