People ingest them (not as common), snort them, Smoke them off of tin foil sheets with a pen with the ink cartridge taken out, in a glass pipe like crack, or they are melted off a spoon and injected. Burn marks around the mouth, sores inside the mouth, or burns on fingers are telltale signs that your patient may be a smoker, (freebasing-- BTW--don't ever refer to a "high end" crack addict as a crack addict--they "freebase cocaine" which in those circles is WILDLY different and will at least get you to some theraputic level in my experience) lots of sniffing and nose rubbing with the inside of the nose being chaffed and red, as well as un-naturally puffy eyes is a sign that your patient may be a snorter. Small bruises and puncture marks on the hands, feet, groin, neck--those are areas that whomever is injecting may be using so that it is not the typical a/c area. Explosive diarrhea is also a sign that someone could be ingesting-- A "speedball" is combining bath salts with cocaine and lots of other substances--ex-lax to protien drinks to benedryl. The dealers want to make a buck, therefore, they can and do mix just about anything together. Unfortunetely the dealers are getting smarter. They will hound a fresh detox with "free stuff" until they subcumb. Which is huge education component.