Stimulants

Stimulants are sympathomimetic substances that include cocaine, amphetamines, and cathinones. Approximately 1% of Americans have used illicit stimulants in the past month, and nearly 25,000 deaths were attributed to stimulant overdose in 2017. Acute effects include tachycardia, elevated blood pressure, and euphoria. High doses of stimulants may lead to cardiac arrhythmias, severe hypertension, agitation, myocardial infarction, aortic dissection, stroke, hyperthermia, or rhabdomyolysis. Abstinence after regular use of stimulants may lead to dysphoria, fatigue, insomnia, and agitation. People who use stimulants may present with acute effects or medical complications. Cocaine metabolites and amphetamines can be detected in urine for a few days after use. The most serious complications of acute use are cardiovascular (especially myocardial infarction and stroke) and psychiatric (agitation and delirium); the risk of hyperthermia is also increased. A number of psychosocial modalities appear to reduce stimulant use among selected individuals, including individual and group counseling, cognitive–behavioral therapy, contingency management, and community reinforcement. No medication has been consistently shown to reduce complications and use of stimulants, although prescription stimulants and topiramate show some promise for treating cocaine use disorder. Syringe exchange programs and safe consumption sites are associated with decreased stimulant use-related complications. Caffeine has mild stimulant effects and may lead to a mild dependence syndrome.