Stimulant use disorder

From IDWiki

Background

  • A substance use disorder that includes cocaine (freebase, crack, rock), methamphetamine (crystal meth, meth, crystal, jib, speed, ice, tina, side), and other amphetamine-like substances (including prescription stimulants)
Stimulant Mechanism Half-life Routes of administration
Cocaine
Powder cocaine dopamine reuptake inhibitor 30 to 120 minutes snorted, but can be mixed with water and injected
Crack cocaine smoked, but can be mixed with an acid and injected
Freebase similar to crack, but may explode when smoked
Methamphetamine
Powder dopamine reuptake inhibitor, also increases dopamine release wide variability, about 10 to 30 hours snorted or pressed into a pill and taken orally
Base swallowed or injected
Crystal smoked, dissolved and injected, or snorted

Epidemiology

  • Stimulants are the second-most commonly used illicit substances after marijuana

Pathophysiology

  • All stimulants act mainly on the dopamine system

Clinical Manifestations

Acute intoxication

  • Common symptoms include tachycardia or bradycardia, pupillary dilatation, high or low blood pressure, sweating, chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain, arrhythmias, confusion, seizures, dyskinesia, dystonia, and coma
  • Severe intoxication may cause mania, paranoia, severe delirium, hypertension, agitation, sweating, formication and skin picking, choreoathetosis, and ataxia

Stimulant-induced psychosis

  • Schizophrenia complicates about 15 to 25% of chronic stimulant use within 2 to 5 years
  • Unclear what the causal relationship is between stimulants and schizophrenia

Other sequelae

Withdrawal

  • Symptoms include depressed mood, vivid dreams, fatigue, insomnia, hypersomnia, cravings, psychomotor agitation or impairment, increased appetite, agitation, irritability, and cognitive impairment

Investigations

Urine drug screen

Management

Intoxication

  • Generally focussed on supportive care

Withdrawal

Chronic treatment

References

  1. a b  Krista J. Siefried, Liam S. Acheson, Nicholas Lintzeris, Nadine Ezard. Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review. CNS Drugs. 2020;34(4):337-365. doi:10.1007/s40263-020-00711-x.
  2. ^  Vitor S. Tardelli, Adam Bisaga, Felipe B. Arcadepani, Gilberto Gerra, Frances R. Levin, Thiago M. Fidalgo. Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis. Psychopharmacology. 2020;237(8):2233-2255. doi:10.1007/s00213-020-05563-3.
  3. ^  Nadine Ezard, Adrian Dunlop, Michelle Hall, Robert Ali, Rebecca McKetin, Raimondo Bruno, Nghi Phung, Andrew Carr, Jason White, Brendan Clifford, Zhixin Liu, Marian Shanahan, Kate Dolan, Amanda L Baker, Nicholas Lintzeris. LiMA: a study protocol for a randomised, double-blind, placebo controlled trial of lisdexamfetamine for the treatment of methamphetamine dependence. BMJ Open. 2018;8(7):e020723. doi:10.1136/bmjopen-2017-020723.
  4. ^  Marco Antonio Nocito Echevarria, Tassio Andrade Reis, Giulianno Ruffo Capatti, Victor Siciliano Soares, Dartiu Xavier da Silveira, Thiago Marques Fidalgo. N-acetylcysteine for treating cocaine addiction – A systematic review. Psychiatry Research. 2017;251:197-203. doi:10.1016/j.psychres.2017.02.024.
  5. ^  Pier Paolo Pani, Emanuela Trogu, Rosangela Vacca, Laura Amato, Simona Vecchi, Marina Davoli. Disulfiram for the treatment of cocaine dependence. Cochrane Database of Systematic Reviews. 2010. doi:10.1002/14651858.cd007024.pub2.
  6. ^ minozzi2015an 
  7. ^  Yolanda Alvarez, Magí Farré, Francina Fonseca, Marta Torrens. Anticonvulsant drugs in cocaine dependence: A systematic review and meta-analysis. Journal of Substance Abuse Treatment. 2010;38(1):66-73. doi:10.1016/j.jsat.2009.07.001.
  8. ^  Mohit Singh, Dipinder Keer, Jan Klimas, Evan Wood, Dan Werb. Topiramate for cocaine dependence: a systematic review and meta-analysis of randomized controlled trials. Addiction. 2016;111(8):1337-1346. doi:10.1111/add.13328.
  9. ^  Clara Pérez-Mañá, Xavier Castells, Marta Torrens, Dolors Capellà, Magi Farre. Efficacy of psychostimulant drugs for amphetamine abuse or dependence. Cochrane Database of Systematic Reviews. 2013. doi:10.1002/14651858.cd009695.pub2.
  10. ^  Xavier Castells, Ruth Cunill, Clara Pérez-Mañá, Xavier Vidal, Dolors Capellà. Psychostimulant drugs for cocaine dependence. Cochrane Database of Systematic Reviews. 2016. doi:10.1002/14651858.cd007380.pub4.
  11. ^  Meha Bhatt, Laura Zielinski, Lola Baker-Beal, Neera Bhatnagar, Natalia Mouravska, Phillip Laplante, Andrew Worster, Lehana Thabane, Zainab Samaan. Efficacy and safety of psychostimulants for amphetamine and methamphetamine use disorders: a systematic review and meta-analysis. Systematic Reviews. 2016;5(1). doi:10.1186/s13643-016-0370-x.
  12. ^  Silvia Minozzi, Laura Amato, Pier Paolo Pani, Renata Solimini, Simona Vecchi, Franco De Crescenzo, Piergiorgio Zuccaro, Marina Davoli. Dopamine agonists for the treatment of cocaine dependence. Cochrane Database of Systematic Reviews. 2015. doi:10.1002/14651858.cd003352.pub4.
  13. ^  Pier Paolo Pani, Emanuela Trogu, Simona Vecchi, Laura Amato. Antidepressants for cocaine dependence and problematic cocaine use. Cochrane Database of Systematic Reviews. 2011. doi:10.1002/14651858.cd002950.pub3.
  14. ^  Marta Torrens, Francina Fonseca, Gerard Mateu, Magí Farré. Efficacy of antidepressants in substance use disorders with and without comorbid depression. Drug and Alcohol Dependence. 2005;78(1):1-22. doi:10.1016/j.drugalcdep.2004.09.004.
  15. ^  Blanca I Indave, Silvia Minozzi, Pier Paolo Pani, Laura Amato. Antipsychotic medications for cocaine dependence. Cochrane Database of Systematic Reviews. 2016. doi:10.1002/14651858.cd006306.pub3.