Substance withdrawal assessment

Indications of a suspected overdose

Indications of a suspected overdose include:

• increasing agitation
• cold and clammy skin
• pinpoint pupils indicate opioids
• changing mental state, e.g. hallucinations, panic or deep depression
• changes to heart rate, e.g. irregular, below 60 bpm or above 120 bpm
• lowered body temperature
• slow and noisy respiration
• muscle twitching
• cyanosis
• pulmonary oedema
• stupor
• convulsions
• coma.

Indications of intoxication

Indications of intoxication include:

• maladaptive behaviour
• evidence of intoxication from patient history and physical examination
• blood alcohol level by breath analysis
• results from saliva, urine or blood testing for alcohol and other drugs.

Behavioural and physical signs of specific agents

Agent	Behavioural and physical signs
Alcohol	Loss of control of voluntary movements, slurred speech, disinhibition, low blood pressure and smells of alcohol
Benzodiazepines	Slurred speech, loss of control of voluntary movements, sedation, nystagmus (repetitive eye movement), low blood pressure, drooling and disinhibition
Opioids	Pinpoint pupils, sedation, low blood pressure, slowed pulse, itching and scratching
GHB	Rapid onset of drowsiness, disinhibition, dizziness, nausea, muscle spasms, movement and speech impairment
Cannabis	Increased pulse, confusion, restlessness, excitement, hallucinations, anxious or panicky, disconnected from reality, paranoia, violent or suicidal behaviour
Psychostimulants, e.g. amphetamines, cocaine and ecstasy	Increased confidence, excitement, euphoria, anxiety, agitation, speech, hypervigilance, increased body temperature and blood pressure, dry mouth, paranoia, and psychotic features
LSD, magic mushrooms, psilocybin	Anxiety, fear, frightening hallucinations, panic, a feeling of loss of control, going mad, paranoia, violent or suicidal behaviour
PCP, angel dust	Similar to LSD, with euphoria, numbness, psychosis and aggression
Ketamine	Thought disorder, hallucinations, perceptual distortion, anxiety, agitation, tachycardia, hypertension, analgesia and sensory dissociation