Amfetamine use disorder

Last reviewed: 3 Jan 2023
Last updated: 10 Sep 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • hyper-vigilance
  • hyper-arousal
  • anxiety
  • hallucinations
  • chest pain
  • paranoia
  • increased BP
  • dilated pupils
  • tachycardia
  • hyponatraemia
  • skin picking, skin lesions, excoriations
  • dental decay, gum disease, 'meth mouth
  • trismus, bruxism
  • dyspnoea
  • hyperthermia
More key diagnostic factors

Other diagnostic factors

  • guarded/suspicious behaviour
  • euphoria
  • alertness
  • increased concentration
  • headache
  • irritability
  • aggression
  • nausea, vomiting
  • depression
  • anorexia
  • increased motor activity
  • anhedonia
  • haemoptysis
  • increased empathy
  • pacing
  • cardiac arrhythmias
  • vasculitis
  • cerebral haemorrhage
Other diagnostic factors

Risk factors

  • history of previous stimulant misuse
  • violent or criminal 'lifestyle
  • polysubstance misuse
  • history of body packing, body stuffing, or 'parachuting
  • history of illicit manufacturing or distribution
  • pre-existing depression
More risk factors

Diagnostic investigations

1st investigations to order

  • urine toxicology testing
  • gas chromatography/mass spectrometry of urine or blood
  • ECG
  • serum sodium
  • serum creatine phosphokinase
  • abdominal x-ray
More 1st investigations to order

Investigations to consider

  • blood toxicology testing
  • echocardiogram
More investigations to consider

Treatment algorithm


acute toxic exposure via ingestion


chronic misuse and dependence



Timothy E. Albertson, MD, MPH, PhD, FRCP
Timothy E. Albertson

Professor of Medicine

Anesthesiology, Pharmacology and Toxicology, and Emergency Medicine

Division of Pulmonary and Critical Care Medicine

University of California Davis School of Medicine




TEA declares that he has no competing interests.

Peer reviewers

Richard J. Geller, MD, MPH, FACP

Associate Clinical Professor of Medicine

University of California San Francisco School of Medicine

San Francisco



RJG declares that he has no competing interests.

  • Differentials

    • Cocaine misuse
    • Malignant hypertension
    • Anticholinergic drug exposure
    More Differentials
  • Guidelines

    • Guidelines for identification and management of substance use and substance use disorders in pregnancy
    • Substance misuse detainees in police custody: guidelines for clinical management (fourth edition)
    More Guidelines
  • Patient leaflets

    Amphetamine-use disorder

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer