Uncovering a stimulant use history carries importance

While opioid use remains the front-burner topic in treatment of many of today's patients, there are good reasons why treating professionals will want to uncover any past history of stimulant abuse in the individuals they serve.

Absent a full history, some of the withdrawal symptoms that are common in patients who have used cocaine or methamphetamine could be misunderstood as other conditions, or might not be treated aggressively enough, suggests James Alfred Chiverton, MD, attending physician at River Oaks Hospital outside of New Orleans.

Chiverton explains, for example, that hallucinations are more commonly seen in stimulant withdrawal. If a treating professional observes this symptom and believes the patient has been using only opioids, the conclusion might be that the individual has a psychotic disorder, when in reality the symptom is related instead to stimulant use. “So I'll ask for a history,” Chiverton says.

Heart rate is another factor that should be closely considered in the initial stages of treatment, he explains. In patients with a stimulant use history, the heart rate likely will be higher than what is usually seen during withdrawal. “You may have to treat this more proactively,” says Chiverton, who considers this a highly important withdrawal symptom to monitor.

Polydrug use common

Chiverton estimates that as many as 60% of the opioid users he sees in practice have also used cocaine and/or methamphetamine. Stimulant use is most prevalent in the 18-to-40 age group, with methamphetamine generally more common among whites and cocaine seen more in the African-American population.

While stimulant use is growing in many parts of the country, the opioid issue still remains most prominent in professionals' discussions of areas of concern, says Chiverton, with benzodiazepies probably the second most cited problem.