Cited by 78Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentForensic Toxicology and Drug Analysis

The DOI matches its Crossref record; 326 of the 327 references it cites were found in a registry or an index, and 1 are not checked yet; 146 of the 390 sources its claims cite were checked for support.

The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder

Open access
Clinical Guideline Committee (CGC) Members, ASAM Team, AAAP Team, IRETA Team·2024·Journal of Addiction Medicine

Abstract

Clinical Guideline Committee (CGC) Members: Steven Batki, MD Daniel Ciccarone, MD, MPH Scott Hadland, MD, MPH Brian Hurley, MD (Co-Chair) Kimberly Kabernagel, DO Frances Levin, MD James McKay, PhD Larissa Mooney, MD (Co-Chair) Siddarth Puri, MD Andrew Saxon, MD Kevin Sevarino, MD, PhD Kevin Simon, MD, MPH Timothy Wiegand, MD ASAM Team: Maureen Boyle, PhD Amanda Devoto, PhD Sarah Framnes-DeBoer Taleen Safarian AAAP Team: Kathryn Cates-Wessel Michelle Dirst IRETA Team: Dawn Lindsay, PhD Piper Lincoln, MS Jillian Helmick Peter Luongo, PhD Funding: The development of this guideline was generously funded with contract support from the Centers for Disease Control and Prevention (CDC) and the National Institute on Drug Abuse (NIDA). ASAM and AAAP are honored that this clinical practice guideline has been endorsed by: American College of Medical Toxicology (ACMT) American Society for Adolescent Psychiatry (ASAP) American Society of Addiction Nursing (ASAN) Abstract: The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use. Keywords: Stimulant Use Disorder, Clinical Guideline, Addiction Treatment, Stimulant Intoxication, Prevention - TABLE OF CONTENTS Executive Summary 2 Purpose 2 Background 2 Key Takeaways 2 Summary of Recommendations 3 Treatment of Stimulant Use Disorder Recommendations 3 Stimulant Intoxication and Withdrawal Recommendations 6 Secondary and Tertiary Prevention Recommendations 8 Introduction 10 Purpose 10 Background 10 Scope of Guideline 10 Intended Audience 10 Qualifying Statement 10 Methodology 11 Overview of Approach 11 GRADE Methodology 11 Literature Review 11 Systematic Reviews and Meta-Analyses 12 Primary Literature Search 12 Gray Literature Search 12 Literature Extraction 12 Guideline Development 12 Rating Outcomes 13 Rating Quality of Evidence 13 Developing Evidence to Decision Tables 13 Developing Recommendation Statements 13 Approving the Recommendations 13 Rating the Strength of Recommendations 13 Developing the Guideline Document 13 Engaging Stakeholders 14 Treatment of Stimulant Use Disorder 14 Assessment 14 Initial Assessment 14 Comprehensive Assessment 14 Behavioral Treatment 16 Contingency Management 16 Community Reinforcement Approach 17 Cognitive Behavioral Therapy 17 Matrix Model 17 Behavioral Treatment Recommendations 17 Technology-Based Interventions 18 Continuing Care 19 Pharmacotherapy 19 Non-Psychostimulant Medications 19 Psychostimulant Medications 22 Co-occurring Disorders 24 General Guidance 24 Concurrent Management of StUD and ADHD 25 Population-Specific Considerations 26 Adolescents and Young Adults 26 Pregnant and Postpartum Patients 30 Additional Population-Specific Considerations 31 Stimulant Intoxication and Withdrawal 33 Assessment and Diagnosis 34 Initial and Comprehensive Assessment 34 Assessment and Diagnosis Recommendations 36 Setting Determination 37 Setting Determination Recommendations 37 Managing Stimulant Intoxication and Withdrawal 37 Stimulant Intoxication 37 Stimulant Withdrawal 43 Monitoring 43 Suicidality 43 Managing Stimulant Intoxication and Withdrawal in Pregnant Patients 43 Secondary and Tertiary Prevention 44 Screening 44 Screening Recommendations 44 Assessment 44 Assessment Recommendations 45 Early Intervention for Risky Stimulant Use 45 Interventions to Reduce Risky Stimulant Use 45 Referral to Treatment for Stimulant Use Disorder 46 Harm Reduction 46 Harm Reduction Education 46 Overdose Prevention and Reversal 46 Safer Sexual Practices and Contraception 47 Injection Drug Use 47 HIV Preexposure Prophylaxis 48 Oral Health 48 Nutrition 48 Bibliography 48 Appendix A. Glossary of Terms A1 Appendix B. Abbreviations and Acronyms A4 Appendix C. Differential Diagnosis for Agitation and Psychosis A9 Appendi

