Amphetamine and methamphetamine use disorders involve compulsive substance use despite negative consequences.
Polysubstance use, for example with opioids, is an increasing problem, and increases mortality.
Psychosocial interventions such as contingency management, cognitive behavioral therapy (CBT), and motivational interviewing are the mainstays of treatment; no medication has yet proven effective.
Effective management strategies incorporate a degree of long-term continuing care in addition to acute management of exacerbations.
Evaluation and management of co-occurring psychiatric conditions is essential.
Not all people with amphetamine/methamphetamine use disorder are actively seeking treatment; harm reduction strategies are especially important for this group.
Amphetamine and methamphetamine are non-catecholamine sympathomimetic amines that may be taken by various routes including inhalation, intravenous, intramuscular, or transmucosal (oral/nasal). They have a number of therapeutic uses including for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adults, for narcolepsy, and occasionally as a short-term treatment for obesity. Prescribed doses of amphetamine and methamphetamine are typically much lower than those taken in misuse. Prescribed stimulants may be diverted into the illegal market, and methamphetamine is often manufactured illicitly. Amphetamine and methamphetamine are both highly addictive stimulants, which affect the central nervous system in similar ways; methamphetamine differs from amphetamine in that, at comparable doses, greater amounts of drug get into the brain, resulting in increased potency. Methamphetamine also has longer-lasting and more severe adverse effects on the central nervous system than amphetamine. This results in a higher potential for widespread misuse for methamphetamine compared to amphetamine.
Amphetamine and methamphetamine use disorders involve the recreational use of these substances (other than for unapproved medical indication) and are defined by a pattern of substance use leading to clinically significant impairment or distress, defined by the presence of at least 2 of 11 symptoms during a 12-month period. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) classifies both amphetamine and methamphetamine as "amphetamine-type substances" and lists their respective use disorders under the subheading "stimulant use disorders." Stimulant use disorders may be mild, moderate, or severe depending on the number of symptoms within a 12-month period.
See: Amphetamine overdose.
History and exam
Key diagnostic factors
- compulsive stimulant use despite negative consequences
- chest pain
- increased BP
- dilated pupils
- skin picking, skin lesions, excoriations
- dental decay, gum disease
- trismus, bruxism
Other diagnostic factors
- guarded/suspicious behavior
- increased concentration
- nausea, vomiting
- increased motor activity
- cardiac arrhythmias
- cerebral hemorrhage
- history of previous stimulant use
- selling/producing drugs, or other criminal justice system involvement
- polysubstance use
- history of body packing, body stuffing, or "parachuting"
- history of illicit manufacturing or distribution
- history of a mental health disorder
- Adverse childhood events
1st investigations to order
- comprehensive blood panel
- cardiac blood markers
- serum creatine phosphokinase
- urine toxicology testing
- gas chromatography/mass spectrometry of urine or blood
- chest x-ray
Investigations to consider
- blood toxicology testing
- abdominal flat plate x-ray
- abdominal CT scan
nonpregnant adults and adolescents
continued use or relapse
- Cocaine use disorder
- Malignant hypertension
- Anticholinergic drug exposure
- Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient
- Clinical practice guideline for the management of substance use disorders
Amphetamine-use disorderMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer