Road to Recovery Blog

When you suspect someone you care about might be using drugs, their eyes often tell the story first. “High eyes” (pupils that are unusually dilated or constricted, bloodshot, or glassy) are among the most recognizable physical signs of drug use. But the eyes are just one indicator, and different substances leave distinct physical markers on the body.

While behavioral changes like mood swings or social withdrawal are important indicators, the physical manifestations of drug use are often harder to hide and can provide crucial evidence that intervention is needed.

What Are “High Eyes”?

The term “high eyes” refers to the distinctive appearance of someone’s eyes when they’re under the influence of drugs. Different substances affect the eyes in different ways, making them a valuable diagnostic indicator for the type of drug being used.

How Different Drugs Affect the Eyes

• Marijuana: Bloodshot, red eyes with drooping eyelids are classic signs of marijuana use. The blood vessels in the eyes dilate, causing redness. Users often appear to have difficulty keeping their eyes fully open.
• Opioids (heroin, prescription painkillers): Extremely constricted pupils, often described as “pinpoint pupils,” are the hallmark of opioid use. The pupils remain small even in dim lighting and don’t respond normally to changes in light.
• Stimulants (cocaine, methamphetamine, Adderall): Dilated pupils that remain large even in bright light are typical. The eyes may appear wide and alert, sometimes with a glassy or unfocused quality despite apparent alertness.
• Hallucinogens (LSD, psilocybin): Significantly dilated pupils along with rapid eye movements. Users may have difficulty focusing their gaze and their eyes may dart around unpredictably.
• Benzodiazepines and alcohol: Droopy eyelids, bloodshot eyes, and a glassy, unfocused appearance. The person may have difficulty maintaining eye contact or keeping their eyes open.

Other Eye-related Signs

Beyond pupil changes, watch for:

• Excessive tearing or dry, irritated eyes
• Yellow tinting in the whites of the eyes (can indicate liver damage from long-term substance use)
• Inability to track moving objects smoothly
• Uncontrolled eye movements or twitching
• Different pupil sizes in each eye (can indicate a serious medical emergency)

Physical Signs of Stimulant Use

Stimulants like cocaine, methamphetamine, and prescription drugs like Adderall create distinct physical changes beyond the eyes.

Immediate Physical Indicators

People using stimulants often display:

• Excessive energy and restlessness, unable to sit still
• Rapid or irregular heartbeat you can sometimes see in their neck
• Jaw clenching or teeth grinding
• Excessive sweating, even in cool environments
• Rapid speech and animated gestures
• Decreased appetite and skipped meals
• Dilated pupils and wide-eyed appearance

Long-term Physical Signs

Chronic stimulant use creates more permanent physical changes:

• Significant weight loss and gaunt appearance
• Skin problems, including sores, acne, or a picking habit that leaves marks
• Dental problems (“meth mouth” with rotted or missing teeth)
• Premature aging of the skin
• Nose damage or frequent nosebleeds (from snorting)
• Track marks or skin infections (from injection)

Physical Signs of Opioid Use

Opioids (including heroin, fentanyl, and prescription painkillers like oxycodone) leave their own distinctive physical markers.

Acute Signs of Opioid Intoxication

When someone is currently under the influence of opioids, you might notice:

• Pinpoint pupils that don’t respond to light
• Drowsiness or “nodding off” at inappropriate times
• Slow, shallow breathing
• Slurred speech
• Flushed skin
• Itching and scratching
• Nausea and vomiting
• Constipation

Chronic Opioid Use Indicators

Long-term opioid use creates additional physical signs:

• Track marks, bruising, or scarring on arms, legs, hands, or feet
• Wearing long sleeves or pants even in warm weather to hide injection sites
• Frequent respiratory infections
• Weakened immune system leading to constant illness
• Poor hygiene and self-care
• Weight loss and malnutrition

Signs of Opioid Withdrawal

When someone dependent on opioids stops using, withdrawal symptoms appear quickly:

• Excessive sweating and chills
• Dilated pupils (opposite of intoxication)
• Muscle aches and restless legs
• Goosebumps (“cold turkey” appearance)
• Runny nose and watery eyes
• Severe gastrointestinal distress

Physical Signs of Marijuana Use

While marijuana is often considered less dangerous than other drugs, regular use still creates recognizable physical signs.

Active Marijuana Intoxication

Current marijuana use typically produces:

• Red, bloodshot eyes
• Droopy eyelids and slow blinking
• Dry mouth and frequent drinking
• Increased appetite and snacking
• Slower reaction times and movements
• Distinct odor on clothes, hair, and breath
• Poor coordination

Chronic Marijuana Use Signs

Long-term regular marijuana use can lead to:

• Persistent cough or respiratory issues
• Yellow-stained fingers (from holding joints)
• Decreased motivation and energy
• Memory problems affecting daily function
• Tolerance requiring more to achieve effects

Physical Signs of Alcohol Abuse

Alcohol abuse creates numerous physical indicators, especially with chronic use.