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223 of 223
  • The paper relies on this without support.

    Co-occurring conditions including ADHD, depression, anxiety, eating disorders, and other substance use disorders are common in patients with stimulant use disorder.

    “Co-occurring conditions-including but not limited to attention-deficit/ hyperactivity disorder (ADHD), depression, anxiety, eating disorders, and other SUDs-are common in patients with StUD.”
  • The paper relies on this without support.

    Chlorpromazine and clozapine may increase the risk of seizures in patients with stimulant-induced psychosis.

    “Clinicians should avoid the use of chlorpromazine and clozapine for stimulant-induced psychosis as these medications may place patients at increased risk for seizures”
  • The paper relies on this without support.

    Suicidality may increase during waning intoxication and acute withdrawal.

    “in particular, suicidality may increase during waning intoxication and acute withdrawal”
  • The paper relies on this without support.

    Calcium channel blockers, alpha-1 adrenergic antagonists, alpha-2 adrenergic agonists, and nitric oxide-mediated vasodilators may be most beneficial for treating hypertension and vasospasm.

    “While calcium channel blockers, alpha-1 adrenergic antagonists, alpha-2 adrenergic agonists, and nitric oxide-mediated vasodilators may be most beneficial in treating hypertension and vasospasm”
  • The paper relies on this without support.

    These agents may cause side effects including poor control over tachycardia or reflex tachycardia.

    “clinicians should be alert to potential side effects, including poor control over tachycardia or reflex tachycardia”
  • The paper relies on this without support.

    Cocaine has local anesthetic-like effects at sodium channels and can cause QRS widening with impaired cardiac contractility during severe cocaine intoxication.

    “Cocaine has local anesthetic-like effects at sodium channels and can cause QRS widening with impairment in cardiac contractility during severe cocaine intoxication.”
  • The paper relies on this without support.

    Sodium bicarbonate improves conduction block and contractility and also improves metabolic acidosis if present.

    “clinicians should administer sodium bicarbonate to improve the conduction block and contractility; this will also improve metabolic acidosis if present”
  • The paper relies on this without support.

    HIV, viral hepatitis, and sexually transmitted infections are more prevalent among patients with StUD, which justifies routine baseline testing.

    “the higher prevalence of HIV, viral hepatitis, and sexually transmitted infections (STIs) in patients with StUD justifies baseline testing in this population.”
  • The paper relies on this without support.

    Non-infectious disease screening labs such as CBC and CMP can help identify comorbidities in patients with StUD.

    “non-infectious disease screening labs (eg, complete blood count [CBC], comprehensive metabolic panel [CMP]) can help identify comorbidities as part of a comprehensive assessment.”
  • The paper relies on this without support.

    Tests for novel or designer stimulants are often expensive and have limited availability.

    “The CGC noted that tests for novel or designer stimulants are often expensive with limited availability.”
  • The paper relies on this without support.

    Concern about interpreting the federal Anti-Kickback Statute has been a significant policy barrier to contingency management.

    “Concern regarding interpretation of this statute has been a significant policy barrier to the use of CM.”
  • The paper relies on this without support.

    Implementation of contingency management in compliance with the OIG Final Rule is not well defined.

    “However, implementation of CM in compliance with the OIG Final Rule is not well defined”
  • The paper relies on this without support.

    Financial cost is a commonly reported barrier to implementing contingency management.

    “A commonly reported barrier to implementing CM is financial cost.”
  • The paper relies on this without support.

