Amphetamine and methamphetamine use disorder

The complex nature of stimulant use disorders makes straightforward monitoring difficult. Programs that offer both psychological and sociological interventions and monitoring of urine for toxicologic evidence of continued use may help to reduce recurrence. Additionally, patients require ongoing assessment and treatment of comorbid medical and psychiatric conditions.

Nonsterile injecting practices and risky sexual behavior among people who use amphetamine/methamphetamine is a major contributor to the spread of HIV, hepatitis, and other infections.[23]Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment for stimulant use disorders: updated 2021. Treatment Improvement Protocol (TIP) series, no. 33. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999 (updated 2021). https://www.ncbi.nlm.nih.gov/books/NBK576541 http://www.ncbi.nlm.nih.gov/pubmed/35041354?tool=bestpractice.com ​[138]Fischer B, Haydon E, Rehm J, et al. Injection drug use and the hepatitis C virus: considerations for a targeted treatment approach - the case study of Canada. J Urban Health. 2004 Sep;81(3):428-47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3455943/pdf/11524_2006_Article_313.pdf http://www.ncbi.nlm.nih.gov/pubmed/15273266?tool=bestpractice.com  Frequent monitoring of HIV and hepatitis B and C status is indicated. For those who engage in risky sexual behaviors, expert opinion supports the offer of ongoing testing/referral for testing for sexually transmitted infections at least every 3-6 months.[13]American Society of Addiction Medicine/American Academy of Addiction Psychiatry. The ASAM/AAAP clinical practice guideline on the management of stimulant use disorder. J Addict Med. 2024 May-Jun;18(1S):1-56. https://journals.lww.com/journaladdictionmedicine/fulltext/2024/05001/the_asam_aaap_clinical_practice_guideline_on_the.1.aspx ​ 

Random and unexpected urine toxicology screening for those in treatment programs and those under legal monitoring (i.e., parole) may provide deterrence. Echocardiogram can be used to evaluate for valve abnormalities and pulmonary hypertension associated with intravenous drug use and amphetamine use. Hospital evaluation is required for any patient who uses intravenous stimulants with an unexplained febrile event or any patient with amphetamine/methamphetamine use disorder who experiences unexplained chest pain or shortness of breath.