Physical Examination

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A. Intranasal cocaine use may cause damaged nasal mucosa.

B. IV drug abuse may be associated with injection site scars and bacterial endocarditis.

C. Nystagmus is often seen in abusers of sedatives, hypnotics, or cannabis.

D. Mydriasis (dilated pupils) is often seen in persons under the influence of stimulants or hallucinogens, or in withdrawal from opiates. Miosis (pinpoint pupils) is a classic sign of opioid intoxication.

E. The patient should be assessed for the withdrawal symptoms.

F. An enlarged liver, spider angioma, impaired liver function, ascites, and signs of poor nutrition are indicators of chronic alcohol use.

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