    A consistent funding source, typically government funding or payer reimbursement, is needed to support contingency management implementation.

    “A consistent funding source-typically government funding or payer reimbursementis needed to support implementation.”
  • The paper relies on this without support.

    Contingency management interventions require programs to develop protocols and dedicate resources, including staff training and time.

    “CM interventions require programs to develop protocols around its use and dedicate resources, including staff training and time, toward its implementation.”
  • The paper relies on this without support.

    Patients with StUD often have co-occurring mental health and biomedical needs.

    “Patients with StUD often have co-occurring mental health and biomedical needs.”
  • The paper relies on this without support.

    Identifying urgent or emergent biomedical or psychiatric concerns is necessary to preserve the health and safety of patients presenting for StUD treatment.

    “Identifying urgent or emergent biomedical or psychiatric concerns is necessary to preserve the health and safety of patients who present for StUD treatment”
  • The paper relies on this without support.

    Effective CM implementation requires funding, training, drug-testing capacity, and usually at least twice-weekly clinical contact.

    “Effective implementation of CM requires availability of several components, including funding, training, capacity for drug testing, and-typically-at least twice weekly clinical engagement.”
  • The paper relies on this without support.

    CBT is widely utilized and accepted.

    “CBT is a widely utilized and accepted treatment modality.”
  • The paper relies on this without support.

    CBT requires highly trained clinicians for proper delivery.

    “CBT does require resourcesnamely, the availability of highly trained clinicians for proper delivery.”
  • The paper relies on this without support.

    CBT can be delivered in group sessions, making it more feasible for many programs than other behavioral interventions.

    “On the other hand, CBT can be delivered in group sessions, which makes it more feasible for many programs compared to other behavioral interventions.”
  • The paper relies on this without support.

    The Matrix Model is compatible with many SUD treatment programs' structure and staffing and has been widely adopted.

    “With respect to implementation, the Matrix Model is compatible with the structure and staffing at many SUD treatment programs and has been widely adopted, demonstrating feasibility.”
  • The paper relies on this without support.

    Little regulatory oversight exists for many technology-based tools.

    “Another point of caution is that little regulatory oversight currently exists for many of these technology-based tools.”
  • The paper relies on this without support.

    Most digital technologies have little to no evidence of effectiveness, and existing evidence may be low quality or conflicted.

    “Most digital technologies have little to no evidence of effectiveness; existing evidence may be low quality or those conducting the studies may have conflicts of interest.”
  • The paper relies on this without support.

    Addiction is a chronic illness best addressed with a chronic care model.

    “Addiction is a chronic illness best addressed with a chronic care model of disease management.”
  • The paper relies on this without support.

    No pharmacotherapies have been approved by the FDA for StUD.

    “No pharmacotherapies have been approved by the US Food and Drug Administration (FDA) for the treatment of StUD.”
  • The paper relies on this without support.

    Generic bupropion is commonly available on formularies and relatively easy to titrate.

    “The generic formulation of bupropion is commonly available on medication formularies, and it is relatively easy to titrate dosing.”
  • The paper relies on this without support.

    Confirmation of opioid-free status is required before initiating naltrexone.

    “Confirmation of the patient's opioid free status is required prior to initiating naltrexone.”
  • The paper relies on this without support.

    At publication, bupropion and oral naltrexone are available in generic formulations.

    “At the time of this publication, bupropion and oral naltrexone are available in generic formulations.”
  • The paper relies on this without support.

    Mirtazapine is widely available and straightforward to prescribe.

    “Mirtazapine is widely available and straightforward to prescribe.”
  • The paper relies on this without support.

    Mirtazapine's benefits may be tempered by side effects such as weight gain, drowsiness, and metabolic issues for some patients.

    “These benefits may be tempered by side effects such as weight gain, drowsiness, and metabolic issues (eg, poor glucose control) for some patients.”
  • The paper relies on this without support.

    Modafinil inhibits metabolism of hormonal contraceptives and can reduce the effectiveness of this type of birth control.

