How to approach a patient with amphetamine (stimulant) use?

From the Guidelines

When approaching a patient with amphetamine use, it is crucial to prioritize a comprehensive and non-judgmental assessment, focusing on psychosocial interventions as the first-line treatment, as recommended by international clinical guidelines 1. This approach is based on the understanding that amphetamine addiction is associated with significant psychological and physical sequelae, including psychosis, mental illnesses, neurological disorders, and cardiovascular dysfunctions, which necessitate a multifaceted treatment plan 1.

Key Components of Assessment and Management

• Perform a thorough physical examination, including vital signs, cardiovascular status, and neurological function, to identify potential complications of amphetamine use.
• Conduct laboratory tests, such as complete blood count, electrolytes, liver and kidney function tests, and urine toxicology, to assess the patient's overall health and detect any potential organ damage.
• For acute intoxication, provide a calm environment and consider administering benzodiazepines, such as diazepam or lorazepam, to manage agitation or tachycardia, while closely monitoring vital signs.
• In cases of severe hypertension, consider using antihypertensives like labetalol to prevent cardiovascular complications.

Long-term Management

• Consider a combination of cognitive behavioral therapy (CBT) and contingency management (CM) as the primary treatment approach, as these interventions have shown moderate efficacy in reducing amphetamine use 1.
• Although medications are not FDA-approved specifically for amphetamine use disorder, consider using bupropion or naltrexone to help reduce cravings, while also addressing any co-occurring psychiatric conditions like ADHD, depression, or anxiety.
• It is essential to recognize that amphetamines affect dopamine and norepinephrine systems, causing both acute stimulant effects and potential long-term neuroadaptations, which require a comprehensive treatment plan incorporating both pharmacological and psychological interventions 1.

From the FDA Drug Label

Before prescribing methylphenidate hydrochloride oral solution, assess each patient’s risk for abuse, misuse, and addiction Educate patients and their families about these risks, proper storage of the drug, and proper disposal of any unused drug. Throughout methylphenidate hydrochloride oral solution treatment, reassess each patient’s risk of abuse, misuse, and addiction and frequently monitor for signs and symptoms of abuse, misuse, and addiction

When approaching a patient with amphetamine use, assess the patient's risk for abuse, misuse, and addiction. It is essential to educate the patient and their family about the risks associated with amphetamine use, proper storage, and disposal of the drug. Frequent monitoring for signs and symptoms of abuse, misuse, and addiction is crucial throughout treatment.

• Key considerations:
  • Assess patient's risk for abuse, misuse, and addiction
  • Educate patient and family about risks and proper storage/disposal
  • Frequently monitor for signs and symptoms of abuse, misuse, and addiction 2 2

From the Research

Approaching a Patient with Amphetamine Use Disorder

When approaching a patient with amphetamine use disorder, it is essential to consider the following factors:

• The patient's physical and mental health status, including any potential comorbidities 3
• The patient's social and environmental factors, such as unstable housing, unemployment, and history of incarceration 4
• The patient's substance use history, including any concurrent use of other substances, such as opioids or cocaine 4

Treatment Options

The treatment options for amphetamine use disorder include:

• Psychosocial interventions, such as cognitive behavioral therapy, contingency management, and behavioral activation 5, 3, 6
• Pharmacological interventions, although the evidence for their effectiveness is limited and inconsistent 7, 6
• Combination of psychosocial and pharmacological interventions, which may be more effective than a single-treatment strategy 5

Key Considerations

When developing a treatment plan for a patient with amphetamine use disorder, the following considerations are crucial:

• The importance of comprehensive and sustained psychosocial interventions to reduce substance use and improve treatment adherence 5
• The need for individualized treatment approaches, taking into account the patient's unique needs and circumstances 3
• The potential for concurrent use of other substances, and the need for screening and intervention protocols to address this issue 4