Cocaine, Methamphetamine, and Other Stimulants: Board Review (2025-2026 Recording)-Cocaine, Methamphetamine, and Other Stimulants: Board Review Recording

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Video Summary

This didactic session from UCSF provided a board-style review of cocaine, methamphetamine, and other stimulants, with a strong focus on addiction medicine, harm reduction, and treatment. The talk opened with the long history of stimulant use in the U.S., including early coca and ephedra use, the appearance of cocaine in patent medicines and sodas, and later policy shifts such as the Harrison Act, the Controlled Substance Act, and the Anti-Drug Abuse Act of 1986. Speakers highlighted the racial inequities of the crack cocaine sentencing disparity and the ongoing consequences of drug criminalization.<br /><br />The session then reviewed stimulant types, mechanisms of action, methods of use, intoxication, withdrawal, and complications. Cocaine primarily blocks monoamine reuptake, while methamphetamine both blocks reuptake and increases neurotransmitter release, producing longer-lasting effects. Acute stimulant intoxication may cause agitation, hypertension, tachycardia, psychosis, and hyperthermia; first-line treatment includes benzodiazepines, supportive care, and antipsychotics when needed. Withdrawal commonly includes depression, fatigue, hypersomnolence, and cravings. The presenters also discussed binge patterns, chemsex, cocaethylene toxicity from mixing cocaine and alcohol, and harm-reduction strategies such as safer smoking supplies, hydration, nutrition, and STI prevention.<br /><br />The second half focused on treatment. Contingency management was emphasized as the current gold standard behavioral intervention. Urine toxicology interpretation and false positives were reviewed, including bupropion causing false-positive amphetamine screens. Off-label pharmacotherapy was reviewed for cocaine and methamphetamine use disorders, including bupropion, topiramate, mirtazapine, long-acting amphetamines, and bupropion plus extended-release naltrexone for methamphetamine use disorder. The session ended with a brief overview of other stimulants such as caffeine, nicotine, MDMA, ephedrine, and prescription stimulants.

Keywords

cocaine

methamphetamine

stimulants

addiction medicine

harm reduction

contingency management

withdrawal

intoxication

benzodiazepines

cocaethylene

urine toxicology

bupropion

controlled substance act