26
Treatment
Secondary and Tertiary Prevention
Screening
74. When general healthcare providers screen adolescents or adults
for risky substance use per United States Preventive Services
Task Force (USPSTF) guidelines, they should include screening for
stimulant misuse (ie, nonmedical or nonprescribed use; VL-S).
75. Clinicians should consider more frequent screening for stimulant
misuse in patients who take prescribed psychostimulant medications
(VL-S).
76. Clinicians should check their state's prescription drug monitoring
program (PDMP) prior to prescribing psychostimulant medications
(M-S).
Assessment
77. For patients who screen positive for stimulant misuse:
a. Clinicians should conduct a focused history and clinical exam to evaluate
complications of use related to route of administration and type of preparation
used and provide treatment or referrals as appropriate (VL-S).
b. Clinicians should assess the following to determine harm reduction service and
counseling needs:
i. risky patterns of stimulant use, including :
1. frequency and amount of use, including binge use (H-S);
2. use of stimulants with no one else present (H-S);
3. concurrent use of prescribed and nonprescribed medications and other
substances, particularly opioids, alcohol, and other central nervous
system depressants (H-S);
4. history of overdose (H-S); and
5. history of stimulant-related ED visits and hospitalizations (H-S);
ii. routes of administration, particularly injection drug use (VL-S); and
iii. risky sexual behaviors (H-S).
c. Clinicians should consider asking patients about:
i. the context of their stimulant use (eg, using substances to enhance sexual
experiences [chemsex], weight loss, academic or work performance, staying
awake; CC-S),
ii. trauma (CC-S), and
iii. intimate partner violence (IPV) (CC-S).
d. Clinicians should conduct baseline laboratory testing based on clinical
assessment of risk factors (see Assessment; CC-S).
78. Patients who engage in nonmedical use of prescription stimulants
should be evaluated for ADHD, which may also require treatment
(CC-S).
