2026-2027 | On-Demand Session | Cocaine, Methamphetamine, and Other Stimulants: Board Review | November 2026-Cocaine, Methamphetamine, and Other Stimulants: Board Review Recording

Video Transcription

Video Summary

Dr. Andrew Rizzo’s board-review lecture covers cocaine, amphetamines and methamphetamine, MDMA, synthetic cathinones, and other stimulants. He reviews addiction neurobiology, including mesolimbic dopamine signaling, reward and craving pathways, and the anhedonia that may persist during withdrawal.<br /><br />The lecture compares drug mechanisms: cocaine blocks monoamine reuptake, amphetamines promote neurotransmitter release and reverse transport, and MDMA acts primarily on serotonin. It also reviews intoxication and withdrawal presentations, including agitation, psychosis, cardiovascular and neurologic emergencies, hyperthermia, and stimulant-related cardiomyopathy. Clinicians should assess patients in context and avoid treating urine drug screens as evidence of current impairment. Cocaine mixed with alcohol can produce cocaethylene, extending cardiovascular risk.<br /><br />Management includes supportive care, a low-stimulation environment, and appropriate evaluation of acute complications. Benzodiazepines are presented as the standard first-line treatment for cocaine-related agitation, while the speaker’s preference for phenobarbital is identified as a personal, evidence-limited view. Contingency management, paired with psychosocial treatment, is emphasized as the best-supported approach for stimulant use disorders. Potential medication options include naltrexone plus bupropion for methamphetamine use disorder, alongside less-established options such as mirtazapine or topiramate.<br /><br />The lecture also discusses MDMA-related hyponatremia and serotonin toxicity, cathinone intoxication, nicotine treatment, harm reduction, stimulant use in pregnancy, and co-occurring mental health conditions. It stresses individualized, nonjudgmental care and consideration of fentanyl exposure when patients use illicit drugs.

Keywords

cocaine

amphetamines

methamphetamine

MDMA

synthetic cathinones

stimulants

dopamine signaling

withdrawal

psychosis

hyperthermia

cardiomyopathy

benzodiazepines

contingency management

serotonin toxicity

harm reduction