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Treatment
Toxicology Testing
51. In patients presenting with stimulant intoxication or withdrawal,
clinicians can use toxicology testing to:
a. inform clinical thinking regarding the differential diagnosis, along with other
clinical information (CC-S); and
b. identify substance use that could produce drug–drug interactions when
considering pharmacotherapy to manage signs and symptoms of stimulant
intoxication or withdrawal (CC-C).
52. Clinicians should consider the possibility of novel psychoactive
stimulants if stimulant intoxication is suspected but presumptive
testing is negative (CC-C).
Setting Determination
53. Patients with severe clinical concerns or complications related
to stimulant intoxication should be managed in acute care settings
(CC-C).
54. Some patients with acute stimulant intoxication can be safely
managed in lower acuity clinical settings if (CC-C):
a. the patient is cooperative with care;
b. the patient is responsive to interventions (eg, verbal and nonverbal de-
escalation strategies, medications) that can be managed in the clinical setting ;
c. the patient is not experiencing more than mild hyperadrenergic symptoms or is
responsive to medications that can be managed in the clinical setting ; and
d. clinicians are able to:
i. assess for acute issues and complications of stimulant intoxication,
ii. monitor vital signs,
iii. assess and monitor suicidality,
iv. monitor for worsening signs and symptoms of intoxication and emergent
complications related to stimulant intoxication,
v. provide adequate hydration,
vi. provide a low-stimulation environment,
vii. manage the risk of return to stimulant use, and
viii. coordinate clinical testing as indicated.
