By understanding someone’s thoughts on their stimulant use and what they think are the pros and cons of using, you can help them meet their health goals. Start by asking open-ended questions to learn about their goals, hopes, and thoughts about their stimulant use.

Talking about what they like and don’t like about using stimulants can help someone decide what changes they want to make, if any.

Whether or not the person wants to change their use, there are options. Let them know that if they want to quit, cut back, or keep using stimulants, there are ways to support and improve their health. And, let them know you welcome them back whether they feel like they’re doing well or not.

Heart and Blood Vessels

Stimulants can harm the heart and blood vessels in both the short and long term.

In the short term, they can make blood vessels tighten suddenly, which can lead to a heart attack or stroke. Over time, they cause swelling and damage inside the body, which raises the risk of heart disease, stroke, heart attack, and heart failure.

Emergency signs include chest pain, shortness of breath, a racing heart rate, slurred or jumbled speech, unable to walk or move, numb limbs, a splitting headache, confusion, shaking, and unable to wake up. If these signs occur, call 911. You can describe the person’s symptoms and indicate it’s urgent, but you don’t have to say you think it’s drug related to the 911 dispatcher.

Brain and Mood

Stimulants increase a neurochemical called dopamine in the brain, which can cause a person to feel really good, but can also cause hallucinations, delusions, paranoia, anxiety, depression, and other mood changes.

Stimulants can also affect memory and decision-making. Injuries, fights, and motor vehicle crashes can all happen due to stimulant use.

Mental health crisis: Stimulants may increase the risk of harm to oneself or others. If you believe someone is at risk of harming themselves or others, call 911 and state that they are experiencing a mental health crisis (Espiridion & Charron, 2024; McKetin et al., 2014).

For those who are not interested or ready to stop using stimulants, these tips can help reduce harm:

• Sleep/rest: Sleep is important for health, but it can be hard to get when using stimulants. Setting aside time to sleep, or resting in a quiet, safe place, can help the brain.
• Hydration: Stimulants can cause dehydration. Drinking water and other drinks with electrolytes helps prevent dehydration.
• Nutrition: Stimulants reduce appetite, leading to weight loss and malnutrition. Eating small amounts, even when not hungry, is helpful. Nutritious foods high in protein are ideal. Soft foods and liquid nutrition can help.
• Safer ways to use: Smoking or eating drugs is safer than injecting.
• Avoid sharing supplies: Sharing injection, inhalation, and smoking supplies can spread infectious diseases. Provide these supplies onsite if possible or refer to a community partner.
• Use in safe places with people you trust: Being with trusted people and in safe environments helps people feel secure. Ask the person what this looks like for them.
• Test drugs & carry naloxone: Drugs can be mixed with unexpected substances like fentanyl. Provide fentanyl test strips and referrals to drug checking services. Share the latest information on what’s in the local drug supply. Encourage people to carry naloxone and remind them that someone else needs to be present to administer it in case of an overdose.

Overamping

Overamping happens when the effects of a stimulant become overwhelming, sometimes called a stimulant overdose. It can lead to heart attack, stroke, seizure, or overheating, but overamping is not always life-threatening.

Contributing factors can include:

• Lack of sleep
• Not eating or drinking enough
• Being in a different environment or with people you don’t trust
• Using too much
• Mixing stimulants with other substances

Source: StopOverdose.org: Methamphetamine Overdose/Overamping

No matter if someone wants to stop or cut back on stimulant use, there are ways to support their health (CIAO SFDPH, 2024). Here are some interventions to discuss with their healthcare team:

• Blood pressure management: Stimulants tighten blood vessels, causing inflammation and high blood pressure. Treating chronic high blood pressure with medication and lifestyle changes can reduce the risks of heart disease, heart attack, and stroke.
• Oral and dental health: Methamphetamine reduces saliva production, increasing mouth acidity and risk of tooth decay, gum disease, and infections. Interventions include:
  • Brushing teeth with fluoride toothpaste and flossing.Drinking water to stay hydrated.Chewing sugar-free gum.Rinsing the mouth with water.
• Wounds and skin: Stimulants affect blood flow and may slow wound healing. Stimulant use can cause dehydration, causing dry skin. And people who use stimulants may pick at or scratch their skin, leading to skin breakdown and infection. Interventions include:
  • Asking them if they have skin or wound concerns.Referring to the health care team for assessment and care.
• Screening for STIs, HIV, Hep B, and Hep C: These infections can be transmitted sexually or through shared drug supplies. Screening helps with early detection and treatment. Interventions include:
  • Offering harm reduction supplies and education about the risks of sharing drug use supplies.
  • Referring to the health care team for screening and treatment.
• Pre- and post-exposure medicine for HIV and STIs: Medications to prevent HIV and STIs are available. Interventions include:
  • Post-Exposure Prophylaxis (PEP): Emergency antiretroviral medications taken within 72 hours of exposure to HIV to prevent infection with the virus, taken daily for 28 days.
  • Pre-Exposure Prophylaxis (PrEP):Antiretroviral medication taken to prevent HIV infection in people at risk.

• Pregnancy testing and birth control: Offer pregnancy testing and birth control to people who may become pregnant. Interventions include:
  • Connect with an OBGYN experienced in supporting people who use drugs if the pregnancy test is positive.
  • Engaging in shared decision-making to help them choose their best birth control option.
• Vaccinations: Vaccines save lives by protecting individuals and building community immunity. Encourage people to stay up to date on their vaccinations.
• Treating co-morbid mental health and substance use disorders:
  • Connect with the health care team if the person reports co-morbid mental health and substance use disorder symptoms.
  • Medications for opioid use disorder, like buprenorphine and methadone, should be started or continued for anyone with opioid use disorder. These medications can improve the health of a person even if they continue using stimulants.
  • Antipsychotic medications may be offered to manage psychotic symptoms, like hallucinations and delusions (Fluyau et al., 2019).

Contingency Management

Contingency Management (CM) is a proven method for treating stimulant use disorder. It uses rewards to motivate people to reach their treatment goals. Rewards may include gift cards, vouchers, or prizes. Studies show that CM can reduce stimulant use, cravings, new use, and risky behaviors related to HIV (Brown & DeFulio, 2020; Ginley et al., 2021; ASAM 2024).

• How it works: Participants earn rewards for negative drug tests.
• Why it helps: Immediate rewards and celebration encourage positive behavior changes, like reducing or stopping stimulant use.

Psychosocial Support

Other types of support that can help include:

• Counseling: Techniques like Cognitive Behavioral Therapy (CBT), Community Reinforcement Approach (CRA), and motivational interviewing.
• Peer groups: Programs like 12-step groups, SMART Recovery, and groups for people who use stimulants.

Medications

There are no FDA-approved medications for stimulant use disorder, and evidence for off-label use is limited. However, there may be medications that help people feel better and cut back on their use.

Medications that health care providers may offer:

• Bupropion, Mirtazapine, or Long-Acting Injectable Naltrexone plus Bupropion may be used to help people stop and/or reduce methamphetamine use (Colfax et al., 2011; Elkashef et al., 2008; Lee et al., 2018; Trivedi et al., 2021).
• Topiramate, Bupropion, Disulfiram, Modafinil, or Long-Acting Amphetamines may be used to help people stop and/or reduce cocaine use (Chan et al., 2019; Dackis et al., 2012; Kampman et al., 2025; Traccis et al., 2024).

The section covers the Stimulants and Health handout step-by-step, including how to talk about stimulant use with people, safer use tips, health effects of stimulants, and support for reducing stimulant use.

Click the orange number markers to learn more about each section of the handout.

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