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Heroin Track Marks

Heroin track marks are spots of bruising on the skin where repeated injection has occurred. These marks are signs of heroin use.

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Someone who is using heroin may exhibit a temporary high followed by many hours of being in a reduced mental state. People addicted to heroin likely struggle to accomplish activities of daily living. 

What Are Heroin Track Marks?

Heroin track marks are scarring of the veins where heroin is injected. 

As heroin is injected into a vein, often repeatedly at the same site, veins become damaged. It becomes more difficult for users to inject at the site, and blood flow is impaired. As a result, scarring or track marks form. 

Track marks can be identified as small, dark spots, where the needle punctures the skin. Around the puncture, the skin becomes discolored or darkened.

How to Identify Track Marks@2x

Identifying Heroin Drug Use

According to the 2019 National Survey on Drug Use and Health (NSDUH), approximately 745,000 people in the United States had used heroin in the past year. The same year, nearly 20 percent of drug overdose deaths involved the use of heroin. 

Heroin is a dangerous and addictive drug that can be life-threatening. From 1999 to 2020, almost 143,000 people died from an overdose related to heroin use.  

Identifying heroin use is essential to help heroin users access services and essential health care that could prevent overdose and addiction. Signs of heroin use include the following:

  • Evidence of a short-term high or “rush”
  • Warm skin flushing 
  • Dry mouth
  • Heavy sensations in the arms and legs
  • Nausea and vomiting 
  • Severe itching 
  • Being drowsy for several hours following the initial high 
  • Reduced mental function 
  • Slowed heart rate and breathing 
  • Track marks
  • Physical dependence (withdrawal symptoms when not using the drug)
  • Health complications
  • Brain damage

In addition to the above signs of someone currently under the influence of heroin, other signs may indicate heroin dependence or heroin use disorder. Someone who has become dependent on heroin experiences withdrawal symptoms as soon as they stop using heroin. 

Heroin use disorder (opioid use disorder) occurs following repeated heroin use. It is marked by an uncontrollable urge to use the drug despite the consequences. 

Common Places Track Marks Appear @2x

Common Places Track Marks Appear 

Track marks can appear wherever repeated injection occurs. Most often, users begin by injecting heroin into their forearms. As track marks form and injection become less feasible at the sight, users may inject elsewhere. 

Areas where track marks may appear include the following:


Track marks on the forearms are mostly likely found in the crook of the elbow. This is where most people initially inject heroin. As track marks form or veins collapse, people search for alternate injection sites.

Neck, Hands & Feet

People may move to the neck, hands, or feet when veins on the forearms disappear or become unusable. Although it is a painful process to inject in these locations, larger veins that pop out can be targeted.


When injected into the legs, track marks are usually found on the inner thigh. The same bruises, swelling, and irritation at the injection site that occur on the arms can also be found on the legs.


Researchers have learned that following the arms, heroin users are mostly likely to inject into the groin, as it offers an easily accessible injection site. 

Additionally, the longer people use heroin, the more likely they are to move from the arms to other parts of the body. Rotating injection sites may even be a technique for preventing scarring, such as track marks. 

Long-Term Effects of Heroin Use

Chronic or long-term heroin use can lead to many mental and physical problems. No matter how heroin is ingested, a variety of medical issues are likely to occur, explains the National Institute on Drug Abuse (NIDA). 

Physical and mental effects of long-term heroin use include the following:

Damaged Veins

Chronic injection drug use can lead to serious damage of the veins, including track marks and collapsed veins. Veins may collapse after repeated injection causes damage and scarring, and the veins can no longer maintain their structure. 


Heroin use can lead to a host of infections throughout the body. Bacterial infections of blood vessels and heart valves can occur. Abscesses on the skin and wound botulism are also great concerns. Additionally, lung infections are seen in people who chronically use heroin. 

Mental Health Issues

People struggling with heroin use are likely to develop mental health problems. Depression, insomnia, and antisocial personality disorder have been observed in people addicted to heroin. The presence of mental health issues increases the likelihood of continued substance abuse.

Physical Side Effects

There are many undesirable physical side effects of long-term heroin use. 

For people who inject heroin, track marks may occur on the skin. For people who snort it, damage to their nasal tissue can happen. For all who chronically use heroin, constipation, infection, sexual dysfunction in men, and irregular menstrual cycles in women can develop. 

In addition to the above effects of chronic heroin use, people who share injection equipment put themselves at risk for contracting serious diseases, such as HIV, hepatitis B and C, and other infectious diseases that are transferred via blood.

Can Track Marks Go Away?

Track marks can heal somewhat, though they are scar tissue, so they are unlikely to disappear entirely. For this reason, users often select discrete injection sites or wear long clothing to hide track marks. 

Bruising and discoloration of the skin is likely to vanish over time, though calloused and damaged skin may not. 

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Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More

Updated March 19, 2024
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  2. Drug Injection to Sites Other Than Arm: A Study of Iranian Heroin Injectors. (April 2014). Frontiers in Psychiatry.
  3. Injection Drug Use. (June 2020). MSD Manual.
  4. Injection Drug Use and Wound Botulism. (May 2022). Centers for Disease Control and Prevention.
  5. Opioids. (May 2022). Centers for Disease Control and Prevention.
  6. Opioids and Injection Drug Use. (October 2022). Minnesota Department of Health.
  7. What Are the Immediate (Short-Term) Effects of Heroin Use? (June 2018). National Institute on Drug Abuse.
  8. What Are the Long-Term Effects of Heroin Use? (June 2018). National Institute on Drug Abuse.
  9. What Are the Medical Complications of Chronic Heroin Use? (June 2018). National Institute on Drug Abuse.
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