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How to Tell if Someone is Shooting Up: 10+ Signs of IV Drug Use

Illicit substances can be consumed by swallowing, smoking, or snorting. But intravenous (IV) drug use or direct injection of drugs into the bloodstream is known as the fastest way to reach that high, euphoric sensation. 

10 Minutes Read | Published Sep 17 2023 | Updated Feb 23 2024 Expert Verified
Emma Collins
Written by
David Levin
Reviewed by
Emma Collins
Written by
David Levin
Reviewed by

Drugs flowing directly into the blood vessels can pose serious health risks. People engaged in IV drug use typically end up requiring more serious medical attention than snorters. There are also reports of overdose, weight loss, vein inflammation, abscess, and even death because of IV drug use. 

However, it’s not always straightforward to see if someone injects drugs. It’s easy to conceal needle marks and bruises or to deny the fact simply. Therefore, you must know how to tell if someone is shooting up to save a family or friend who might be suffering from IV drug use addiction. 

What Does Shooting Up Mean? 

When someone is shooting up, it means that the person put drugs into his body by injection. To become injectable, solid drugs must be transformed into liquid form so a syringe can contain them. 

The “high” from drug injection is way faster compared to the drug ingestion. The substance goes straight to the blood vessel, letting it flow with the blood as the heart pumps and reaches the brain really fast. That blitz effect is the reason why some can’t even pull the needle after injection. 

There are three common ways to “shoot up” drugs:

  • Intravascular or “into the veins”.

  • Intramuscular or “into the muscle” 

  • Subcutaneous or “under the skin”

All IV drug use methods above are known for their instantaneous and intense effect on the user.

Why Do People Shoot Up Drugs?

If it’s easier to snort or swallow illicit drugs, why do abusers opt for a more painful and harmful way of injecting drugs?

Most IV drug users don’t begin shooting up. But as their drug use becomes more frequent and intense, their tolerance and dependence on the substance develop, and the effect through oral or nasal drug use becomes “weaker.” 

So, in hopes of achieving the same level of pleasure they want, drug addicts try injecting for a near-instant and more intense effect. 

It’s also possible that IV drug use is driven by peer pressure. Some groups view injecting drugs as “hippy” or “cool”. So, people who want to fit in a group that injects drugs might resort to IV drug use just to be part of the flock. 

What Common Substances Do People “Shoot Up”?

There are different types of drugs out there, but what do people shooting up typically use? 

The three most common ones are meth, cocaine, and heroin:

Methamphetamine: Meth is a highly addictive stimulant in crystal or powdered form. The powder can be dissolved using water or alcohol for injection. Meth injection provides a rapid boost of dopamine which can be extremely addictive. 

Cocaine: A stimulant drug from the leaves of coca plant native. Powdered or cracked cocaine can be dissolved with water for injection.

Heroin: This is an opioid drug from morphine that acts as an addictive depressant for the nervous system. Heroin typically comes in powdered form that can be dissolved with water or alcohol. Heroin injection is pretty common (with over 50% of users injecting the drug)  and intense but usually short-lived, leaving some craving for more, leading to the formation of addictive behavior.

Aside from the three above, other opioids like fentanyl, oxycodone, and hydrocodone are used by some people shooting up. 

What Are the Dangers of Shooting Up Drugs? 

Shooting up drugs poses medical risks that may put the user in grave danger. And as with other methods of consuming addictive drugs, IV drug use can damage one’s mental and emotional well-being.

People injecting drugs are at risk of:

  • Skin infections include cellulitis, abscesses, and wound botulism (a serious illness due to a microorganism called Clostridium botulinum entering and infesting the wound).

  • Poor blood circulation leads to foot and leg swelling.

  • Bone infection

  • Tuberculosis, pneumonia, emphysema, pneumothorax, and other respiratory diseases.

  • Collapsed (or scarred) blood vessel.

  • HIV/AIDS, hepatitis, and other infectious diseases because of using shared and contaminated needles.

  • Overdose (users typically have no idea of what amount of the substance is considerably excessive when injected).

  • Malnourishment and weight loss.

  • Sexual dysfunction

  • Needle embolization (happens when a fragment of the needle breaks off, leading to infection of blood vessels)

  • Myocarditis (heart muscle inflammation)

  • Septicemia (inflammation of the body due to infection)

What are the Reliable Signs To Tell if Someone is Shooting Up?

If you suspect that your family or friend is suffering from IV drug abuse, it’s important to confirm it as soon as possible for immediate action. Physical and behavioral signs of IV drug use must be considered to confirm your suspicion and save someone’s life.

In this section, we share useful tips to tell if someone is shooting up.

Physical Signs of IV Drug Use

Here are some physical indicators of Intravenous drug use:

Presence of Needle Marks

The track marks are obvious signs of injection. These are round, dark bruises that go more lightly moving away along the person’s arm or poorly-healed punctured wounds.

Here are some common body spots where you can see track marks:

  • Forearm (inner and outer)

  • Biceps

  • Neck

  • Calves

Track marks are typically long, round, or oblong, covering the area over the blood vessel.

