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Stimulant use disorder

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Updated 2024 ASAM/AAAP guidelines for the diagnosis and management of stimulant use disorder.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of stimulant use disorder are prepared by our editorial team based on guidelines from the American Society of Addiction Medicine (ASAM/AAAP 2024), the American Heart Association (AHA 2023,2016), the World Health Organization (WHO 2023), the American Heart Association (AHA/ASA 2021), the Society of Cardiovascular Computed Tomography (SCCT/SCMR/AHA/SAEM/ASE/ACC/ACCP 2021), the United States ...
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Screening and diagnosis

Indications for screening: as per DoD/VA 2021 guidelines, insufficient evidence to recommend for or against screening for drug use disorders in primary care to facilitate enrollment in treatment.
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  • Indications for testing (hypertension)

  • Indications for testing (chest pain)

  • Indications for testing (stroke)

  • Indications for testing (status epilepticus)

Diagnostic investigations

Initial assessment: as per AAAP/ASAM 2024 guidelines, identify any urgent or emergent biomedical or psychiatric signs or symptoms, including acute intoxication or overdose, in patients being assessed for stimulant use disorder and provide appropriate treatment or referrals.
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  • Evaluation of intoxication and withdrawal (clinical assessment)

  • Evaluation of intoxication and withdrawal (laboratory testing)

Medical management

Antidepressants: as per AAAP/ASAM 2024 guidelines, consider offering bupropion to promote cocaine abstinence in patients with cocaine use disorder.
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  • Anticonvulsants

  • Psychostimulants (general principles)

  • Psychostimulants (modafinil)

  • Psychostimulants (amphetamines)

  • Psychostimulants (methylphenidate)

  • Other agents

  • Management of hyperadrenergic symptoms

  • Management of chest pain

  • Management of acute coronary syndrome

  • Management of cardiomyopathy

  • Management of QRS widening

  • Management of seizures

  • Management of psychosis

  • Management of cocaine overdose

  • Management of amphetamine overdose

  • Management of amphetamine withdrawal

Nonpharmacologic interventions

Brief intervention: as per AAAP/ASAM 2024 guidelines, offer screening and a brief intervention in patients using stimulants, using motivational interviewing or motivational enhancement therapy to facilitate referral for stimulant use disorder assessment where necessary.
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  • Psychotherapy

  • Mindfulness-based therapies

  • Technology-based interventions

  • Recovery-oriented interventions

  • Harm reduction strategies

  • Nutritional support

Specific circumstances

Pregnant and postpartum patients: as per AAAP/ASAM 2024 guidelines, incorporate additional elements into the comprehensive assessment of stimulant use disorder in pregnant patients, including:
referrals to prenatal care providers if not already established
reviewing eligibility criteria for locally available programs that specifically address biopsychosocial needs related to pregnancy and parenting, such as childcare and Women, Infants, and Children programs. (Low certainty, Strong Recommendation).
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  • Vulnerable populations

  • Injection drug users

  • Patients with comorbid disorders

  • Patients with opioid use disorder

  • Patients with alcohol use disorder

  • Patients with tobacco use disorder

  • Patients with depressive disorder

  • Patients with ADHD

Patient education

Oral health counseling: as per AAAP/ASAM 2024 guidelines, advise patients using stimulants to maintain good oral hygiene and seek regular dental care, as they are at high risk of dental complications, such as poor dentition, dental carries, abscesses, and subsequent malnutrition. Offer referrals to dental care providers as necessary.
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  • Sexual health counseling

Preventative measures

HIV preexposure prophylaxis: as per AAAP/ASAM 2024 guidelines, offer HIV preexposure prophylaxis in patients using stimulants and having risk factors for HIV:
engaging in risky sexual behaviors
regularly accessing postexposure prophylaxis
injecting drugs.
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