Detecting benzodiazepine use through induced eye convergence inability with a smartphone app: a proof-of-concept study

BACKGROUND: Benzodiazepines (BZDs) are readily available potent drugs that act as central depressants. These drugs are widely used, misused, and abused. For patients with BZD use disorder, the traditional sobriety monitoring method is periodic urine tests.

METHODS: The utility of eye-scanning data related to non-convergence (the ability to cross eyes) collected using smartphones with the Previct Drugs app before and after ingestion of the BZD lorazepam for detecting BZD-driven effects was evaluated using data from 12 individuals from a historic clinical study (NCT05731999). Using a novel metric that represents the change in distance between irises when converging eyes, either in absolute terms (NCdiff) or individualized (NCdiffInd), classifiers were built using logistic regression.

RESULTS: The ability to converge eyes is a strongly individual and acquired skill that is impaired after ingesting lorazepam. The maximum NCdiff for a BZD-sober individual may be smaller than the impaired NCdiff for another individual. Using the NCdiff measured in a sober condition after approximately 1 week of regular eye-scanning as the individual baseline to form NCdiffInd produced a highly functional classifier with an area under the curve (AUC) = 0.88, which was superior to a classifier based on NCdiff with an AUC = 0.79.

CONCLUSIONS: The loss of eye convergence induced by lorazepam is continuous, individual, and can be partial. Smartphone-based eye-scanning technology combined with a classifier adapted to the ability of eye convergence of individuals shows promising performance in detecting ingestion of lorazepam.