There’s a whole lot of truth in the adage “the eyes don’t lie.” So much so that, in law enforcement and medical communities that deal with substance misuse, the dilation level of an individual’s eyes is considered a key marker indicating that there has been consumption of an illicit drug and can often lend assistance in identification of the drug used.
Dilation of the pupil (mydriasis), or opening of the iris, is caused by the activation of two muscle groups in the eye: the iris sphincter and the iris dilator. The body’s parasympathetic nervous system (providing control of a person’s autonomic bodily processes when at rest) is what triggers the sphincter response. The sympathetic nervous system, which controls the body’s fight-or-flight response, triggers action of the dilator.
Certain drugs, most commonly psychotropic stimulants, have a large effect on both systems causing the pupils to respond by dilating. Drugs can affect the parasympathetic or sympathetic nervous systems individually or in combination and depends on the type of drug taken. This occurs when elements of the drugs affect neurotransmitters in the brain that work in part to control mydriasis – thus allowing the pupils of the user to dilate to differing degrees.
Drugs that Cause Dilated Pupils
There are many drugs that can work on the brain’s neurotransmitters and affect the dilation of pupils. These include SSRI antidepressants, amphetamines, MDMA, psilocybin, LSD, ecstasy, cocaine, and mescaline. In the case of these drugs, serotonin (a brain chemical affecting mood) agonizes the 5-HT2A receptors in the brain and kicks off the dilation. Adrenergic receptors, another neurotransmitter, is affected by other drugs (such as marijuana) when dopamine is released, again affecting the eyes so the pupils become dilated.
Simply put, drugs take affect on the muscles in the eye that control the amount of light being allowed in. Since many drugs affect perception in the brain, the reaction to light can be altered, allowing the pupils to react in atypical fashion as to what is expected. Because this alone is an imperfect way to check against sobriety, officials have also learned to take other factors into play, such as heavy sweating, dry mouth, excessive activity, and the like.
Dilated Pupils on Drugs – Seeing the Difference
In the event there is suspicion of substance misuse, there is a tool to help at least part of the determination. An official chart showing pupils on drugs is the “Drug Recognition Card,” used mostly by law enforcement and emergency medical teams. This card is based on standards set by the International Association of Chiefs of Police (IACP) and provides a means to readily assess likely substance use categories (depressants, stimulants, hallucinogens, phencyclidine, narcotics, inhalants, cannabis) based on pupil diameter.
The chart lists the drug categories in columns, and the physical conditions noticed (horizontal/vertical gaze, convergence, state of pupil dilation, light reaction rate, etc.) so a likely match can be obtained. It also features a scale of pupil dilation that, when held up to the user, provides a physical, visual gauge for referencing how much or little dilation there is. Other charts showing the effects of drugs on pupil dilation do exist though, while helpful, they are not always as reliable as the one provided by the IACP which can be readily purchased online for home use.
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One of the older classes of drugs, barbiturates are used for the treatment of insomnia, headaches, muscle cramping, and seizures as well as being a pre-operative sedative. Barbiturates are central nervous system depressants that affect the ability of the body’s nerves to communicate with one another. Some examples of barbiturates include Seconal, Donnatal, Nembutal, Fortabs, Fiorinal with Codeine, Ascomp, Butisol Sodium, Amytal Sodium, Belladonna, Esgic, and Fioricet. These drugs are available as injections, tablets, capsules, or oral liquids, depending on which is being used.
When used properly under a health care provider’s supervision, these barbiturates are considered to be highly effective for managing symptoms of anxiety and sleeplessness. However, as with any drug, there can be abuse - and this group is known for its addiction potential.
People who use barbiturates recreationally are typically looking for something that will help sedate them and possibly to even lower inhibitions. They describe having a feeling of tranquility and better overall well-being. These drugs initially induce a state-of-being similar to being drunk, but the condition can progress to one of total relaxation - sometimes to the point of losing one’s life. Individuals who abuse prescription opiates have been shown to seek out barbiturates if they are out of opiates or to give a dose of heroin more kick.
Effects of Barbiturates
Barbiturates’ effects are broad, as they act on the body both mentally and physically. This combination occurs because these drugs work on the central nervous system, slowing down both cognitive and motor processes. Effects of barbiturates use can include any of the following individually, but most often in conjunction with each other, as the central nervous system is the source of control for all functions of the human body.
At issue are the barbiturates’ side effects. Since barbiturates produce a sense of calm and drowsiness, someone experiencing any of the listed side effects post-use may have a lack of concern about them. They may not act on those concerns or seek assistance from somebody who can help. Additionally, the sedated user can sometimes become confused about how much of the drug they have consumed, or when the last time of use was. This can lead to an unintentional overdose with the possibility of lethal consequences. A final issue for those who misuse barbiturates is that, because the drugs affect the body’s normal ability to breathe, they are then at greater risk of developing pneumonia or bronchitis.
