Stimulant Use Disorder

Stimulant use disorder is a type of substance use disorder that involves the non-medical use of stimulants. It is defined in the DSM-5 as “the continued use of amphetamine-type substances, cocaine, or other stimulants leading to clinically significant impairment or distress, from mild to severe”.

Based on DSM 5 (2013), SUD is a single diagnosis, with severity determined by the number of symptoms present.

Symptoms can be categorized into: 

– Loss of control
– Risky use
– Social problems
– Drug effects 

Stimulant Use Disorder: 

Substance use disorder involving any of the class of drugs that include cocaine, methamphetamine and prescription stimulants.

Highly addictive, affects the central nervous system, more potent, longer lasting effects

 – Initially desirable effects (euphoria, increase in energy, attention, wakefulness, self-confidence and sexuality, decrease in appetite)
– Risk of infectious diseases such as HIV and Hepatitis B and C (risky sexual behavior, injection practices)
 – Long-term MA misuse may cause sexual dysfunction 
– Weight loss – Severe dental problem (due to bruxism, dry mouth, poor oral hygiene) 
– Cognitive problems/
– Psychosis, violent behavior
– OD: hyperthermia, convulsions, arrhythmia, stroke, death
– In the 1980s, MA use increased due to production in clandestine labs. In 2005, Congress passed the Combat Methamphetamine Epidemic Act, regulating the precursor chemicals (ephedrine and pseudoephedrine) used in the production of MA. How much of the US MA supply is from the outside.

Cocaine

  • – Cocaine is plant based. 
  • – Cocaine preparations vary in potency (e.g. coca leaves, coca paste, cocaine hydrochloride, and cocaine alkaloids such as freebase and crack)
  • – Is used as an anesthetic in ENT surgeries and to limit bleeding.
  • – Similar desirable effect as MA (increase in energy and sexuality, decrease in appetite and euphoria) 
  • – Risk of cardiac problems such as MI and arrhythmia 
  • – OD: seizures, cardiac arrhythmias, respiratory failures, stroke 
Common forms: 
  • – Salt (most commonly hydrochloride salt) 
  • – Base form (not neutralized by an acid to make salt)

Prescription Stimulants

  • – Prescription stimulants include medications such as amphetamine and dextroamphetamine (Adderall and Dexedrine) , and methylphenidate (Ritalin, Concerta).
  • – All forms of amphetamines were classified as DEA Schedule II drugs. (Schedule II drugs have an accepted medical use and high potential for abuse.) 
  • – Treatment of ADHD, narcolepsy and obesity. 
  • – Can be misused and result in stimulant use disorder, in some cases individuals begin stimulant use to control weight or to improve performance in school, work, or athletics.

Epidemiology

  • – Stimulants, including MA, are the world’s second most used illicit drug class. 
  • – An estimated 1.1 million people aged >12 had methamphetamine use disorder in 2018, up from 684,000 in 2016. (SAMSHA, 2018 NSDUH)
  • – Regional variability: highest in the western and midwestern regions 
  • – In 2018, 977,000 people aged >12 had a cocaine use disorder up from 867,000 in 2016. (SAMSHA) 
  • – An estimated 561,000 people aged >12 had a prescription stimulant use disorder similar in the past year. (SAMSHA) 
  • – Between 2012 to 2018, OD deaths involving cocaine increased 3 fold and those involving stimulants, including MA, increased 5 fold. (CDC)