Various medical conditions may occur depending on the route of administration. Intrana- sal users often develop sinusitis, irritation, bleeding of the nasal mucosa, and a perforated nasal septum. Individuals who smoke the drugs are at increased risk for respiratory prob- lems (e.g., coughing, bronchitis, and pneumonitis). Injectors have puncture marks and ”tracks," most commonly on their forearms. Risk of HIV infection increases with frequent intravenous injections and unsafe sexual activity. Other sexually transmitted diseases, hepatitis, and tuberculosis and other lung infections are also seen. Weight loss and mal- nutrition are common.
Chest pain may be a common symptom during stimulant intoxication. Myocardial in- farction, palpitations and arrhythmias, sudden death from respiratory or cardiac arrest, and stroke have been associated with stimulant use among young and otherwise healthy individuals. Seizures can occur with stimulant use. Pneumothorax can result from per- forming Valsalva-like maneuvers done to better absorb inhaled smoke. Traumatic injuries due to violent behavior are common among individuals trafficking drugs. Cocaine use is associated with irregularities in placental blood ﬂow, abruptio placentae, premature labor and delivery, and an increased prevalence of infants with very low birth weights.
Individuals with stimulant use disorder may become involved in theft, prostitution, or drug dealing in order to acquire drugs or money for drugs.
Neurocognitive impairment is common among methamphetamine users. Oral health problems include "meth mouth" with gum disease, tooth decay, and mouth sores related to the toxic effects of smoking the drug and to bruxism while intoxicated. Adverse pulmo- nary effects appear to be less common for amphetamine-type stimulants because they are smoked fewer times per day. Emergency department visits are common for stimulant-re— lated mental disorder symptoms, injury, skin infections, and dental pathology.
Primary mental disorders. Stimulant-induced disorders may resemble primary mental disorders (e.g., major depressive disorder) (for discussion of this differential diagnosis, see ”Stimulant Withdrawal"). The mental disturbances resulting from the effects of stimulants should be distinguished from the symptoms of schizophrenia; depressive and bipolar dis- orders; generalized anxiety disorder; and panic disorder.
Phencyclidine intoxication. Intoxication with phencyclidine ("PCP” or ”angel dust") or synthetic ”designer drugs” such as mephedrone (known by different names, including ulant intoxication by the presence of cocaine or amphetamine—type substance metabolites in a urine or plasma sample.
Stimulant intoxication and withdrawal. Stimulant intoxication and withdrawal are dis- tinguished from the other stimulant-induced disorders (e.g., anxiety disorder, with onset during intoxication) because the symptoms in the latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.
Stimulant-related disorders often co-occur with other substance use disorders, especially those involving substances with sedative properties, which are often taken to reduce in- somnia, nervousness, and other unpleasant side effects. Cocaine users often use alcohol, while amphetamine-type stimulant users often use cannabis. Stimulant use disorder may be associated with posttraumatic stress disorder, antisocial personality disorder, atten- tion-deficit/hyperactivity disorder, and gambling disorder. Cardiopulmonary problems are often present in individuals seeking treatment for cocaine-related problems, with chest pain being the most common. Medical problems occur in response to adulterants used as ”cutting” agents. Cocaine users who ingest cocaine cut with levamisole, an antimicrobial and veterinary medication, may experience agranulocytosis and febrile neutropenia.