    “The CGC noted that modafinil inhibits metabolism of hormonal contraceptives and can reduce the effectiveness of this type of birth control;”
  • The paper relies on this without support.

    People with stimulant use disorders and co-occurring psychiatric disorders experience additional barriers to accessing and remaining in substance use disorder treatment.

    “The CGC noted that people with StUDs and co-occurring psychiatric disorders experience additional barriers to accessing and remaining in SUD treatment.”
  • The paper relies on this without support.

    Studies on integrated behavioral treatment approaches are limited and heterogeneous in design, target population, and outcomes of evaluation.

    “Studies on integrated behavioral treatment approaches are limited and heterogeneous in design, target population, and outcomes of evaluation.”
  • The paper relies on this without support.

    Symptoms of depression, anxiety, insomnia, and/or attentional problems are commonly observed during periods of ongoing stimulant use and withdrawal.

    “Symptoms of depression, anxiety, insomnia, and/or attentional problems are commonly observed during periods of ongoing stimulant use and withdrawal.”
  • The paper relies on this without support.

    These symptoms often resolve with effective management of withdrawal.

    “While these symptoms often resolve with effective management of withdrawal,”
  • The paper relies on this without support.

    Adherence to and effectiveness of medications for psychiatric conditions is likely to be reduced in the context of ongoing stimulant use.

    “Clinicians should be aware that adherence to and effectiveness of medications for psychiatric conditions is likely to be reduced in the context of ongoing stimulant use.”
  • The paper relies on this without support.

    Individuals with stimulant use disorder who have acquired tolerance for the effects of stimulants may require higher doses of prescribed psychostimulant medications to reach clinical benefit.

    “The CGC noted that individuals with StUD who have acquired tolerance for the effects of stimulants may require higher doses of prescribed psychostimulant medications to reach clinical benefit.”
  • The paper relies on this without support.

    Addressing ADHD symptoms as part of StUD treatment improves outcomes for patients with co-occurring StUD and ADHD.

    “For patients with co-occurring StUD and ADHD, clinicians should address ADHD symptoms as part of the treatment of StUD”
  • The paper relies on this without support.

    Extended-release psychostimulant formulations reduce misuse or diversion risk compared with other formulations in patients with co-occurring StUD and ADHD.

    “using extended-release formulations (Clinical consensus, Strong Recommendation)”
  • The paper relies on this without support.

    Monitoring strategies such as pill counts, drug testing, more frequent clinical contact, and more frequent PDMP checks reduce misuse or diversion in patients prescribed psychostimulants.

    “maintaining a level of monitoring commensurate with the risk profile for the given medication and patient-monitoring may include pill counts, drug testing, more frequent clinical contact, and more frequent PDMP checks”
  • The paper relies on this without support.

    Direct observation of medication administration by a parent, health professional, or other trusted adult reduces misuse or diversion in adolescent and young adult patients with co-occurring StUD and ADHD.

    “arranging for a parent, health professional (eg, trained school nurse), or other trusted adult to directly observe administration of the medication, especially if using a short-acting formulation”
  • The paper relies on this without support.

    Safe storage and restricted access to controlled medications reduce misuse or diversion in adolescent and young adult patients.

    “counseling families on the importance of safely storing and restricting access to controlled medications”
  • The paper relies on this without support.

    Integrated treatment of underlying ADHD or eating disorders improves StUD outcomes in adolescents and young adults.

    “a general principle in the care of adolescents and young adults with SUD is to address underlying mental health conditions with an integrated approach.”
  • The paper relies on this without support.

    Age-specific treatment and support programs improve outcomes for adolescents and young adults with StUD.

    “If available, clinicians should refer adolescent and young adult patients to agespecific treatment and support programs to address identified biopsychosocial needs”
  • The paper relies on this without support.

    Family involvement improves engagement and efficacy of treatment for adolescents and young adults with StUD.

    “the CGC recognized that family involvement can enhance both engagement and efficacy of treatment in adult populations and would be a worthwhile endeavor to explore with adolescent and young adult patients.”
  • The paper relies on this without support.

