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Stimulant use disorder

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 World Health Organization (WHO 2023), the American Heart Association (AHA 2023; 2016), the United States Department of Defense (DoD/VA 2021), the Society of Cardiovascular Computed Tomography (SCCT/SCMR/AHA/SAEM/ASE/ACC/ACCP 2021), the American Heart Association (AHA/ASA 2021), the National Institute for Health and Care Excellence (NICE 2020), the U.S. Preventive Services Task Force (USPSTF 2020), the American Academy of Family Physicians (AAFP 2018), the American College of Preventive Medicine (ACPM/PCNA/ABC/ASPC/ASH/AAPA/AGS/AHA/NMA/ACC/APhA 2018), the German Working Group on Methamphetamine-related Disorders (MD-GWG 2017), the American Heart Association (AHA/ACC 2014), the British Association for Psychopharmacology (BAP 2012), and the Neurocritical Care Society (NCS 2012).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per 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)

2.Medical management

Pharmacotherapy: as per WHO 2023 guidelines, do not use dexamphetamine, methylphenidate, or modafinil for the treatment of cocaine or stimulant use disorders because of safety concerns.
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  • Management of cocaine overdose

  • Management of amphetamine-induced psychosis

  • Management of amphetamine overdose

  • Management of amphetamine withdrawal

3.Nonpharmacologic interventions

Brief intervention
Offer screening and brief intervention in adults using psychostimulants. Include at least a single session, incorporating individualized feedback and advice on reducing or stopping psychostimulant consumption and the offer of follow-up care in the brief intervention.
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Consider referring adult patients with hazardous psychostimulant use or stimulant use disorder not responding to brief interventions for specialist intervention.
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  • Psychotherapy

  • Mindfulness-based therapies

  • Technology-based interventions

  • Recovery-oriented interventions

4.Specific circumstances

Patients with comorbid opioid use disorder
Insufficient evidence to favor either methadone maintenance therapy or buprenorphine maintenance therapy for patients using both opioids and cocaine.
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Insufficient evidence to recommend adding bupropion, desipramine, amantadine, or gabapentin to methadone or buprenorphine maintenance treatment to reduce cocaine use in opioid-dependent cocaine users.
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  • Patients with comorbid alcohol use disorder

  • Patients with cocaine-related acute coronary syndrome

  • Patients with cocaine-related cardiomyopathy