Which Drugs Cause Pinpoint Pupils?

Pinpoint pupils are pupils that appear and remain very small even in bright lights. The presence of pinpoint pupils as a symptom is often a warning sign for drug use, poisoning, or a hemorrhage. With prescription drug misuse on the rise both globally and in the U.S., particularly opioids, understanding what pinpoint pupils are and how you can identify them can possibly save a life.

What Are Pinpoint Pupils or Miosis?

Pinpoint pupils, medically known as miosis, are a distinctive condition where the pupils constrict to an unusually small size, appearing like the head of a pin. Unlike normal pupils that naturally dilate and constrict to adjust to changes in light, pinpoint pupils remain fixed and do not respond to variations in light.

While pinpoint pupils can occur naturally in some individuals, they often serve as a critical warning sign, particularly when associated with illicit drug use or substance abuse, poisoning, or certain medical conditions like Horner syndrome (a rare condition caused by a tumor or stroke that causes damage to the central nervous system or brainstem).

In some cases, the use of certain medications, such as clonidine (a medication prescribed for high blood pressure or hypertension), or eyedrops may also lead to the development of pinpoint pupils.

Understanding the nature of pinpoint pupils is essential for identifying potential substance abuse and getting appropriate treatment and support.

Connection Between Drug Use and Pinpoint Pupils

One of the most common causes of pinpoint pupils is drug use. Certain drugs, particularly opioids (like morphine or other prescription medications commonly used for pain relief) and other central nervous system depressants, can lead to constricted pupils causing them to become unusually small. This phenomenon is known as pinpoint pupils or miosis.


Opioid drugs, including heroin, morphine, codeine, oxycodone, hydrocodone, and fentanyl, are notorious for causing pinpoint pupils. As these drugs bind to opioid receptors in the brain and spinal cord, they also affect the autonomic nervous system, leading to the constriction of the pupils.

Other Depressants

Other central nervous system depressants like benzodiazepines (e.g., Xanax, Valium) and barbituates (e.g. phenobarbital) can cause pinpoint pupils. These drugs act on the brain’s GABA receptors, which play a role in pupil size regulation.


While pinpoint pupils are more commonly associated with depressant drugs, high doses of certain stimulants like cocaine and amphetamines can also result in constricted pupils. Stimulants exert their effects on different neurotransmitters, and their influence on pupil size can vary.

Drug Combinations

It’s essential to note that pinpoint pupils may also occur as a result of drug interactions or polydrug use. Mixing multiple substances, especially depressants can lead to unpredictable effects on pupil size.

Recognizing miosis in individuals who are not prescribed medication or receiving medical treatment that could cause this condition should raise suspicion of drug use. It is crucial for healthcare professionals, family members, and individuals themselves to be aware of this connection and be vigilant for potential signs of substance abuse. 

While this effect on pupils can be indicative of drug use, it’s important to remember that their presence alone does not confirm intoxication or abuse. Other medical conditions or factors can cause this symptom. Seeking professional evaluation and guidance is essential to determine the underlying cause and provide appropriate care and support.

Identifying Substance Abuse: Signs of Pinpoint Pupils

Identifying substance abuse can be challenging, but pinpoint pupils or changes in pupil size serve as a vital red flag. 

Both pinpoint and dilated pupils can be indicative of drug use and intoxication. Understanding these contrasting signs is crucial for recognizing substance abuse and seeking help.

Here’s what to look for:

What do Pinpoint Pupils (Myosis) look like?

Unusually small and fixed pupils: Pinpoint pupils appear constricted and main a tiny size, resembling the head of a pin. They do not respond to changes in light and remain smaller even in well-lit areas. These can also be present in those experiencing head injury or cluster headaches which makes it essential to consult with a medical professional if you have any concerns about constricted pupils.

What do Dilated Pupils (Mydriasis) look like?

Remarkably Enlarged: Dilated pupils are significantly larger than normal and do not constrict properly in response to light changes. They remain wide even in dim lighting. Stimulants like cocaine, amphetamines, and hallucinogens are frequently linked to pupil dilation.

Other Things to Look Out for with Substance Use Disorder (SUD) or Substance Abuse:

Behavior Changes: In addition to changes in pupil size, it is important to pay attention to any changes in behavior. Individuals experiencing drug intoxication may display altered behavior, mood swings, impaired coordination, or confusion. 

Combination of Signs: The presence of both pinpoint and dilated pupils, along with other drug-related paraphernalia or behavior, may suggest polydrug use or the use of a variety of substances.

If you notice any of these changes above, particularly in someone not under appropriate medical care, seek professional help immediately. Healthcare professionals, addiction specialists, or rehabilitation facilities can provide the necessary support and intervention for recovery.

Risks and Dangers of Pinpoint Pupils

While changes in pupil size themselves may not be harmful, they serve as a crucial indicator of potential risks associated with drug use and substance abuse. 

Substance Use Disorder (SUD): The American Psychiatric Association (APA) defines SUD as a complex condition where an individual experiences substance abuse, or, uncontrolled use of a substance despite harmful consequences. SUDs are also often referred to as addiction and can lead to a physical and psychological dependence on the substance, escalating the risks of overdose and other health complications.

Overdose Potential: The most common drugs associated with pinpoint pupils are opioids or depressant drugs. The presence of pinpoint pupils can indicate the possibility of an overdose. An overdose from opioids can lead to respiratory depression, loss of consciousness, and in severe cases, death.

Timely treatment is crucial for individuals struggling with addiction to break free from its grip and avoid potential long-term consequences.

Treatment Options for Substance Use Disorder

If constricted pupils are a consequence of substance use and you’re seeking guidance, we have solutions available at Riverside Recovery of Tampa. Substance use disorders often present a myriad of other side effects that may pose even greater dangers than the pupils alone. But it’s essential to remember that recovery, even from the most profound depths of addiction, is achievable. Our primary mission is to guide you toward long-lasting recovery, equipping you with the tools and support needed to regain control of your life.

Below are a few various options available to you or your loved one who is suffering from a substance use disorder.

  • Medical Evaluation: If pinpoint pupils are observed in someone not under appropriate medical care or prescribed medications that could cause this condition, seek immediate medical evaluation. There is no single cause for pinpoint pupils so consulting a qualified medical professional can help identify the exact reason for pinpoint pupils and recommend appropriate treatment.
  • Addiction Treatment Programs: Comprehension addiction treatment programs such as inpatient or outpatient rehabilitation, counseling, and support groups can provide the necessary tools and support to overcome substance use disorder and addiction.
  • Behavioral Therapy: Behavioral therapies, such as cognitive-behavioral therapy (CBT) and contingency management, are effective in addressing the psychological aspects of addiction and promoting lasting behavioral changes.
  • Medication-Assisted Treatment (MAT): MAT may be recommended for individuals struggling with opioid addiction. This approach combines behavioral therapies with medications like methadone, buprenorphine, or naltrexone to manage withdrawal symptoms and reduce cravings.

Recovery from substance abuse is possible with the proper support and guidance. At Riverside Recovery, we discuss the journey to recovery, the importance of seeking help from reputable rehabilitation facilities, and the positive outcomes that can be achieved with comprehensive treatment programs. We offer compassionate and evidence-based treatment for substance abuse. Our experienced team is dedicated to helping you or your loved ones find a path to healing and recovery. Take the first step towards a healthier and happier life by reaching out to us today.

To learn more about our treatment programs, contact our admissions team today.