When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Amphetamine and methamphetamine use disorder

Last reviewed: 5 Sep 2023
Last updated: 22 Feb 2023



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 intoxication

nonpregnant adults and adolescents



sustained remission

continued use or relapse

treatment resistant



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




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




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




MR declares that she has no competing interests.

  • Differentials

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

    • 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
    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