There are indications of increased injecting drug use in Romania associated with the increased cross-border traffic of heroin. At the same time, there are indications of HIV transmission associated with drug injecting in countries close-by or neighbouring Romania. In the absence of data on patterns of injecting drug use, we undertook a preliminary assessment in four major Romanian cities (Bucharest, Iasi, Constanta and Timisoara) to describe the extent and nature of drug injecting and its associated adverse health consequences. The assessment is the first of its kind on injecting drug use in Romania. We found that little information exists on injecting drug use. In addition, we found recruiting IDUs into the assessment difficult. We note that future assessments need to find ways of recruiting IDUs directly in the community. We also note the need for future assessments to concentrate in greater detail on the potential for intervention developments in prevention, health promotion, treatment and policy.