Stimulant Use Disorder

Central nervous system (CNS) stimulants, including cocaine and methamphetamine, remain prominent fixtures in the global drug market. Understanding that the use of not only classic CNS stimulants but also new synthetically derived stimulants is likely to continue, it is imperative for the critical care clinician to be familiar with the management of acute intoxication with and withdrawal from CNS stimulants. Acute stimulant toxicity is best described as sympathetic overactivity, and treatment is largely symptomatic and supportive in nature. While a withdrawal syndrome is not reported following cocaine cessation, amphetamine withdrawal is possible. Finally, an understanding of the impact chronic use has on critical illness in the non-abstaining patient is essential.