Former Gov. Howard Dean, right, discusses Donald Trump during an MSNBC appearance. (Screenshot: MSNBC)

Howard Dean isn’t backing down.

On an already unusual debate night, Dean — a former Vermont governor, presidential candidate and Democratic National Committee chair — raised some eyebrows when he sent out a tweet asking: “Notice Trump sniffing all the time. Coke user?”

Notice Trump sniffing all the time. Coke user? — Howard Dean (@GovHowardDean) September 27, 2016





It did indeed sound like Republican nominee Donald Trump was battling allergies or congestion Monday night, although he insisted Tuesday on “Fox & Friends” that “there was no sniffling.” But while the sniffling immediately led to jokes on Twitter — and, naturally, a @TrumpSniff parody account — Dean’s tweet was a surprising take from a high-profile supporter of Democratic nominee Hillary Clinton.

Dean was asked about the tweet Tuesday afternoon on MSNBC, and he said he would never attempt to make a diagnosis over the television. Before he was DNC chair and governor of Vermont, Dean spent 10 years running a family medical practice with his wife, who is also a physician.

Even so, Dean doubled-down on his “user” observation, pointing out what he’d noticed about Trump’s performance in the debate. “He sniffs during the presentation, which is something [cocaine] users do,” said Dean. “He also has grandiosity, which is something that accompanies that problem. He has delusions — I’m not talking about being crazy, but for example when he told everybody he was very smart not to pay taxes, then denied he said it in front of a 100 million people.”

“Do I think at 70 years old he has a cocaine habit?” Dean asked. “Probably not. But you know it’s something I think it’d be interesting to ask him and see if he ever had a problem with that.”

Asked if he would delete the tweet or regretted publishing it, Dean was unapologetic: “No.”

It’s hard to know whether Dean is being serious, especially since his speculation is so similar to the “people are saying” formulation Trump often favors when lobbing vague charges at his own opponents.

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What’s clear is that the Clinton campaign is pleased by the turnabout on health questions, after weeks of enduring taunts from Trump and other Republicans about “coughing fits” and her diagnosis of pneumonia. On Clinton’s plane Tuesday, campaign officials referenced Trump’s “snorting” on Monday night.

Additional reporting by Liz Goodwin.