Stimulants & Polysubstance Use
Cocaine, methamphetamine, contingency management.
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.
- Contingency management: VA implementation and Medicaid pilots
- ADAPT-2: injectable naltrexone plus bupropion for methamphetamine
- Topiramate, mirtazapine, and modafinil evidence in stimulant use
- Polysubstance overdose: fentanyl-stimulant co-detection trends
- Stimulant-induced cardiomyopathy and reversibility
- Methamphetamine-associated psychosis and acute management
- Cocaine vaccine and immunotherapy pipeline