PCSS-MOUD: Systemic Solutions for Managing Methamphetamine Use (On-Demand)-Presentation

Video Transcription

Video Summary

Dr. Coffin, a physician specializing in addiction and infectious diseases, discusses methamphetamine use disorder (MUD), highlighting its rising prevalence in the U.S. and significant morbidity and mortality trends. Methamphetamine-related emergency visits primarily involve psychiatric, cardiovascular, and trauma complaints. Deaths involving both methamphetamine and opioids, mainly fentanyl, resemble opioid overdoses and require similar prevention strategies; in contrast, methamphetamine-only deaths often result from chronic cardiovascular and cerebrovascular conditions rather than acute overdose.<br /><br />Methamphetamine toxicity manifests mainly through cardiovascular damage—such as cardiomyopathy, arrhythmias, strokes, and ischemia—and neuropsychiatric effects including psychosis, cognitive impairment, and increased risk behaviors leading to HIV. Toxicity often stems from chronic and binge use patterns, akin to alcohol-related harm.<br /><br />Addressing MUD clinically involves a systematic four-tier approach: assessment (diagnosis and understanding use motivation), routine prevention (infectious disease screening, vaccination, naloxone distribution), use reduction (contingency management and medications like bupropion, mirtazapine, and naltrexone), and toxicity prevention (treating cardiovascular/neuropsychiatric effects aggressively and promoting sleep hygiene). Statins and dental care may reduce methamphetamine’s long-term harms.<br /><br />Despite limited FDA-approved medications, contingency management is highly effective. Emerging treatments like GLP-1 agonists show promise. Dr. Coffin emphasizes personalized, evidence-informed care addressing both use disorders and non-use-disorder-related toxicities to reduce morbidity and mortality associated with methamphetamine.

Keywords

Methamphetamine Use Disorder

Addiction Medicine

Cardiovascular Toxicity

Neuropsychiatric Effects

Contingency Management

Opioid and Methamphetamine Overdose

Infectious Disease Screening

Pharmacologic Treatments

Personalized Addiction Care