    Home drug testing without oversight of a trained clinician is harmful or less useful than clinician-overseen drug testing for assessing stimulant use in adolescents and young adults.

    “Clinicians should counsel parents/guardians not to conduct drug tests at home to assess stimulant use in adolescents and young adults without the oversight of a trained clinician.”
  • The paper relies on this without support.

    Increasing prenatal care attendance improves outcomes for pregnant patients with StUD and their children.

    “Clinicians should consider CM to incentivize attendance at prenatal appointments, if feasible, in addition to usual targets (eg, stimulant abstinence).”
  • The paper relies on this without support.

    Additional treatment support around the time of birth reduces return to stimulant use and overdose in postpartum patients.

    “Clinicians should consider providing additional treatment support around the time of birth; the postpartum period is typically a time of increased stress, which may lead to increased risk of return to stimulant use and heightened potential for overdose.”
  • The paper relies on this without support.

    Breastmilk may contain high levels of stimulants, which has the potential to harm infants.

    “breastmilk may contain high levels of stimulants, which has the potential to harm infants.”
  • The paper relies on this without support.

    None of the medications studied for treatment of stimulant use disorder are contraindicated during breastfeeding.

    “The CGC noted that none of the medications that have been studied for treatment of StUD are contraindicated during breastfeeding.”
  • The paper relies on this without support.

    There is no reason to expect telephone monitoring and counseling to be differentially effective for patients with amphetamine-type stimulant use disorder compared with cocaine use disorder.

    “The CGC noted that there is no reason to expect this practice to be differentially effective for patients with ATS use disorder.”
  • The paper relies on this without support.

    In the guideline committee's clinical experience, suicide risk may resolve more rapidly in stimulant withdrawal than in other substance withdrawal syndromes.

    “In the CGC's clinical experience, suicide risk may resolve more rapidly in stimulant withdrawal compared to other substance withdrawal syndromes.”
  • The paper relies on this without support.

    People with physical and cognitive disabilities have complex clinical needs.

    “However, people with physical and cognitive disabilities have complex clinical needs.”
  • The paper relies on this without support.

    Body stuffing or packing can result in more severe and prolonged symptoms of intoxication and should be managed in acute care settings.

    “Body stuffing or packing can result in more severe and prolonged symptoms of intoxication and should be managed in acute care settings.”
  • The paper relies on this without support.

    Observation of clinical effects and patient self-report are often more informative and more immediate than toxicology testing.

    “Observation of clinical effects and patient self-report are often more informative and more immediate than toxicology testing.”
  • The paper relies on this without support.

    Toxicology tests indicate exposure that may have occurred 72 or more hours prior.

    “These tests indicate exposure, which may have occurred 72 or more hours prior.”
  • The paper relies on this without support.

    Toxicology testing cannot detect every adulterant or contaminant.

    “Clinicians should understand it is impossible to detect all adulterants or contaminants with toxicology testing and should be careful to avoid overinterpretation of findings.”
  • The paper relies on this without support.

    Benzodiazepines are commonly regarded as the first-line option for stimulant-induced agitation.

    “Benzodiazepines are generally considered first-line treatment for the management of stimulant-induced agitation (see Appendix N for additional agents to consider).”
  • The paper relies on this without support.

    Onset of intramuscular ketamine is very rapid.

    “Onset of IM ketamine is very rapid, which makes it particularly useful when a patient is experiencing severe agitation such that placing an IV would be challenging and delay effective care.”
  • The paper relies on this without support.

    Suicide risk may rise as intoxication wanes and acute withdrawal begins.

    “Clinicians should monitor for progression of psychiatric symptoms, breakthrough psychosis, suicidality, and emergence of trauma-related symptoms; in particular, suicidality may increase during waning intoxication and acute withdrawal (Clinical consensus, Conditional Recommendation).”
  • The paper relies on this without support.

    Stimulant intoxication or withdrawal can worsen serious co-occurring medical or psychiatric conditions.

    “Serious co-occurring medical or psychiatric health concerns can be exacerbated by stimulant intoxication or withdrawal.”
  • The paper relies on this without support.

