Intravenous drug use has become a worldwide public health hazard and continues to affect all strata of our society. It has been associated with a multitude of severe infectious complications, such as hepatitis B, hepatitis C, human immunodeficiency virus, and endocarditis, though others such as skin and soft tissue infections are also extremely common. Rectus sheath abscess remains a rare medical condition. Here we report a 62-year-old man, who used heroin daily, presenting with an abdominal swelling with pain for two weeks. CT of the abdomen revealed a large left-sided rectus sheath abscess. Intravenous antibiotics were started and the abscess drained. The patient responded favorably to treatment. While managing complications of injection drug abuse, apart from the medical management, interventions to treat addiction assume prime importance. Rehabilitation, needle exchanges, and injection hygiene remain key to battling this malady.