Managing Stimulant Use Disorder







Stimulants are “uppers”, they speed the body up
Stimulants include: amphetamines, cocaine, crack, MDMA, Ritalin, Dexedrine, caffeine,
nicotine
Can be ingested, snorted, injected, or smoked
Often used as a survival strategy (eg to stay awake all night to protect themselves or
their belongings)
No evidence based pharmacological approach to treatment at present, although trials
have occurred with a number of drugs including Ritalin, Dexedrine, topiramate,
modafinil and meth amphetamine
Evidence supports the use of contingency management, motivational interviewing and
CBT as well as other psychosocial approaches
Patients can be referred to the contingency management group at RAAC by AMCT SW
Substance
Food
Sex
Morphine
Nicotine
Cocaine
Amphetamines
Crack
Initial Effects
Lasts 5-30 mins
Feelings of intense euphoria
Warm skin, dry mouth
Feeling thirsty, not hungry
Rapid HR and RR
Auditory hallucinations
Withdrawal
Feeling restless, sweaty and
twitchy
Sensitive to light and noise
Feelings of paranoia
Strong cravings for more crack
Dopamine increase (relative to baseline)
150%
200%
200%
225%
350%
1000%
Crystal Meth
Initial Effects
Lasts 4-24+ hours
Feeling alert and energetic
Not feeling hungry or tired
Dry mouth
Rapid HR and RR
Feeling restless, anxious,
paranoid, unable to sleep
Withdrawal
Feeling extremely tired, unable
to sleep, anxious,
Hungry and thirsty
Clenched jaw
Strong cravings for more meth
Stimulant Overdose
Tachycardia
Tachypnia
Hypertension
hyperthermia
Diaphoresis, tremors
Chest pain
Anxiety, paranoia, agitation
Confusion, hallucinations
Loss of consciousness
Vomiting
Seizures
Severe headache
Jerking limbs, involuntary body
movements
Sleep deprivation
There is no antidote to stimulant overdose, treatment requires supportive management.
Naloxone will not work for a stimulant overdose, but should still be used if presentation
cannot be differentiated form opiate overdose











Stimulant withdrawal is often confused with over sedation from opioids. Patients who
use both opioids and stimulants should still have their opioid withdrawal treated even if
they are in bed sleeping as a result of withdrawal from stimulants. Patients withdrawing
from stimulants will likely have a POSS score of “S”, patients over sedated from opioids
will have a POSS score of 3 or 4
If the patient has no pulse, call code blue and initiate CPR
Stimulants can be contaminated with opioids and this has resulted in inadvertent opioid
overdoses
If alert and can safely swallow, encourage hydration
Encourage them not to take any more substances until the current substance has worn
off
Low stimulation environment if possible (eg. private room or semi-private room)
Reassurance and support
Consider need for medications such as anxiolytics and antipsychotics
If overheated, cool them down with cold towels or ice packs
Always offer harm reduction strategies and supplies to patients who use stimulants and
inform them of OPS hours and location
Drug testing is available at the OPS for fentanyl and benzodiazepines, this can be
especially life-saving for people who only use stimulants as they do not have a tolerance
for opioids