    Taking opioids, alcohol, or other sedatives together with stimulants can unpredictably change the timing and severity of intoxication and acute effects.

    “Co-intoxication with opioids, alcohol, or other sedatives can alter both the time course and severity of intoxication and acute effects in unexpected ways.”
  • The paper relies on this without support.

    Transfers involve some risk because patients may choose to leave treatment rather than initiate and engage in treatment elsewhere.

    “However, transfers involve some risk, as patients may choose to leave treatment rather than initiate and engage in treatment elsewhere.”
  • The paper relies on this without support.

    Restraints can temporarily prevent violent behavior but increase risk of injury to patients and staff and can be psychologically traumatic.

    “While restraints can temporarily prevent violent behavior, their application increases the risk of injury to patients and staff and can be psychologically traumatic for patients.”
  • The paper relies on this without support.

    Long-acting antihypertensives carry a risk of abrupt hemodynamic collapse.

    “Long-acting antihypertensives should be avoided because of the risk of abrupt hemodynamic collapse.”
  • The paper relies on this without support.

    Beta blockers with concomitant alpha-1 antagonism have a low risk of unopposed alpha stimulation.

    “If considering pharmacotherapy with a beta blocker, one with concomitant alpha-1 antagonism (eg, labetalol) is preferred due to low risk of unopposed alpha stimulation, although this risk is still a debate in the field.”
  • The paper relies on this without support.

    Treatment needs are determined by dynamic factors and will change throughout intoxication or withdrawal.

    “Treatment needs are determined by a number of dynamic factors, meaning they will change throughout the course of intoxication or withdrawal.”
  • The paper relies on this without support.

    High fever, seizure, chest pain, psychosis, and suicidality are clinical features that usually signal a need for emergency medical treatment.

    “Clinical features that typically indicate the need for emergency medical treatment include high fever, seizure, chest pain, psychosis, and suicidality.”
  • The paper relies on this without support.

    Engaging the patient as an active partner is important to alleviating distress and reducing risk.

    “The process of engaging the patient as an active partner in their assessment, treatment, and recovery is important to alleviating distress and reducing risk.”
  • The paper relies on this without support.

    Health information technologies and patient navigators may help make transfers effective by bridging care across settings.

    “The use of health information technologies and patient navigators may help facilitate effective transfers by bridging care between settings.”
  • The paper relies on this without support.

    When medication shortages limit recommended drugs, expert consultation may be especially useful.

    “Expert consultation may be particularly helpful when medication shortages impact the availability of recommended medications.”
  • The paper relies on this without support.

    Levamisole is a common adulterant in cocaine supply and can cause immunosuppression, particularly neutropenia, and small vessel vasculitis.

    “When analyzing CBC results for patients with cocaine intoxication or withdrawal, clinicians should be alert to neutrophil levels, as levamisole is a common adulterant in the cocaine supply and can cause immunosuppression -in particular, neutropenia-and small vessel vasculitis (Clinical consensus, Conditional Recommendation).”
  • The paper relies on this without support.

    The growing influence of synthetic drugs and drug adulteration and contamination means clinicians may increasingly make treatment decisions without toxicological confirmation.

    “The growing influence of synthetic drugs and drug adulteration and contamination means that clinicians may be making treatment decisions in the absence of toxicological confirmation with increasing frequency.”
  • The paper relies on this without support.

    Regional surveillance reporting is often available on prevalence of novel psychoactive substances, including stimulants and their frequency of detection with other substances.

    “Regional surveillance reporting is often available on the prevalence of novel psychoactive substances, including stimulants and their frequency of detection with other substances.”
  • The paper relies on this without support.

    Acidosis from stimulant intoxication is typically caused by excessive movement or muscle activity and drug-specific effects such as temperature elevation, with seizures possibly contributing.

    “Acidosis from stimulant intoxication is typically due to a combination of excessive movement or muscle activity and drug-specific effects (eg, temperature elevation).Seizures may also contribute to acidosis.”
  • The paper relies on this without support.

