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Amphetamine and methamphetamine use disorder

Last reviewed: 10 Nov 2024
Last updated: 30 May 2024

Summary

Definition

History and exam

Key diagnostic factors

  • compulsive stimulant use despite negative consequences
  • hypervigilance
  • hyperarousal
  • anxiety
  • hallucinations
  • chest pain
  • paranoia
  • increased BP
  • dilated pupils
  • tachycardia
  • skin picking, skin lesions, excoriations
  • dental decay, gum disease
  • trismus, bruxism
  • dyspnea
  • hyperthermia
Full details

Other diagnostic factors

  • guarded/suspicious behavior
  • euphoria
  • alertness
  • increased concentration
  • headache
  • irritability
  • aggression
  • nausea, vomiting
  • depression
  • anorexia
  • increased motor activity
  • anhedonia
  • hemoptysis
  • pacing
  • cardiac arrhythmias
  • vasculitis
  • cerebral hemorrhage
Full details

Risk factors

  • Adverse childhood events
  • 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
Full details

Diagnostic tests

1st tests to order

  • comprehensive blood panel
  • cardiac blood markers
  • serum creatine kinase
  • hepatitis serology
  • HIV serology
  • urine toxicology testing
  • gas chromatography/mass spectrometry of urine or blood
  • ECG
  • chest x-ray
Full details

Tests to consider

  • blood toxicology testing
  • abdominal flat plate x-ray
  • abdominal CT scan
  • echocardiogram
Full details

Treatment algorithm

INITIAL

acute intoxication or withdrawal

ACUTE

nonpregnant adults and adolescents

pregnant

ONGOING

sustained remission

continued use or relapse

treatment resistant

Contributors

Authors

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

Distinguished Professor of Medicine

Anesthesiology, Pharmacology and Toxicology, and Emergency Medicine

Division of Pulmonary and Critical Care Medicine

University of California Davis School of Medicine

Sacramento

CA

Disclosures

TEA declares that he has no competing interests.

Peer reviewers

Alexis Ritvo, MD, MPH

Assistant Professor and Addiction Psychiatry Fellowship Director

University of Colorado School of Medicine

Aurora

CO

Disclosures

AR declares that he is contracted as medical director for the Alliance for Benzodiazepines Best Practices, a nonprofit organization.

Maria Rahmandar, MD

Medical Director, Substance Use & Prevention Program

The Potocsnak Family Division of Adolescent and Young Adult Medicine

Ann & Robert H. Lurie Children's Hospital of Chicago

Assistant Professor

Northwestern University Feinberg School of Medicine

Chicago

IL

Disclosures

MR declares that she has no competing interests.

  • Differentials

    • Cocaine use disorder
    • Malignant hypertension
    • Anticholinergic drug exposure
    More Differentials
  • Guidelines

    • The ASAM/AAAP clinical practice guideline on the management of stimulant use disorder
    • Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient
    More Guidelines
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