The CGC agreed that some tests may be considered based on symptomatology and presence of risk factors. Clinicians should consider a CBC, a CMP; liver function tests (LFTs); and markers for muscle breakdown (eg, CK, lactate), cardiac injury (eg, troponin), and renal injury (eg, BCR, urine albumin). They also have high rates of chronic health conditions and infectious diseases such as HIV and hepatitis C virus (HCV).185 Attending to this patient population’s SDOH would be expected to support overall health and wellness but not necessarily reduce substance use.
Characteristics of included studies [ordered by study ID]
The most common hallucinogens are lysergic acid diethylamide (LSD) and phencyclidine (PCP). People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried.
Behavioral Treatment Recommendations
Comparison 1 Any pharmacological treatment versus Placebo, Outcome 2 Average score in global state. Test of heterogeneity is important to check whether the results of studies are similar within each comparison. The reviewers checked whether differences between the results of trials were greater than could be expected by chance alone.
Qualitative data synthesis
The CGC agreed that clinicians should treat StUD and any co-occurring psychiatric disorders concurrently. The CGC recommended that clinicians use an integrated behavioral treatment approach whenever possible. Integrated care can range from concurrent care with coordination between providers to treatment by a provider or program that provides skilled interventions does gabapentin help you sleep for both conditions and addresses the interactions between them. In addition to reduction of cocaine use, there is evidence that psychostimulant medications can reduce ADHD symptoms in adults with co-occurring ADHD. While a systematic review showed mixed results,140 these may have been impacted by insufficient dosing (see Concurrent Management of StUD and ADHD).
Treatment of amphetamine abuse/use disorder: a systematic review of a recent health concern
A person should make sure that they take their prescription drugs as their doctor instructs and read any leaflet information to check for potential interactions with alcohol and other drugs. A person should only take medication that a doctor prescribes for them and should store their medications safely. These medications are part of the phenethylamine group, which includes drugs that can cause hallucinations, enhance a desire for social contact, or act as stimulants. Because of this, a person living with addiction is not “weak” or “lacking in willpower.” A person can manage this chronic, progressive health condition with appropriate treatment, just as people can manage many other health conditions. If you experience strong drug cravings, you may find it easier to go through amphetamine withdrawal in a hospital setting.
The results of the literature review inform estimates of the size of benefits and harms and the certainty of the evidence of effects. A survey distributed to the patient panel and the clinical experience of the CGC informed judgments about patient preferences for different intervention outcomes. The feasibility of interventions was determined primarily by the clinical experience of the CGC, as acceptability and feasibility were not targets of the literature review. Prescribed courses of treatment described in this Guideline are most effective if the recommendations are followed as outlined. Because lack of patient understanding and adherence may adversely affect outcomes, clinicians should make every effort to promote the patient’s understanding of and adherence to prescribed and recommended treatment services.
The CGC noted the risk of misusing PDMP information would not preclude the benefit of initiating a conversation about a patient’s prescriptions. It is important to differentiate between short-term symptoms of stimulant withdrawal and underlying psychiatric disorders to determine appropriate treatment. When considering pharmacotherapies, clinicians should always consider the risks (eg, NMS, serotonin syndrome) and benefits in the context of each patient’s full clinical presentation. Benzodiazepines are generally considered first-line treatment for the management of stimulant-induced agitation (see Appendix N for additional agents to consider). Significant agitation should typically be managed in acute care settings given the need for a higher level of monitoring and clinical resources (eg, intravenous [IV] medications, telemetry, cooling) than are typically available outside of controlled settings. An appropriate treatment setting allows for assessment of acute issues and complications, screening for acute intoxication potential, monitoring of the intoxication syndrome, and administration of appropriate clinical interventions.
Providers may also use amphetamines to treat obesity, though this is less common. No tests can determine drug misuse or addiction, but a medical professional can discuss a person’s substance use with them and assess possible risk factors that support the possibility. In 2020, about 5.1 million people in the United States reported misusing alcohol and the etiology of depression american journal of psychiatry prescription stimulants, such as Adderall, within the past year. Reports indicate that children as young as eighth grade have misused prescription medications for ADHD. They treat attention deficit hyperactivity disorder and narcolepsy, a sleep disorder. They’re also sometimes used by medical professionals to treat other disorders.
