From the Guidelines
Heroin use is characterized by constricted pupils, drowsiness, slurred speech, and alternating consciousness, while cocaine use is marked by dilated pupils, increased energy, and euphoria, and methamphetamine use is distinguished by extremely dilated pupils, hyperactivity, and paranoia. The signs and symptoms of heroin, cocaine, and methamphetamine use are distinct and can be identified through physical and behavioral changes. Heroin users often display constricted pupils, drowsiness, slurred speech, and may alternate between consciousness and semi-consciousness (nodding off) 1. They may have track marks on their arms or other injection sites, poor hygiene, and experience nausea, vomiting, and constipation. Cocaine users typically exhibit dilated pupils, increased energy, talkativeness, and euphoria, followed by crashes with irritability and depression 1. They may have nasal problems like frequent sniffing, nosebleeds, or damaged nasal septum if snorting the drug. Methamphetamine users show extremely dilated pupils, hyperactivity, decreased appetite leading to weight loss, severe tooth decay ("meth mouth"), skin picking resulting in sores, and may experience paranoia or hallucinations. Some key differences in the signs and symptoms of these substances include:
- The timing of symptoms, which varies based on whether the person is experiencing intoxication, ongoing use, or withdrawal
- The physical signs, which can include track marks from injection, changes in sleep patterns, and dramatic weight fluctuations
- The behavioral changes, which can include isolation, financial problems, and neglect of responsibilities. It is essential to recognize these signs and symptoms to identify potential substance use disorders and provide appropriate treatment, as opioid withdrawal, for example, can be very uncomfortable but is rarely directly life-threatening as a sole condition, and treatment may involve symptomatic relief with α2-adrenergic agonists or initiation of medication for addiction treatment (MAT) with buprenorphine or methadone 1.
From the Research
Heroin, Cocaine, and Methamphetamine: Signs and Symptoms
- Heroin:
- Signs: drowsiness, confusion, impaired coordination, slowed breathing, constricted pupils 2
- Symptoms: nausea, vomiting, dry mouth, sweating, itching, constipation, loss of appetite, insomnia, anxiety, depression
- Cocaine:
- Signs: increased energy, alertness, and talkativeness, dilated pupils, increased heart rate and blood pressure, restlessness, irritability 3
- Symptoms: paranoia, anxiety, agitation, hallucinations, seizures, stroke, heart attack
- Methamphetamine:
- Signs: increased energy, alertness, and talkativeness, dilated pupils, increased heart rate and blood pressure, weight loss, poor oral health 4
- Symptoms: paranoia, anxiety, agitation, hallucinations, seizures, stroke, heart attack, memory loss, cognitive impairment
Treatment Options
- Medication-assisted treatment (MAT) is an effective approach for treating opioid use disorder, including heroin addiction 2, 3, 4
- Buprenorphine and methadone are commonly used medications for MAT, with methadone showing higher treatment retention rates than buprenorphine 3, 4
- Residential treatment services can be effective for individuals with severe and complex substance use problems, including those struggling with cocaine and methamphetamine addiction 5
Comparison of Buprenorphine and Methadone
- Buprenorphine and methadone have different effectiveness profiles, with methadone showing higher treatment retention rates and lower risk of treatment discontinuation 3, 4
- Buprenorphine may be preferred for patients with higher risk of methadone toxicity, such as the elderly or those taking high doses of benzodiazepines 2
- Methadone may be preferred for patients at higher risk of treatment dropout, such as injection opioid users or those with a history of substance use disorders 2, 6