Heroin is a commonly abused opioid in the United States. Heroin is derived from morphine, which occurs naturally in opium poppy plants. Heroin addiction is a major problem in the United States since many people who are addicted to prescription opioids turn to heroin since it can be cheaper and easier to access. Heroin can enter the brain quickly after being snorted, sniffed or injected, causing euphoria, pain relief, and decreased respiratory rate.
Any drug that is injected into the body with a needle, including heroin, can cause visible marks to form, usually along a vein. These visible marks are known as track marks and they can often be seen on the arms, legs, and hands.
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What Are Track Marks?
Track marks are areas of discoloration along a vein which was damaged due to injecting drugs intravenously. Track marks are often noticeable along the forearms, where visible veins are present, although they can be anywhere on the body that has been used as an injection site. Track marks can appear as puncture wounds or as discolored and scarred veins.
Where Can Track Marks Appear?
Heroin track marks can appear anywhere a person injects the drug. Heroin injection sites can be anywhere on the body, although some spots are more common injection sites than others. Track marks are commonly visible in the forearms since forearm veins are accessible and easy to puncture.
Once veins in the forearm become too damaged or scarred, it is common for people to progress to veins in the hands, feet, and legs. Sometimes people inject drugs into veins in the groin or neck area as well. Any place on the body that has visible veins close to the surface are potential areas for track marks to develop.
Common Heroin Injection Sites
- Arms and Hands: The veins in the arms and hands are often very visible and easy to inject into, which is why they are commonly used for heroin injection. In most people, these veins are close to the surface of the skin, making them accessible. Arms are also easy to cover with long-sleeved clothing, so people can hide their injection marks. Sometimes when people run out of areas on the arms to inject, they may move on to their hands since those veins are also quite visible. However, it is harder to hide track marks on the hands.
- Legs and Feet: Veins in the lower extremities can also be common injection sites, especially when hand and arm veins are damaged or collapsed. Veins in the legs can sometimes be deeper under the skin, thus harder to access although veins at the top of the feet may be easy to inject into. Many people cover up injection marks on the legs and feet by wearing pants and socks, so some might choose these areas before hands and arms if they are trying to hide their track marks.
What Do Track Marks Look Like?
Track marks can look like small holes in the skin, in various stages of healing. New puncture wounds may look bright red or pink. The skin may be covered by a scab or new scar tissue. Older track marks can look like white or light pink healed scars. Sometimes the vein itself becomes scarred as well. If this is the case, the vein may take on a darkened appearance and it may be quite noticeable in some cases. Track marks can also look like bruises.
People often try to hide track marks on their arms by wearing long-sleeved shirts and jackets, even when the weather doesn’t dictate the need for warm clothing.
Why Do Track Marks Happen?
Track marks can occur because of repeated injections to the same vein. This constant damage to the skin and underlying vein can cause scabbing and scar tissue to develop. If these wounds become infected, the damage may be even more obvious.
Using dull or dirty needles to inject can also increase the chances of developing track marks. Dull or used needles are not sharp enough to puncture the skin cleanly, so wounds and scarring can occur. Also, not cleaning the skin surface before injecting may cause track marks. This scarring can happen because puncturing skin that is not clean can introduce bacteria, fungi or other foreign material into the skin and vein, increasing the chance of vein damage due to inflammation or infection.
The drug itself may also cause irritation to the vein. If a drug solution is not prepared with sterile water, it can introduce unwanted bacteria into the bloodstream. Also, if the drug solution is too acidic, not acidic enough or too concentrated, it can cause irritation and inflammation to a vein.
Risks and Side Effects of Track Marks
There are several risks associated with track marks. The presence of track marks on a person’s body indicates that they are injecting drugs intravenously, which is associated with many risks, including:
- Infection: Risk of infection is associated with any injection, especially when used, dirty or dull needles are used. Also, if the drug is not prepared with sterile water, the drug solution itself may be contaminated with bacteria or fungi, which can cause infections. Bloodstream infections can be serious and require urgent medical treatments. If an infection is present in the blood, the bacteria or fungus can travel throughout the body to cause infection in other places, like the lining of the heart, the brain, and other organs.