For some who have experienced long-term use of barbiturates, their tolerance to the drug is increased as the effectiveness seems to be reduced, leading them to self-increase their dosage. This often leads to “doctor shopping” where they seek out prescriptions from multiple health care providers to gain access to more quantities (or higher doses) of the drug.
Coming Off Barbiturates
Users usually notice the first signs of withdrawal within 24 hours of the last dose. Barbiturate withdrawal symptoms can include insomnia, anxiety, delirium, or tremors. Heavy users have even been known to have seizures when attempting to stop using barbiturates.
For a person who wishes to stop barbiturate misuse, medical supervision or detox in a managed detox facility is recommended, as this is not an easy thing to accomplish alone.
For those working to withdraw from alcohol misuse, the effects of withdrawing can be overpowering and unpleasant, often leading them to quit the process. In some cases, medications can be prescribed to help with those symptoms, however these drugs can be very strong on one’s body, can have side-effects of their own to be concerned with, and can sometimes lead to addiction themselves.
To help health care professionals objectify the severity of alcohol withdrawal symptoms when considering if medications are needed to ease or alleviate symptoms, a standardized tool called the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was created. Over time, this alcohol withdrawal scale has also been used for assessing patients in various situations other than those being considered for prescription drug administration to alleviate symptoms. These include assessment of those in general outpatient, emergency, surgical, or psychiatric care. Because patients sometimes under-report alcohol consumption, misuse can be overlooked by physicians. Potentially life-threatening consequences, such as delirium tremens or seizures, can be missed if alcohol withdrawal symptoms go unrecognized.
The CIWA-Ar Alcohol Withdrawal Scale
The CIWA-Ar scale consists of ten checkpoints (or conditions) for an attending health care provider to review towards an assessment of alcohol withdrawal. Each is evaluated separately, then an aggregated score is obtained to indicate the severity of alcohol withdrawal. It should be noted that any sign indicating a pattern, or the side-effects, of excessive alcohol consumption should raise a concern for the possibility of alcohol withdrawal being present.
The ten checkpoints of the scale are as follows. Some checkpoints give the provider instructions on what to say to the patient or what the patient should be asked to do. Once each is done, there are seven qualifiers for the health care provider to use for the assessment - some based on observation of the patient, while others are based on answers to questions they ask of the patient.
Upon completion of the assessment, the points are tallied, and the level of alcohol withdrawal is calculated. A score of less than or equal to eight shows that withdrawal is absent or minimal; nine through nineteen indicates mild to moderate alcohol withdrawal; twenty and above is considered severe alcohol withdrawal.
Once the severity has been calculated, the health care provider can further reference a part of the tool that provides information on drugs that can be used to manage alcohol withdrawal symptoms when needed.
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While it is commonly known that alcohol and drugs don’t mix, this is especially true for the class of psychoactive drugs. Psychoactive drugs are chemical substances that alter behavior, thought processes, and overall mood. These drugs carry the greatest risks when they are mixed with alcohol.
To best understand how the combination of alcohol and psychoactive drugs can alter a person’s mood, it is necessary to know more about the drugs and the effects that they have on the brain.
Interestingly, alcohol is classified as a depressive psychoactive drug itself, so combining it with any other psychoactive or depressant drugs can exacerbate the effects of both substances.
Psychoactive drugs fall into the following sub-categories: depressants, stimulants, opiates and opioids, and psychedelics.
Depressants depress activity in the central nervous system, leading to sedation and decreased physiological activity throughout the body. Alcohol, barbiturates, and benzodiazepines are drugs in this category. All of these can be legal substances, with alcohol being non-therapeutic while the others are considered to be therapeutic.
Stimulants work by stimulating the central nervous system, leading to an increase in physiological processes and motor function. Drugs in this category include drugs such as cocaine, amphetamine, caffeine, ecstasy, and nicotine. Cocaine, amphetamine, and ecstasy are all illegal, therapeutic drugs, while caffeine and nicotine are both legal, non-therapeutic drugs.
Opiates and Opioids
Opiates and opioids are pain-relieving drugs that act on opioid receptors in the central and peripheral nervous system, as well as the gastrointestinal tract, to produce effects like those of morphine. This group includes drugs such as heroin, Fentanyl, Vicodin, and Hydrocodone. All but heroin are legal when prescribed and each is considered to be a therapeutic drug.
Psychedelics are known for acting on the central nervous system to alter mood and perception. This category of drugs includes marijuana (THC), LSD, psilocybin (mushrooms), and phencyclidine (PCP). Each is considered to be illegal except for marijuana, which is legal as a medicinal and recreational drug in some states.
All of these substances can also be considered to be psychoactive drugs as they act on various parts of the brain to produce these effects. Psychoactive drugs typically activate dopamine receptors in the “reward pathway” of the brain.
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I'm April Bailey, a freelance writer and editor for hire who has been writing about various topics for many years. Most of my early print work was destroyed in a major house fire. Luckily, I was able to pull some copies from an old PC and have posted them here. Other items on this blog reflect my current articles and blog posts written for online publications and copied here so I never lose my work again!