Former Democratic National Committee chairman Howard Dean refused to back down Tuesday from suggesting during the presidential debate that Donald Trump used cocaine.

Mr. Dean first raised the issue in a tweet when the Republican nominee repeatedly sniffled during the debate Monday night.

“You can’t make a diagnosis over the television. I would never do that,” Mr. Dean, a physician, said Tuesday on MSNBC. “But that is a signature of people who use cocaine. I’m not suggesting that he does.”

Mr. Dean insisted he wasn’t suggesting that Mr. Trump had a cocaine habit. He then listed the symptoms that he said pointed to cocaine use by the New York billionaire.

“He sniffs during the presentation, which is something that users do. He also has grandiosity, which is something that accompanies that problem. He has delusions,” Mr. Dean said. “He has trouble with pressured speech. He interrupted … Hillary Clinton 29 times. He couldn’t keep himself together.”

Mr. Dean, who objected to doctors speculating about the health of Mrs. Clinton when the Democratic nominee collapsed at a Sept. 11 memorial event, said that he was not doing the same thing to Mr. Trump.

He refused to apologize for the tweet raising the cocaine use issue or delete the tweet.

“Do I think at 70 years old he has a cocaine habit? Probably not. But, you know, it’s something that I think would be interesting to ask him and see if he ever had a problem with that,” said Mr. Dean, a former Vermont governor who ran unsuccessfully for the 2004 Democratic presidential nomination.

“I don’t think this was a ridiculous idea. Something funny was going on with Trump last night. Do I think it was cocaine? Probably not,” he said. “But again the sniffling, the grandiosity, delusions, the pressured speech. You know, this guy has already proven himself to be unstable. The question is why is he unstable.”

During the debate, Mr. Dean tweeted: “Notice Trump sniffing all the time. Coke user?”

The remark quickly went viral and provoked an onslaught of criticism.

“Said the Vermont acid freak,” responded Mikey Adams. Dean Stuckey tweeted to him “@GovHowardDean dude you’re such a [f***ing] loser.” And Ryan Miller replied: “It’s a stupid comment from someone who should be taking the high ground.”

National Lampoon chimed in: “Well it is The Real Thing.”

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