- Collapsed veins: Veins may collapse with repeated punctures. Collapsed veins often occur because of multiple punctures, which don’t allow the vein walls to stay open to allow normal blood flow. Collapsed veins are difficult to puncture. Continuing to try injecting a drug into a collapsed vein will likely be unsuccessful, painful and cause inflammation or swelling.
- Scars: Scar tissue may form with frequent intravenous injections, especially if injection sites are not allowed to heal before further injections are performed. Scarring can be extensive and some veins develop so much scar tissue that they cannot be used for intravenous access again.
- Abscesses: An abscess is a swollen, tender mass that is usually caused by an underlying infection. Generally, they are caused by bacterial infections and can be quite painful and warm to the touch. Abscesses usually need to be opened surgically and drained to release the buildup of pus and debris. Often antibiotics are necessary to rid the body of infection.
Can Track Marks Heal?
Sometimes track marks can heal and leave minimal scar tissue behind. Older track marks that haven’t been re-punctured can be nearly invisible in some cases. Sometimes the damage to the skin and veins is irreversible, even after healing has occurred. In areas of the body with especially thin skin, like the tops of the hands and feet, visible track marks may linger.
How to Get Rid of Physical Track Marks
The best way to avoid track marks is by not injecting drugs intravenously or by using clean, sharp needles and preparing drug solutions with sterile components to avoid infection. Keep existing wounds clean will promote good healing. Using medicated ointment and covering the wounds can improve healing as well.
For newer skin scarring, there are scar reduction products that can be placed topically on the scars to help them fade faster. These products usually do not work well on older scar tissue.
How to Heal Veins from IV Drug Use
Sometimes veins may never recover from intense intravenous drug use, especially veins that are very close to the skin surface. They may heal with a large amount of scar tissue, which may be visible for life, although most of the time they will fade to some degree. Some plastic surgeons or vascular surgeons may be able to reduce the appearance of discolored, damaged veins.
It is important to have your damaged veins evaluated by an expert to ensure no infection occurs. Serious bloodstream infections can appear to be vein damage, so it is crucial to see a doctor if there is any concern about vein infection.
Key Points: Heroin Track Marks
Keep the following key points in mind when considering track marks:
- Track marks on the skin can occur with intravenous heroin use
- Track marks can look like punctures, scabs, or bruising along the site of injection
- Common places for track marks include the forearms, hands, legs, and feet
- Track marks are more likely to occur with frequent injections into the same area, without allowing for healing time
- Track marks can become infected and this can sometimes lead to serious bloodstream infections which require immediate medical treatment
- Injecting with clean, sharp needles and using sterile components to prepare injectable drugs can lower the risk of track mark development
- Injecting drugs can cause infections, abscesses, scarring, and collapsed veins
- Track marks can sometimes fade over time, but in some cases, they will always be visible
- It is important to visit a health care provider if an infection within a vein is suspected
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National Institute on Drug Abuse. “Heroin.” June 2019. Accessed June 30, 2019. Pieper, Barbra; et al. “Impact of Injection Drug Use on Distribution and Severity of Chronic Venous Disorders.” July 2009. Accessed June 30, 2019. Gordon, Elana. “Healing the Wounds from Injecting Drugs.” March 8, 2018. Accessed June 30, 2019. WebMD. “Abscess.” October 12, 2017. Accessed June 30, 2019.
National Institute on Drug Abuse. “Heroin.” June 2019. Accessed June 30, 2019.
Pieper, Barbra; et al. “Impact of Injection Drug Use on Distribution and Severity of Chronic Venous Disorders.” July 2009. Accessed June 30, 2019.
Gordon, Elana. “Healing the Wounds from Injecting Drugs.” March 8, 2018. Accessed June 30, 2019.
WebMD. “Abscess.” October 12, 2017. Accessed June 30, 2019.