Most people use the veins in the crooks of their arms (the soft inner part where the elbow is bent) as the site injection. But over time, the site can be painful, so the drug abuser is usually forced to use the veins in their other body parts such as legs, hands, and feet. As much as possible, they try to conceal these marks, to the point that they will use locations that are not commonly visible, like the groin. 

Skin Infection

Infected needle marks and drug side effects can cause skin infections like abscesses. 

Poor hygiene due to behavioral drug effects is the common cause of deteriorating skin health. But aside from that, other factors that can lead to skin infection include:

  • Use of dirty, non-sterilized needles and syringes.

  • Injection of vasoconstrictor drugs like heroin or cocaine, which can tighten and constrict blood vessels in the skin. 

  • Damaging the skin tissue surrounding the injection site.

  • Infecting the skin by “saliva” when the person licks the needle before use.

Weight Loss

Injecting addictive stimulants induces excessive energy that can translate to massive burning of calories, lack of sleep, and an erratic eating schedule. So, it’s common for IV drug users to experience sudden weight loss. 

Skin Popping

Most inexperienced IV drug users tend to accidentally inject their muscles, leading to a build-up of scar tissue or skin popping.

“Peculiar” Clothing to Conceal Punctured Marks

Track marks are sometimes very noticeable among IV drug users. Some users wear inappropriate clothing to conceal them. For instance, a person injecting drugs might always wear long-sleeved clothes and long pants despite the summer season. 

Behavioral Signs of IV Drug Use

With its fast-acting and more intense effect on the user, IV drugs tend to alter someone’s mental and emotional well-being drastically. Here are some behavioral changes an IV drug user might experience:

Increased Anxiety and Paranoia

Regular IV drug use can seriously alter one’s nervous system due to the intense pharmacological effect of the injected drugs. 

So, people shooting up might be more anxious, defensive, combative, and paranoid at times because of the extreme stimulation brought by the drug.

Failure to Meet Commitments and Responsibilities

Frequent drug injection increases one’s tolerance of the drug, making him/her crave larger doses. This ultimately leads to addiction that can distract the person from functioning at work, school, or home. 

Change in Personality

Large doses of IV drugs can reduce one’s inhibition, altering one's personality, actions, and behaviors. You might notice that a person becomes more irritable or reclusive because of excessive drug injection. 

There are also some instances where someone becomes more sleepy and exhausted all the time because of restlessness and lack of sleep due to the surge of stimulants flowing in their bloodstream.

You might also notice that some lose interest in sports or hobbies. They typically change their habits to spend more time consuming their drugs.

Social Isolation

To avoid getting caught, some IV drug users withdraw from their family members and friends. They also avoid social gatherings because they might be ashamed of the physical changes manifesting because of their drug addiction.

Being socially isolated and living in solitude due to drug addiction can induce feelings of loneliness, which leads to serious mental health risks like depression. 

However, there are some instances where a user doesn’t end up socially isolated. Instead, they make friends with other drug users who inject drugs and treat them as their “new family” (since these friends can “understand” their reason for drug use). As they find companionship with these bad influences, they become closer to their family and friends.

Financial Problems

As IV drug addiction can distract someone from functioning properly at work and business, it’s common for the victims to face financial hardships. And since drugs are expensive, some tend to bury themselves in a pile of loans just to sustain their drug addiction.

Increased Consumption of Pornography 

This applies to all forms of drug use, such as oral or nasal consumption. Pornography also offers a dopamine boost that blends well with the pleasure-inducing drug injection. So, it’s common for IV drug users to also indulge in excessive obscene media.

Yet, there are also instances of inability to feel (sexual) pleasure because of extreme drug addiction. At this point, the user only reacts to the pleasure provided by the pharmacological effect of the drugs, making other sources of pleasure useless for him. 

Other Signs that Someone is Shooting Up

Here are more telltale signs on how to spot someone  using intravenous drugs:

  • Large amounts of dark-colored cotton around someone’s place.

  • Presence of drug paraphernalia at home or car (needles, syringes, lighters, spoons, plastic vials, liquid containers, etc)

  • Halitosis (due to neglect of personal hygiene)

  • Slurred speech and impaired coordination.

What To Do If You Know Someone is Shooting Up?

Now that you know how to tell if someone is shooting up, it’s necessary to take immediate action if you suspect that your friend or family is suffering from IV drug addiction.

However, you must recognize that it’s difficult to convince someone to ask for help. Many desire to end their drug addiction but are afraid of the potential health risks and social stigma they have to tackle. Hence, constant emotional support, medical attention, and expert treatment must be provided to patients to ensure their full recovery.

People suffering from drug addiction can change for the better. Just like any other disease, addiction is treatable with the help of professional healthcare specialists. As long as the patient has the determination to get rid of his destructive habits and his loved ones are there to support him along the recovery process, everything will go well.

If you or someone you know is shooting up, call 911 immediately for medical attention. You can also get in touch with Better Addiction Care to help you locate the nearest rehabilitation centers that can stop IV drug use. 


bullet CDC
"HIV and Injection Drug Use"
Retrieved on January 31, 2024
bullet National Library of Medicine
"The physical health of people who inject drugs: complexities, challenges, and continuity"
Retrieved on January 31, 2024
bullet WILEY Online library
"Loneliness among people with substance use problems: A narrative systematic review"
Retrieved on January 31, 2024

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