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Treatment
Breastfeeding
41. Clinicians should educate patients who use stimulants on the risks
of use while breastfeeding and counsel patients not to breastfeed if
they are actively using stimulants (except as prescribed; VL-S).
Additional Population-Specific Considerations
Sexual Orientation and Gender Identity
42. Clinicians should consider referring sexual and gender minoritized
(SGM) patients with StUD to SGM-affirming programs when their
history and/or behavior suggest they may not be comfortable fully
participating in a general population setting (eg, distress related to
their identities, difficulties discussing drug-related sexual activities,
inner conflicts, trauma histories) (L-S).
Patients Involved in the Criminal and/or Legal Systems
43. Initiation of treatment for StUD is recommended for individuals in
the criminal and/or legal systems, including within jails and prisons
(CC-S).
Patients Experiencing Homelessness or Unstable Housing
44. For patients experiencing homelessness, housing insecurity, food
insecurity, and/or poverty, clinicians might consider:
a. providing case management services or a referral to a case manager or other
appropriate service provider(s) who can help the patient navigate health and
social safety net resources (CC-S); and
b. providing a referral to a recovery residence based on the patient's needs (CC-S).
Stimulant Intoxication And Withdrawal
Assessment and Diagnosis
Initial Assessment
45. The clinical examination should first identify any acute concerns
and complications of stimulant intoxication or withdrawal that would
indicate the patient requires a higher level of care (CC-S). This
includes an assessment of hyperadrenergic symptoms, including
tachycardia, hypertension, hyperthermia, and agitation (CC-S).
46. The initial clinical examination when evaluating for suspected
stimulant intoxication or withdrawal should include (CC-S):
a. a clinical interview (as feasible),
b. physical examination,
c. observation of signs and patient-reported symptoms,
d. review of any available collateral information, and
e. a safety assessment of the patient's risk of harm to self and others.