Acute Alcohol Intoxication

Someone currently intoxicated with alcohol shows:

• Smell of alcohol on breath or skin
• Slurred speech
• Unsteady gait and poor balance
• Flushed skin, especially on face
• Bloodshot or watery eyes
• Poor coordination and motor skills

Chronic Alcohol Abuse Indicators

Long-term heavy drinking causes significant physical changes:

• Facial redness and broken capillaries on the nose and cheeks
• Bloating, especially in the face and abdomen
• Yellow tint to skin and eyes (jaundice from liver damage)
• Hand tremors, especially noticeable in the morning
• Puffy face and under-eye swelling
• Spider veins and skin changes
• Poor dental health

Physical Signs of Benzodiazepine Abuse

Benzodiazepines like Xanax, Valium, and Ativan are commonly misused prescription medications that create specific physical effects.

Benzodiazepine Intoxication Signs

Active use of benzodiazepines creates:

• Extreme drowsiness and sedation
• Slurred speech similar to alcohol intoxication
• Poor coordination and balance problems
• Confusion and disorientation
• Slowed reflexes
• Droopy eyelids and glassy eyes
• Memory problems and difficulty concentrating

Long-term Physical Indicators

Chronic benzodiazepine misuse leads to:

• Persistent drowsiness even when not actively using
• Weakened muscles and overall physical weakness
• Cognitive impairment affecting daily tasks
• Increased accident and injury risk
• Tolerance requiring higher doses

General Physical Warning Signs Across All Substances

Regardless of the specific drug, certain physical signs often indicate substance abuse:

Changes in Physical Appearance

• Sudden weight loss or gain
• Neglected personal hygiene
• Unusual body odor
• Poor grooming and disheveled appearance
• Unexplained bruises, cuts, or injuries
• Burns on fingers or lips (from smoking)

Sleep Pattern Disruptions

• Insomnia or sleeping at unusual times
• Excessive sleeping or inability to wake up
• Irregular sleep schedules
• Appearing exhausted despite sleep

Physical Health Decline

• Frequent illness and weakened immunity
• Persistent cough or respiratory problems
• Nosebleeds and sinus issues
• Chronic headaches
• Unexplained seizures or tremors
• Poor wound healing

Paraphernalia and Other Evidence

Physical signs aren’t just on the body. Look for:

• Needles, syringes, or spoons
• Small plastic bags with residue
• Burned aluminum foil
• Glass pipes or other smoking devices
• Pill bottles not prescribed to them
• Eye drops used to mask bloodshot eyes

What to Do If You Notice These Signs

Recognizing physical signs of drug use is the first step. Taking appropriate action is crucial for helping your loved one get the treatment they need.

Approach with Compassion

If you notice these physical signs in someone you care about:

• Choose a private, calm moment to express concern
• Focus on specific observations without accusation
• Express care and worry rather than anger
• Avoid enabling by making excuses for their behavior
• Be prepared for denial or defensiveness

Encourage Professional Help

Substance use disorder is a medical condition requiring professional treatment. Encourage your loved one to:

• See a doctor for assessment
• Contact an addiction treatment center
• Attend a support group meeting
• Speak with a therapist or counselor

Know When It’s an Emergency

Some physical signs indicate a medical emergency requiring immediate action:

• Difficulty breathing or very slow breathing
• Blue lips or fingernails
• Unconsciousness or inability to wake
• Severe confusion or inability to speak
• Seizures
• Chest pain
• Irregular or racing heartbeat

Call 911 immediately if you observe any of these symptoms.

Getting Help at Rockland Treatment Center

If you’ve recognized physical signs of drug use in yourself or a loved one, Rockland Treatment Center in New Port Richey, Florida, can help. Our comprehensive treatment programs address all types of substance use disorders with evidence-based care tailored to individual needs.

We provide individual and group therapy, dual diagnosis treatment for co-occurring mental health conditions, and personalized treatment plans that address the physical, emotional, and psychological aspects of addiction. Our experienced team understands that seeking help takes courage, and we’re here to support you every step of the way.

Located in New Port Richey, we proudly serve residents throughout the Tampa Bay area, including Tampa, Clearwater, St. Petersburg, Brandon, Wesley Chapel, and Land O’ Lakes.

Don’t Wait for the Signs to Worsen

Physical signs of drug use often become more severe over time. The sooner someone receives professional treatment, the better their chances for full recovery and avoiding serious health complications. If you’ve noticed high eyes or other physical indicators in yourself or someone you love, don’t wait.

If you or a loved one is showing physical signs of drug use, contact Rockland Treatment Center today for a confidential conversation about treatment options. Recovery is possible, and we’re here to help.