Amfetamine and methamphetamine use disorder

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Healthcare screening (adults)

The National Institute for Health and Care Excellence (NICE) in the UK recommends that clinicians routinely screen for harmful drug use in settings where this is common, such as mental health and criminal justice services. In more general settings, they recommend asking about drugs if patients present with suggestive problems, such as chest pain in a young person, acute psychosis, or mood and sleep disorders.[62]

The ASSIST-Lite (Alcohol, Smoking and Substance Involvement Screening Tool - Lite) is licensed for use in adult patients in health and social care settings in the UK.[63] It is based on the longer ASSIST screening tool developed by the World Health Organization (WHO) for use in primary and general medical care settings.[64]

The US Preventive Services Task Force (USPST) recommends that clinicians screen for unhealthy drug use in adults 18 years or older, when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred. Screening in this context refers to asking questions about unhealthy drug use. The American Society of Addiction Medicine (ASAM) and American Academy of Addiction Psychiatrists (AAAP) recommend that clinicians consider more frequent screening for stimulant misuse in people who take prescribed psychostimulant medication.[14]

Patients with substance use disorders often first present in primary care settings.[24] Screening, brief intervention, and referral to treatment (SBIRT) is a well studied and widely used approach to identifying and treating substance use disorders in primary care.[65] This involves quick universal screening using validated measures such as TAPS: National Institute on Drug Abuse (NIDA): TAPS - Tobacco, Alcohol, Prescription medication, and other Substance use tool Opens in new window This is typically followed by an assessment of risk (low, medium, or high) for those who screen positive to help determine treatment needs. A brief motivational intervention is offered to educate patients about substance use and motivate behavioural change. This is followed by referral to treatment for those who need speciality services or a higher level of care.[24]

The American College of Surgeons recommends that trauma centres carry out bedside screening for substance use disorders in patients at high risk of substance use disorders.[66]

Healthcare screening (adolescents)

For adolescents, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for unhealthy drug use, meaning that clinicians should use their judgement about screening by asking questions about drug use in adolescents.[67] The American Society of Addiction Medicine (ASAM) and American Academy of Addiction Psychiatrists (AAAP) recommend that clinicians consider more frequent screening for stimulant misuse in patients who take prescribed psychostimulant medication.[14]

For adolescents, the American Academy of Pediatrics recommends use of an SBIRT approach.[68]

Occupational screening

Workers in specific occupations including transportation (i.e., airline pilots, railway operators, and truck drivers), nuclear power, and the military undergo routine random urine drug testing to deter recreational drug use.

Pregnancy

Healthcare workers should ask women about substance use, including alcohol and tobacco, at all antenatal visits. The UK National Institute for Health and Care Excellence recommends discussing recreational drug use during postnatal care if appropriate, and providing information and further care as required.[69] The UK also has drug misuse and dependence guidelines (often called the Orange Book), which cover testing and assessment of people who use non-prescription/illicit drugs in some detail.[57]

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