    Cardiac complications of stimulant use include chest pain with elevated risks for acute coronary syndrome and cardiac-related mortality.

    “Cardiac complications of stimulant use include chest pain with elevated risks for acute coronary syndrome (ACS) and cardiac-related mortality.”
  • The paper relies on this without support.

    Hyperadrenergic states secondary to stimulant use can lead to hypertension and tachycardia.

    “Hyperadrenergic states secondary to stimulant use can lead to hypertension and tachycardia.”
  • The paper relies on this without support.

    Unopposed alpha stimulation can cause an acute increase in blood pressure and/or coronary artery vasoconstriction after beta blocker administration.

    “Unopposed alpha stimulation can result in an acute increase in blood pressure and/or coronary artery vasoconstriction following beta blocker administration.”
  • The paper relies on this without support.

    Dehydration is a common consequence of stimulant intoxication that can result in electrolyte and fluid imbalances.

    “Dehydration is a common consequence of stimulant intoxication that can result in electrolyte and fluid imbalances.”
  • The paper relies on this without support.

    Neutropenia is generally rare and transient but can be life-threatening.

    “Neutropenia, while generally rare and transient, can be life-threatening.”
  • The paper relies on this without support.

    Neutropenia typically improves quickly in most patients after cessation of levamisole exposure.

    “While neutropenia typically improves quickly in most patients after cessation of exposure to levamisole”
  • The paper relies on this without support.

    Cocaine has local anesthetic effects and can cause QRS widening and impaired cardiac contractility.

    “Cocaine has local anesthetic effects and can cause QRS widening and impaired cardiac contractility.”
  • The paper relies on this without support.

    QRS widening occurs when large amounts of cocaine are consumed rapidly, such as in body stuffing or packing.

    “QRS widening is a particular complication that occurs when large amounts of cocaine are consumed rapidly, such as in body stuffing or packing”
  • The paper relies on this without support.

    Sodium bicarbonate treatment can exacerbate QT prolongation by lowering serum potassium.

    “However, this treatment can exacerbate the risk for QT prolongation, if present, by lowering serum potassium concentrations.”
  • The paper relies on this without support.

    3% hypertonic saline does not correct metabolic acidosis.

    “but it does not correct metabolic acidosis.”
  • The paper relies on this without support.

    Rhabdomyolysis in stimulant intoxication most commonly occurs after severe agitation and hyperthermia.

    “In patients with stimulant intoxication, rhabdomyolysis most commonly occurs following episodes of severe agitation and hyperthermia.”
  • The paper relies on this without support.

    Urinary alkalinization inhibits amphetamine elimination.

    “avoiding urinary alkalinization as it inhibits amphetamine elimination”
  • The paper relies on this without support.

    Seizures are one of the most severe complications of stimulant toxicity.

    “Seizures are one of the most severe complications of stimulant toxicity.”
  • The paper relies on this without support.

    Some medications such as bupropion raise the risk for seizures.

    “Some medications, such as bupropion, raise the risk for seizures.”
  • The paper relies on this without support.

    Seizure may be related to hyponatremia when stimulants are used and is more likely with polysubstance rather than single substance use.

    “Seizure may be related to hyponatremia when stimulants are used and is also more likely with polysubstance rather than single substance use.”
  • The paper relies on this without support.

    Medications may help reduce signs and symptoms associated with stimulant withdrawal.

    “Medications may help reduce signs and symptoms associated with stimulant withdrawal.”
  • The paper relies on this without support.

    Signs and symptoms that may require pharmacotherapeutic management include agitation, psychosis, depression, and insomnia.

    “Signs and symptoms that may require pharmacotherapeutic management include agitation, psychosis, depression, and insomnia, among others.”
  • The paper relies on this without support.

    Many patients with StUD experience persistent post-acute withdrawal symptoms including depression, anxiety, insomnia, and paranoia that can last weeks to months.

    “Many patients with StUD also experience persistent challenges with post-acute symptoms of withdrawal-including depression, anxiety, insomnia, and paranoia, among others-that can last for weeks to months.”
  • The paper relies on this without support.

