ASAM Pocket Guidelines and Patient Guide

Stimulant Use Disorder

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8 Treatment Cocaine Use Disorder: Modafinil 17. For patients with cocaine use disorder and without co-occurring alcohol use disorder, clinicians can consider prescribing modafinil to reduce cocaine use and improve treatment retention (L-C). Cocaine Use Disorder: Topiramate and Extended-Release Mixed Amphetamine Salts 18. For patients with cocaine use disorder, clinicians can consider prescribing a combination of topiramate and extended-release mixed amphetamine salts (MAS-ER) to reduce cocaine use and cocaine craving (M-C). a. Clinicians can give this combination additional consideration for patients with co-occurring alcohol use disorder, as topiramate can also reduce alcohol consumption (M-C). b. Clinicians can give this combination additional consideration for patients with co-occurring ADHD, as MAS-ER can also reduce ADHD symptoms (M-C). Cocaine Use Disorder: Amphetamine Formulation 19. For patients with cocaine use disorder, clinicians can consider prescribing a long-acting amphetamine formulation psychostimulant to promote cocaine abstinence (L-C). a. Clinicians can give long-acting amphetamine formulation psychostimulants additional consideration for patients with co-occurring ADHD, as these medications can also reduce ADHD symptoms (L-C). b. When prescribing a long-acting amphetamine formulation psychostimulant, clinicians can consider dosing at or above the maximum dose approved by the United States Food and Drug Administration (FDA) for the treatment of ADHD to effectively reduce cocaine use (L-C). Amphetamine-Type Stimulant Use Disorder: Methylphenidate (MPH) Formulations 20. For patients with ATS use disorder, clinicians can consider prescribing a long-acting MPH formulation to promote reduced use of ATS (L-C). a. Clinicians can give long-acting MPH formulations additional consideration for patients with moderate or higher frequency of ATS use at treatment start (ie, 10 or more days per month; L-C). b. Clinicians can give long-acting MPH formulations additional consideration for patients with co-occurring ADHD, as these medications can also reduce ADHD symptoms (L-C). c. When prescribing a long-acting MPH formulation, clinicians can consider dosing at or above the maximum dose approved by the FDA for the treatment of ADHD to effectively reduce ATS use (L-C).

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