How to Tell if Someone is Shooting Up

Dr. Saurabh Bhardwaj

Dr. Bhardwaj, Medical Director is a Board-Certified Addiction Psychiatrist (ABPN) and currently the Medical Director of Defining Wellness Center in Brandon MS. He is also an Associate Professor of Psychiatry and Medical Director of Center for Innovation & Discovery in Addictions (CIDA) at the University of Mississippi Medical Center. He has been in Mississippi since 2018, building Addiction services for the state's only medical center and joined Defining Wellness Center in 2022 to provide specialized dual diagnostic services. He is a recipient of Ruth Fox scholarship from AAAP and trailblazer teaching award from UMMC. He is also a Fellow of the American Society of Addiction Medicine.

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Heroin is one of the most harrowing drugs out there, yet more than 948,000 Americans admitted to using it.

That number has been rising between 2007 to 2016 and has probably grown since then. For some time, people failed to recognize how dangerous heroin was, but the public is starting to see it as a serious chronic relapsing condition.

With something this concerning, we understand why you want to learn to spot heroin track marks. You want to prepare for this and feel like you can help and make a difference.

Some people don’t want to learn information like this because they prefer to ignore a problem than face the possibility of their loved ones doing something like this. This is understandable as no one wants their loved ones to have a substance use disorder.

How to Tell if a Loved One Is Shooting Up

You’ve probably seen someone injecting this substance on TV or in a movie, but it’s more involved in that. The truth is that figuring out if someone is shooting up takes time.

You need to be observant and pick up on small details. Some signs that someone is using heroin aren’t physical but rather behavioral.

First, we’re going to go over the most common physical signs a person using heroin might display. Try to keep these in mind as you observe your loved one.

Track Marks

Track marks show up on the body, usually the forearm, at some point. They can also show up on the feet, toes, hands, and sometimes even the neck. You’re going to see sores or scars. Keep in mind that a loved one will try to hide these marks. Normally, users wear long-sleeve clothing even when it’s too warm for such clothing.

Heroin Paraphernalia

You’ll likely find some type of paraphernalia associated with this drug. Most of the time, you’ll find these items inside a bag or some type of container. You may see a needle, syringe, cotton, lighters, and a spoon. Sometimes, users hide these items, so look where you normally wouldn’t.

Skin Infections

A person using heroin will likely experience some type of skin infection. This may not happen at the beginning, but as the substance use disorder gets worse, this person might start to share needles or begin to use old needles. At some point, cleanliness may not matter as much, and this exposes users to bigger risks. A skin infection looks different on every person, but it usually means redness, irritation, and abscesses, which are quite painful.

Skin Popping

Most people think heroin is just injected into the veins, but that’s not always the case. Every so often, people inject the substance into the muscle. When it’s injected into the muscles, something else might happen over time called skin popping. Lumps on the skin are often seen with this condition. Scars start to accumulate to form this strange-looking lump.

Damaged Veins

A person dealing with this substance use disorder may damage their veins at some point. This could happen for various reasons, maybe because your loved one is injecting often. If that’s not the case, maybe it’s because your loved one is using a very dull needle. In either case, the veins can start to scar or collapse. When a vein is severely damaged, it’s going to leave a heavy bruise on the skin. You can’t miss it unless this person is successfully hiding everything using the right clothes.

A Closer Look at Track Marks

We’ve touched on track marks, but you need to know exactly what they look like to recognize them.

A track mark may look like a scar, and after a while, more of these scars may pop up. They usually show up in a row, which makes sense because the user is following the vein. Scars aren’t the only thing you should look for, though. Some folks heal better than others. If this is the case, you’re only going to see some discoloration spots along the vein.

Most of the time, the heroin track is on the dominant hand. If you get a chance to check, concentrate on that arm. We mentioned that heroin track marks can appear in other areas, but most people start on the forearms.

Keep in mind that the appearance of a fresh needle puncture depends on your loved one’s skin color. A fresh needle puncture is going to look pink and bright red. If your loved one’s skin color is dark, then a fresh puncture may not look pink, but you should still see redness.

If the puncture is relatively fresh, then the body is going to start working on repairing the area. At this point, the skin is going to appear either irritated or somewhat inflamed. You might see a scab forming if the puncture isn’t fresh. Usually, if the puncture is relatively fresh, the area looks bruised, but this doesn’t always happen.

When enough time passes, the puncture area starts to look different. What you see is scarring tissue. The color of the scarring tissue varies; it can appear white, while other times, it’s similar to the person’s skin color. The shape of the scars you see are usually circular, but they could look oblong, too, once they’ve fully healed. The scars are quite small.