It is generally agreed that the fixed effect model is valid as a test of significance of the overall null hypothesis (i.e. ‘no effect in all studies’). A statistically significant result obtained by the use of this model indicated that there is an effect in at least one of the studies. Because of these advantages, the fixed effect model was used for the synthesis of a group of data with homogeneity. Although a random effect model can be applied for the synthesis of a group of data with significant heterogeneity, the results obtained by the synthesis of this group of data have to be interpreted with great caution.
If seizures are not controlled by GABAergic medications during severe stimulant intoxication, clinicians may consider emergently inducing paralysis with monitoring (ie, EEG). If a patient is at the level of end-organ dysfunction, cooling should be achieved via medications to inhibit muscle activity (eg, with benzodiazepines) and, potentially, other strategies (eg, IV fluids, lavage, evaporative cooling, ice baths if life-threatening). When ordering a CBC, clinicians should be alert to neutrophil levels in patients with cocaine intoxication or withdrawal.254 Levamisole is a common adulterant in the cocaine supply and can cause immunosuppression—in particular, neutropenia—and small vessel vasculitis. The amount of levamisole contaminating the drug supply and the resulting degree of clinical concern varies by region and over time.
A person may have a stroke, heart problems, or liver or kidney damage due to misuse of amphetamines. You may continue to crave the stimulant even though you know they’re causing persistent or recurrent physical or psychological problems. You’ve built up a tolerance if you need larger doses of amphetamines to achieve the same effect that lower doses once created. The largest chunk, $400,000, will go towards the creation of a Fair Haven harm reduction center.
Naturalistic studies of amphetamine withdrawal symptoms and course are also crucial for the development of study designs appropriate for further treatment studies of amphetamine withdrawal. Symptoms of amphetamine withdrawal are time limited, with most resolving in a week. In clinical practice and in the studies reviewed, treatment antibiotics and alcohol is started as soon as possible following the last dose of amphetamine. In addition to medication, it can be helpful to provide psychosocial and/or behavioral treatments for stimulant abuse to assist the patient in amphetamine withdrawal in sustaining abstinence from amphetamine once their treatment is completed (Lee 2008).
- This Guideline aims to assist clinicians in treating individuals with StUD (including adolescents and individuals who are pregnant), as well as individuals experiencing stimulant intoxication or withdrawal, and individuals who are at high risk of developing StUD.
- People who follow the prescribed, therapeutic dose are unlikely to experience severe adverse effects.
- In certain cases, psychotic symptoms can last for months or years after methamphetamine abuse has ceased.
- People dependent on amphetamines become tired or sleepy—an effect that may last for 2 or 3 days after stopping the drug.
- Clinicians should also inquire about contraceptive practices and related needs to help patients avoid unintended pregnancies.
- You live at home with a strong support system and commute to a treatment facility multiple days a week for counseling and other forms of therapy.
The CGC noted that clinician expertise in both StUD and psychiatric disorders is helpful when treating patients with co-occurring conditions. If stimulant-induced psychosis or mania is suspected, the CGC suggested that clinicians consider a gradual taper off antipsychotic medications after a period of symptom remission. The only undesirable effect noted was the risk of recurrence of psychotic symptoms; no reliable evidence was found to predict the risk of symptom recurrence after tapering using factors such as history of psychosis or symptom severity. Thus, the CGC concluded that the benefits of tapering outweigh potential risks, particularly for patients with stimulant-induced psychosis or mania. While the evidence for combination bupropion and naltrexone is promising, the CGC noted a few implementation considerations.
Ideally, adolescent and young adult patients would be referred to age-specific treatment and other support programs to address identified biopsychosocial needs, including programs to address food or housing insecurity or transportation needs. However, the CGC noted that few such programs exist, depending on the region, and emphasized that the lack of available specialized programs should not delay or preclude initiation of treatment. When treating adolescents and young adults, the CGC noted that it is especially important to seek additional sources of collateral information beyond family members—such as teachers, guidance counselors, coaches, and roommates—with patient permission. This is also important when establishing a late diagnosis of ADHD in patients with StUD, which requires symptoms to present prior to age 12, even if the diagnosis is made later.