Amphetamine and methamphetamine use disorder

Last reviewed: 2 Sep 2023
Last updated: 22 Feb 2023

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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • comprehensive blood panel
  • cardiac blood markers
  • serum creatine phosphokinase
  • urine toxicology testing
  • gas chromatography/mass spectrometry of urine or blood
  • ECG
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • blood toxicology testing
  • abdominal flat plate x-ray
  • abdominal CT scan
  • echocardiogram
More investigations to consider

Treatment algorithm

ACUTE

acute intoxication

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.

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