Are Addicts Withdrawing From Opiates Under the Influence?

Are They Under the Influence if They are Going Through Withdrawals?

Opiate overdose is now the leading cause of accidental death in the United States. Opiate use in the US has grown exponentially in the past 5 years. In 2008, I was assigned to a Narcotics Unit in a city that was known as having a very strong methamphetamine problem. We began to see a surge in the use of opioid pharmaceuticals, much like the rest of the United States. As we predicted, all of the pill poppers learned that heroin was cheaper and now we have heroin where we used to not have any.

I noticed that many officers were confusing opiate withdrawal signs and symptoms with CNS Stimulant influence. When you look at the influence characteristics of both, you could see where some people could be confused.

I have not seen a study published on the signs and symptoms of opiate withdrawals. That doesn’t mean that one doesn’t exist, I just haven’t seen it. But the topic needs to be broached due to some negative urine screens coming back. The information I am bringing forth is just my personal observations during my evaluations of persons going through opiate withdrawals.

Negative Feedback

To better understand opiate withdrawals, it is important to understand the concept of negative feedback. This isn’t the bad news you receive during a work evaluation, this has to do with what happens as drugs leave your body. I look for the definition in a popular medical dictionary. It described negative feedback as, “That which occurs if the sign or sense of the returned signal results in reduced amplification.” I didn’t understand that either. Let’s try to simplify it.

Basically, as the drug metabolizes out of the body, the body does not return to normal. The body begins to experience the opposite effects of the drug. Lets look at the picture below to bring some clarity into the issue:

The line LD50 represents a lethal dose of a drug for 50% of the population. The line “Homeostasis” represents the normal state of the human body. This is the dynamic balance or steady state involving levels of salts, water and sugar in the body’s fluid. Some examples of homeostasis includes:

• Controls (regulates) body temperature

• Maintaining supplies of bodily fluids

• Intake of oxygen and expelling carbon dioxide

• Eliminating waste

• Integration of functions of the various body systems

NTM represents the body’s neurotransmitters. Neurotransmitters are little chemical messengers in the body. When you take a street drug into the human body, the drug acts like a massive release of a neurotransmitter. This makes it so that we can see the signs and symptoms that we notice when talking to someone that is high. The body will stop or slow the production of that neurotransmitter, which makes the void we see in the picture above. When the drug is out of the body, the gap that we see is negative feedback. We will now see the opposite signs of influence in the person we are evaluating.

Determining Under the Influence vs. Withdrawals

So, referring back to our table above, a person under the influence of an opiate will have constricted pupils, slow pulse and will basically be lethargic. However, when the opiate leaves their body, they will now have dilated pupils, fast pulse and will be hyper while you deal with them. These are the signs and symptoms we see when we see someone using a CNS Stimulant (cocaine/amphetamine/etc). This is an example of negative feedback.

But, don’t just look at the signs and symptoms. Look at the person overall. You will notice that they seem sickly. They will have the sniffles, they will complain that they feel, “icky” and will have hot and cold flashes. Often times, I see them holding themselves. That is because they feel like they have the flu. Imagine when you had the flu. Now multiply that by ten fold and that is how they feel. That is pretty hard. When you had the flu, you probably let everyone know how miserable you were. Opiate addicts going through withdrawals are no different. Now you know that their influence is not a CNS Stimulant, but opiate withdrawal.

For the officers on the list, do you think you could arrest someone for driving under the influence if they are suffering opiate withdrawals? Technically, an opiate user suffering from withdrawals may be considered under the influence. Look at their symptoms: dilated pupils, fast pulse, sweating, hot and cold flashes, impaired time perceptions. These are all signs and symptoms of drug influence. Doing a DAR or DRE exam in addition to your SFST’s will show whether the subject going through withdrawals can safely operate a motor vehicle or not.

This subject, along with many others, are covered extensively in our 3 day Drug Abuse Recognition Course as well as the 4 day DAR/DUI course. I am currently looking for agencies to sponsor the three day school outside of California. If you are interested in hosting, feel free to contact me and we can make arrangements.