It’s important to pay attention to the veins when you check for these scars. Even if the vein isn’t completely damaged, it’s still going to have an off-color appearance, usually darker than normal.

If you notice track marks, then you know something could be wrong. Don’t do this alone, either. Your loved one needs a real support system, such as friends and other family members. Teach those you trust to look for these track marks, too. If you confirm these marks, you can give us a call. Defining Wellness Center can help you cope with what comes next in the fight to overcome a heroin substance use disorder.

We know that once you confirm something like this, you’ll feel devastated, maybe even defeated, but there’s hope with specialized help.

Recognizing the Dangers

Of course, some problems are undeniable when a person develops a heroin substance use disorder. These include personal issues, such as losing a job, losing partners, or losing contact with important friends.

Sometimes, people who develop this problem get in trouble with the law. In short, this disorder can destroy lives in the blink of an eye. It doesn’t end there. You should know that more than 14,000 people overdosed on this drug in 2019. That’s an unimaginable number, and it is a decrease from previous years.

There are other things to worry about concerning heroin. This needle-based delivery method creates additional dangers you need to be aware of. It’s obvious why people use this method. It produces a stronger and quicker reaction. That’s quite attractive to folks who want to experience heroin, but it comes with many risks.

First of all, the overdose risk is higher when people use this delivery method. The user isn’t meticulous when it comes to how much is being shot up. Every time they shoot up, they are probably not measuring the amount to make sure it’s a safe amount. Every injection is a gamble.

On top of that, a person doesn’t know how clean the heroin they’re injecting is. At times, drug distributors use additives and fillers. The way the drug is mixed can differ from mix to mix or seller to seller. This increases the chances of overdosing, and it’s another gamble your loved one takes every time they shoot up.

The following are a few health risks associated with this delivery method.


Endocarditis is one issue that could happen over time. This is a condition where the heart’s lining starts to inflame. This could lead to heart damage and heart failure.


Thrombosis happens when blood starts to clot too much in the veins, and it can get pretty serious. If this goes on, vital organs might not get enough blood. Decreased blood flow to the brain could lead to a stroke.

Transmitted Diseases

Many serious infections can be transmitted through needle use. These could include things like Hepatitis C, HIV, and other STDs.

Chronic Venous Insufficiency

Chronic venous insufficiency is a problem that develops in users. Blood flow is essentially blocked. The body has a hard time getting blood to your feet, legs, and heart, which can be dangerous.

Other Signs to Watch Out For

While the physical signs are sometimes enough, they can be hard to spot. If your loved one doesn’t live with you or is good at hiding the physical signs, then all you’ve got is a suspicion. Even if you try to get them to go to the beach or the pool with you, they will find a way to stop you from checking for the physical signs.

Should this happen, you can try to see some behavioral signs, which can help, too. The following are some signs you should look out for.

Weight Control Issues

Weight control can get difficult for a person using heroin. You might notice them gaining too much or losing too much. Malnutrition may occur because a person only cares about getting their next hit.

Personal Hygiene Problems

Personal hygiene is no longer important to your loved one. This can start with them not taking enough showers or wearing dirty clothes for far too long. Grooming might also suffer.

Uncontrollable Mood Swings

Mood swings are common with someone who’s developed a heroin substance use disorder. These could be pretty drastic at times, maybe even scary, so watch out for these.


Things that used to matter to your loved one won’t matter as much. These things could include work, family, relationships, or even passions. They’d miss big events even if they used to look forward to the events before.

Trouble Sleeping

Some folks start to have trouble sleeping well; they could even develop insomnia. This could happen because your loved one is just anxious to have more and just can’t sleep. Lack of sleep can affect mood, so things may only get worse if your loved one’s already having mood swings.

New Social Circles

A person with this disorder could start to make friends with different types of people; these people might be suffering from the same type of disorder your loved one has.

What you’re going through and the fear you have for your loved one is normal. As hard as all this might be, you need to help your loved one see the light at the end of the tunnel.

Our team at the Defining Wellness Center believes that the more you know, the better. This helps ensure you give us a call to take the next step as soon as possible.

Our Defining Wellness Centers can assist in breaking the chains of heroin use. It starts with taking the step to fight this substance use disorder. Pick up the phone and contact us to learn more.

Begin your Recovery Today

If you are ready to take the step towards a new life, call Defining Wellness today and learn more about how we can help you.