    Patients may experience increased sleep during initial withdrawal followed by persistent sleep disturbances.

    “Patients may experience increased sleep during the initial withdrawal period, followed by sleep disturbances that can be persistent.”
  • The paper relies on this without support.

    It is often extremely difficult, if not impossible, to differentiate methamphetamine-induced hypertension from gestational hypertension.

    “It is often extremely difficult, if not impossible, to differentiate methamphetamine-induced hypertension from gestational hypertension.”
  • The paper relies on this without support.

    A variety of validated screening tools are available to screen for risky sexual behaviors.

    “A variety of validated screening tools are available to screen for risky sexual behaviors.”
  • The paper relies on this without support.

    The medical workup of patients who misuse stimulants but do not meet StUD criteria is similar to that for StUD.

    “Although the context is different, the medical workup of patients who misuse stimulants but do not meet the diagnostic criteria for StUD is similar to that for StUD.”
  • The paper relies on this without support.

    Overdose reversal medications such as naloxone prevent opioid overdose deaths.

    “Overdose reversal medications such as naloxone are well known to prevent opioid overdose deaths.”
  • The paper relies on this without support.

    Drug checking is becoming a standard harm reduction practice.

    “Drug checking is becoming a standard harm reduction practice.”
  • The paper relies on this without support.

    Abrupt discontinuation or reduction in stimulant use can cause stimulant withdrawal syndrome.

    “Abrupt discontinuation or reduction in stimulant use can cause stimulant withdrawal syndrome.”
  • The paper relies on this without support.

    The current standard of care for managing stimulant withdrawal focuses on ameliorating presenting signs and symptoms and minimizing risks.

    “The current standard of care for managing stimulant withdrawal focuses on ameliorating presenting signs and symptoms and minimizing risks.”
  • The paper relies on this without support.

    Lack of community acceptance can be a barrier to implementing programs focused on safer injection practices.

    “lack of community acceptance can be a barrier to implementing programs focused on safer injection practices”
  • The paper relies on this without support.

    Treatment of StUD in patients who are pregnant presents unique clinical challenges.

    “Treatment of StUD in patients who are pregnant presents unique clinical challenges.”
  • The paper relies on this without support.

    Existing guidelines stress using multidisciplinary teams, providing comprehensive prenatal care, and screening for complications of pregnancy and fetal health.

    “Existing guidelines stress using multidisciplinary teams, providing comprehensive prenatal care, and screening for complications of pregnancy and fetal health.”
105 of 105

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Methylphenidate eligibility differs at 10 days per month

    Minor

    The narrative defines the relevant use frequency as greater than 10 days per month, while the recommendation includes patients who use ATS exactly 10 days per month.

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Citations

Cites

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Research works printed but not linked: 1

  1. 2008, Community reinforcement approach (CRA) for cocaine addicts: establishment in a public health setting, An Psiquiatr, 24, 153

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Metadata

Authors
Clinical Guideline Committee (CGC) Members, ASAM Team, AAAP Team, & IRETA Team
Venue
Journal of Addiction Medicine
Published
2024-05
Volume
18
Issue
1S
Pages
1-56
ISSN
1932-0620 (ISSN-L)
OpenAlex
W4395662991
Cited by
78
References
316
Citations by year
2026: 22 · 2025: 42 · 2024: 13
FWCI
23.34
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Journal of Addiction Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion, other-oa)
Funders
  • Centers for Disease Control and Prevention
  • National Institute on Drug Abuse (HHSN271201600056C, HHSN271201700032C, R01DA054190)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
Keywords
stimulant use disorder, stimulant intoxication, stimulant withdrawal, contingency management, pharmacotherapy, off-label drug use, harm reduction, secondary prevention, tertiary prevention, addiction treatment, treatment guidelines, evidence-based practice, American Society of Addiction Medicine, American Academy of Addiction Psychiatry
MeSH terms
Central Nervous System Stimulants, Humans, Substance-Related Disorders, Amphetamine-Related Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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