Q: What are the signs of drug abuse?

A: It depends on the drug and how it is taken. For example:

Snorting cocaine or heroin. There will be irritation around the nostrils that could lead to a perforated septum (the thin layer of tissue that separates the right and left sides of the nose), and even a depression of the nose caused by cartilage damage. Nosebleeds are common. Cocaine users may also experience paranoia or exhibit aggression.

Intravenous use. When heroin and other drugs are injected, red puncture marks can be seen, mostly in the upper forearm. Over time, they may form "track marks" - linear, streak-like scars. Eventually, the veins themselves become too scarred for needles. Users may then inject directly under their skin - "skin popping" - resulting in skin and soft tissue infections that leave oval and round scars.

Prescription opioids. When abused orally, narcotic pain relievers such as Oxycontin may not leave any physical signs. More abuse leads to higher tolerance, driving some users to snort or inject, and to move on to heroin. 

Crack. Because crack cocaine is mostly smoked, users often have burns on their fingers and hands from handling a hot crack pipe, typically made of a tube of hollow glass, and may also have calluses on their thumbs from constant lighter use. Cocaine is an anesthetic so the smoke is numbing; users don't feel irritants in their eyes, leading to scratches and severe irritation. 

Ecstasy. Users are often portrayed as dancing frenetically at "raves" with glow sticks, which enhance the drug's hallucinogenic properties. It also causes severe grinding of the teeth; users may chew on things like pacifiers or leather to protect them. The pills can cause a rapid rise in body temperature and dehydration, and can lead to a dangerous drop in blood sugar. Complications are potentially fatal.

- Dr. Greg McDonald

Greg McDonald, D.O., is director of Forensic Medicine at Philadelphia College of Osteopathic Medicine.