Stimulant Use Disorders

Stimulants Overview - Buzz Basics

• Common Types:
  • Cocaine
  • Amphetamines (e.g., Methamphetamine, MDMA/Ecstasy)
  • Methylphenidate
  • Synthetic cathinones ("Bath salts")
• Core Mechanism: ↑ synaptic Dopamine (DA), Norepinephrine (NE), Serotonin (5-HT).
  • Cocaine: Blocks reuptake of DA, NE, 5-HT.
  • Amphetamines: ↑ release & block reuptake of DA, NE.
• Key Effects: Euphoria, ↑ alertness, ↓ appetite, sympathetic activation.
• Epidemiology: Rising trend globally and in India, especially among youth.

  ⭐ Formication (sensation of insects crawling on/under skin) is a common tactile hallucination in chronic cocaine/amphetamine use. oka

Intoxication & Overdose - Highs & Hazards

• Intoxication (Sympathomimetic Toxidrome):
  • Presents with ↑SNS activity. 📌 Mnemonic: "MATHS" (Mydriasis, Agitation/Arrhythmia, Tachycardia/Tremors, Hypertension/Hyperthermia, Seizures/Sweating).
  • CNS: Euphoria, agitation, psychosis, seizures, hyperthermia (can exceed 40°C).
  • CVS: Tachycardia, hypertension, arrhythmias, chest pain (MI risk).
  • Pupils: Mydriasis (dilated). Skin: Diaphoresis.
• Overdose Hazards (Life-Threatening):
  • Cardiovascular: MI, aortic dissection, stroke.
  • Neurological: Status epilepticus, intracranial hemorrhage.
  • Metabolic: Severe hyperthermia → rhabdomyolysis → AKI.
• Emergency Management:
  • ABCs, IV access, cardiac monitoring.
  • Benzodiazepines (e.g., IV Lorazepam): First-line for agitation, seizures, tachycardia, hypertension.
  • Aggressive cooling for hyperthermia.
  • ⚠️ Avoid pure beta-blockers (risk of unopposed alpha-stimulation causing paradoxical hypertension/coronary vasoconstriction).

  ⭐ In cocaine-associated chest pain, benzodiazepines and nitrates are key. Avoid beta-blockers initially.

Withdrawal & Chronic Use - Crash & Complications

• Stimulant Withdrawal ("Crash"):
  • Symptoms: Intense dysphoria, fatigue, anhedonia, ↑ appetite, vivid dreams.
  • Psychomotor changes (retardation/agitation), insomnia/hypersomnia.
  • Timeline: Peaks 2-4 days, resolves ~1 week. High relapse risk.
• Chronic Use Complications:
  • Cardiovascular: MI, arrhythmias, cardiomyopathy, HTN, aortic dissection.
  • Neurological: Stroke, seizures, movement disorders, cognitive impairment.
  • Psychiatric: Psychosis (paranoid delusions, formication - "meth bugs"), anxiety, depression.

    ⭐ Formication (sensation of insects crawling on skin) is a classic tactile hallucination in chronic stimulant users, often leading to skin picking.

  • Dental: "Meth Mouth" - severe decay (xerostomia, bruxism, poor hygiene).
  • Infectious (IV use): HIV, Hepatitis B/C, endocarditis.
  • Other: Malnutrition, skin excoriations, nasal septal perforation (snorting). oka

Diagnosis & Management - Spotting & Stopping

• Diagnosis (DSM-5): Pattern of use with ≥2 of 11 criteria in 12 months (e.g., impaired control, social impairment, risky use, tolerance, withdrawal). Severity: Mild (2-3), Moderate (4-5), Severe (≥6).
• Screening: Urine drug screen (UDS), clinical interview (e.g., ASSIST, DAST-10).
• Management:
  • Psychosocial interventions are cornerstone.
    • Contingency Management (CM): Reinforces abstinence.
    • Cognitive Behavioral Therapy (CBT).
  • Supportive care for withdrawal ("crash").

⭐ Currently, no FDA-approved pharmacotherapy exists for stimulant use disorder; management relies heavily on behavioral therapies.

High‑Yield Points - ⚡ Biggest Takeaways

• Stimulants (e.g., cocaine, amphetamines) primarily ↑ dopamine.
• Intoxication: Euphoria, agitation, mydriasis, tachycardia, hypertension, formication ("cocaine bugs").
• Withdrawal: Dysphoria, fatigue, ↑ appetite, psychomotor changes, vivid unpleasant dreams.
• Complications: Myocardial infarction, stroke, seizures, nasal septal perforation (cocaine).
• Acute Intoxication Management: Benzodiazepines for agitation/seizures; AVOID beta-blockers (unopposed alpha risk).
• Withdrawal Management: Supportive care; no specific FDA-approved pharmacotherapy for dependence.