BACKGROUND:The lives of persons who use illicit substances are filled with physical adversities and negative outcomes. OBJECTIVES:The purpose of this study was to determine: 1) the frequency of substance-related fights, fractures, and driving accidents in the past year among heroin users entering an inpatient detoxification program, and 2) to determine demographic and recent substance use factors associated with the most common of these physical traumas. METHODS:Between May 2015 and December 2015, we surveyed 433 persons entering a short-term inpatient detoxification program that reported heroin use in the last month and recorded their experiences of physical traumas in the last year. RESULTS:Among participants (72% male; 74% heroin injectors), more than a quarter (28.6%) reported a substance-related fight in the past year. Multivariate modeling revealed cocaine use, hazardous alcohol use, and younger age were significantly associated with fighting, but gender was not. Forty-five (10.4%) persons reported a fracture in the past year, with 64% of fractures related to a substance-related fall or fight. Additionally, 9.0% reported being a driver in a car accident after drinking or using drugs in the past year. Trauma rates were not significantly different from a contemporaneous cohort seeking alcohol detoxification at the same facility. CONCLUSION:Heroin users, both men and women, lead physically traumatic lives, interrupted by interpersonal violence, falls, fractures, and motor vehicle accidents.