Primary prevention
Efforts directed toward education of teenage and preteenage populations are needed. Control of precursor chemicals used in the illicit manufacturing of amphetamines and related substances has reduced the number of illegal drug laboratories in the US. However, smuggling from other countries with laxer controls on these substances has increased. Regulations restricting legal prescription of stimulants have reduced diversion of amphetamines.
In 2020, the US Preventive Services Task Force concluded that there was insufficient evidence to assess the use of primary care-based behavioral counseling interventions to prevent illicit drug use in children, adolescents, and young adults.[48]
Secondary prevention
Expert opinion supports the use of a brief intervention including harm reduction education and motivational interviewing techniques for people presenting to a healthcare professional where there is evidence of risky stimulant use, in order to reduce risk of harm, including progression to stimulant-use disorder.[13] Depending on local service arrangements, consider offering referral for a comprehensive assessment for substance use disorder for all patients who describe a history of risky stimulant use.[13] Harm reduction measures are important for those who continue to engage in nonmedical use of stimulants, see Patient discussions. Referral to local harm reduction services may be indicated, depending on local service arrangements, and on the individual clinical risk. In some locations, patients may be referred to local supervised consumption sites.[13]
The US Centers for Disease Control and Prevention (CDC) recommends hepatitis A vaccination for people who use illicit/recreational drugs via injection and non-injection methods (i.e., all those who use illicit drugs).[139] The CDC also recommends universal hepatitis B vaccination in all adults ages 19-59 years. In people 60 years of age or older, hepatitis B vaccination is recommended in the presence of additional risk factors, including current or recent injection drug use.[139]
The CDC recommends pre-exposure prophylaxis (PrEP) for HIV for adults and adolescents who inject drugs and report injection practices that place them at substantial ongoing risk of HIV exposure and acquisition (e.g., sharing needles).[140]
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