Stimulants & Polysubstance Use

Stimulant use disorder has surged alongside the opioid crisis, with methamphetamine and cocaine now frequently co-detected with fentanyl in overdose decedents. No FDA-approved pharmacotherapy exists, but the ADAPT-2 trial of injectable naltrexone plus oral bupropion, along with evidence for topiramate, mirtazapine, and modafinil, provides a partial pharmacologic toolkit. The strongest evidence remains contingency management — operant reinforcement of stimulant abstinence — now scaled through the VA and state Medicaid demonstrations. Sessions will also address polysubstance overdose response, stimulant-induced cardiomyopathy, methamphetamine psychosis management, and the overlap with HIV and HCV transmission.