What are Track Marks?

Medically Reviewed By: Diana Vo, LMFT

May 3, 2023

Table of Contents

If you have been asking yourself, “What are track marks”, perhaps you suspect a loved one is injecting drugs or struggling with substance abuse.

The appearance of needle track marks is one of the brightest red flags for chronic intravenous drug use. Track marks occur at the site of the injection and can often lead to collapsed veins.

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Drug Track Marks

The act of injecting drugs is referred to as shooting up, jacking up, or slamming.

IV drug abuse is most commonly associated with heroin, opioids, meth, and cocaine.

If you spot fresh track marks on someone’s forearms, these will appear like puncture wounds that have not yet healed. Over time, and with continued injection into the same site, track marks can darken the pigmentation of skin in the affected area. This can cause bruising, lesions, scarring, and damage to the veins.

Any addict track marks are indicative of long-term intravenous drug use, leading many people with needle marks on their arms to wear long sleeves, even in warmer weather.

An image of a person on the beach | What Are Track Marks?

What are Track Marks from?

Among all methods of drug administration, using syringes or needles to inject the substance intravenously is the most dangerous. With any intravenous route of delivery, the substance is injected directly into the bloodstream via the veins, triggering an intense and near-instant effect.

IV drug use is not the same as injecting drugs into a muscle or just below the skin – this is known as skin-popping – with neither intramuscular injections nor skin-popping delivering the drug directly into your bloodstream.

What are track marks on arms, then?

Well, most people injecting illicit drugs start using the veins in the crooks of the arms, using the dominant hand to simplify the injecting process. Over time, people are forced to use veins in other locations – the feet, legs, hands, and groin, for instance. Sometimes, injecting in less obvious sites is an attempt to conceal drug use from others. More frequently, people are forced to vary the location of injections due to inflammation or scarring of the primary injection site.

The substances most commonly intravenously injected include:

  • Heroin
  • Cocaine
  • Opioids
  • Morphine
  • Ketamine
  • Methamphetamine

The above substances may also be mixed together and injected – heroin and cocaine in the form of a speedball, for example. This is a particularly hazardous form of drug abuse, even by the standards of intravenous injection.

While it can be challenging to establish if a loved one is abusing drugs, IV drug abuse leaves physical signs that are difficult to cover up. Track marks in the form of puncture wounds, discoloration, and scarring are the principal warning signs that someone is injecting illicit drugs.

In most cases, people do not immediately begin injecting drugs. Even with drugs like heroin, people commonly start with less direct methods of administration like smoking or snorting. As dependence and tolerance build, though, it is commonplace for those using heroin to switch to a more direct method of delivery like injecting.

These signs are more visible due to the use of needles needed to inject the drug into the body. With other methods of use, there is no need to puncture the skin. 

Needle Marks

Needle marks, also known as track marks, are most visible among those injecting drugs intravenously due to the need to puncture the skin.

These needle marks can be caused by:

  • Chronic drug use: Anyone using the same site to inject drugs long-term will cause damage to the skin and veins, ultimately causing scar formation.
  • Old needles: Using blunt needles for intravenous injection forces you to apply extra pressure so the needle can pierce the skin and vein, leading to additional damage and even worse needle marks.
  • Impure substances: Many illicit drugs contain impurities, bulking agents, and even contaminants. Few street drugs are properly purified, instead being cut with other substances. The resultant toxins will accumulate at the injection site, creating dark-colored track marks.

What Track Marks Look Like

When track marks first appear, they resemble severe bruising. When this bruising subsides, the site of the injection will scab over. You will often notice track marks on all areas of the body when someone has been injecting drugs intravenously long-term. Many will also have clusters of scab marks.

The scabs left by track marks can also look like small dark circles. This form of scarring suggests skin-popping rather than IV drug use.

More recent track marks from heroin use appear like fresh lesions or regular puncture wounds. They can also present as scabs or bruises.

The veins in the hands and feet are much shallower than in other areas of the body. This means damage and scarring are more likely when someone injects substances into these locations. This damage can spread over time, with preferred injection sites becoming compromised.

Older track marks left by IV heroin use often appear as discolored and raised scars.

In the event of infection at the site of the injection, holes and ulcerous sores can develop.

How Long Do Track Marks Last?

Track marks will not automatically disappear when someone stops injecting drugs intravenously. Some severe track marks could take years to fade.

You should always get track marks evaluated by a doctor to check for infections and open wounds.

Track Mark Scars

Most track marks from intravenous drug use will fade over time.

Using topical treatments like aloe vera or vitamin E oil can accelerate the healing process. This will still only yield minimal improvement, though, so keep your expectations reasonable.

Additionally, avoiding direct exposure to the sun will help prevent track marks from darkening.

An image of the beach | What Are Track Marks?

Heroin Addiction Treatment at Renaissance Recovery

If you have been injecting drugs intravenously, it’s not too late to get your life back on track.

You will first need to detox from substances, addressing the physical aspect of addiction. If you require a supervised medical detox, we can connect you with suitable medical detox centers near you.

Here at Renaissance, we can help you conquer substance use disorder without needing to pack your bags and spend a month or more in residential rehab. For anyone requiring more structure and support in recovery than a regular outpatient program provides, we also offer IOPs (intensive outpatient programs) and PHPs (partial hospitalization program). If you are unable to access a treatment center, you can kickstart your recovery with our virtual IOP.

While addiction to heroin or opioid painkillers can be powerfully debilitating, there are several FDA-approved medications to help reduce the discomfort of withdrawal, while at the same reducing cravings. We deliver medication-assisted treatment in combination with talk therapies like CBT and DBT. Through psychotherapy sessions, you will learn to identify what triggers you to use drugs, and you’ll become equipped with superior coping strategies to deal with stress in life substance-free.

In addition to an array of evidence-based treatment for drug addiction, you will also have access to holistic therapies and family therapy, helping you toward whole-body healing.

When you complete your course of treatment, your treatment team will personalize an aftercare and relapse prevention plan, so you maximize your chances of sustained sober living. Make this happen today by calling the friendly team at 866.330.9449.



At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment.

Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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