SYMPTOMS AND SIGNS OF DRUG ABUSE

SYMPTOMS AND SIGNS OF DRUG ABUSE*

Drug

Acute Intoxication and Overdose

Withdrawal Syndrome

CNS Stimulants

Cocaine; amphetamine: dextro-

amphetamine; methylphenidate;

phenmetrazine; phenylpropanola-

mine; STP1; MDMA2; Bromo-

DMA3; diethylpropion; mostam-

phetamine-like anti-obesity drugs

Vital Signs: temperature elevated; heart rate increased; res- pirations shallow; BP elevated Mental Status: sensorium

hyperacute or confused; paranoid ideation; hallucinations;

delirium; impulsivity; agitation; hyperactivity; sterotypy

Physical Exam: pupils dilated and reactive; tendon reflexes hyperactive; cardiac arrhythmias; dry mouth; sweating; tremors; convulsions; coma; stroke

Muscular aches: abdominal pain; chills, tremors; voracious hunger; anxiety; prolonged sleep; lack of energy; profound depression, sometimes suicidal; exhaustion

Opioids

Heroin; morphine; codeine;

meperidine; methadone; hydromorphone; opium; pentazocine; propoxyphene; fentanyl; sufentanil

Vital Signs: temperature decreased; respiration depressed; BP decreased, sometimes shock Mental Status: euphoria; stupor Physical Exam: pupils constricted (may be dilated with meperidine or extreme hypoxia); reflexes diminished to absent; pulmonary edema:; constipation; convulsions with propoxphene or meperidine; cardiac arrhythmias with propoxyphene; coma

Pupils dilated; pulse rapid; gooseflesh; lacrimation; abdominal cramps; muscle jerks; “flu” syndrome; vomiting; diarrhea; tremulousness; yawning; anxiety

CNS Depressants

Barbiturates: benzodiazepines; glutethimide; meprobamate; methaqualone; ethchlorvynol; chloral hydrate; methyprylon; paraldehyde

Vital Signs: respiration depressed; BP decreased, sometimes shock Mental Status: drowsiness or coma; confusion; delirium Physical Exam: pupils dilated with gluthethimide or in severe poisoning; tendon reflexes depressed; ataxia; slurred speech; nystagmus; convulsions or hyper-irritability with methaqualone; signs of anticholinergic poisoning with glutethimide; cardiac arrhythmias with chloral hydrate

Tremulousness; insomnia; sweating; fever; clonic blink reflex; anxiety; cardiovascular collapse; agitation; delirium; hal-lucinations; disorientation; convulsions; shock

Hallucinogens

LSD4; psilocybin; mescaline; PCP5

Vital Signs: temperature elevated; heart rate increased; BP elevated Mental Status: euphoria; anxiety or panic; paranoia; sensorium often clear; affect inappropriate; illusions; time and visual distortions; visual hallucinations; depersonalization; with PCP hypertensive encephalopathy Physical Exam: pupils dilated (normal or small with PCP); tendon reflexes hyperactive; with PCP: cyclic coma or extreme hyperactivity, drooling, blank stare, mutism, amnesia, analgesia, nystagmus (sometimes vertical), gait ataxia, muscle rigidity, impulsive or violent behavior, violent, scatological, pressured speech

None

Cannabis Group

Marijuana; hashish; THC6; hash oil; sinsemilla

Vital Signs: heart rate increased; BP decreased on standing Mental Status: anorexia, then increased appetite; euphoria; anxiety; sensorium often clear; dreamy, fantasy state; time-space distortions; hallucinations may be rare Physical Exam: pupils unchanged; conjunctiva injected; tachycardia, ataxia, and pallor in children

Nonspecific symptoms including anorexia, nausea, insomnia, restlessness, irritability, anxiety, depression

Anticholinergics

Atropine; belladonna; henbane; scopolamine; trihexphenidyl; benztropine mesylate; procyclidine; propantheline bromide; jimson weed seed

Vital Signs: temperature elevated; heart rate increased; possibly decreased BP Mental Status: drowsiness or coma; sensorium clouded; amnesia; disorientation; visual halluci-nations; body image alterations; confusion; with propantheline restlessness, excitement Physical Exam: pupils dilated and-fixed; decreased bowel sounds; flushed, dry skin and mucous membranes; violent behavior; convulsions; with propantheline circulatory failure, respiratory failure, paralysis, coma

Gastrointestinal and musculoskeletal symptoms