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Stimulants

Stimulants

Stimulants are a broad class of drugs that speed up the body's systems and are sometimes referred to as “uppers." Stimulants include prescription drugs (amphetamines, Adderall®, Dexedrine®, Concerta®, Ritalin®, diet aids, and drugs that treat sleep disorders), caffeine, and illicit drugs (methamphetamine or “meth", cocaine, methcathinone, other synthetic cathinones or “bath salts", and MDMA/ecstasy).

The desired effects of using stimulants include increased focus, higher levels of energy, extended wakefulness, feelings of euphoria, increased confidence, reduced appetite, weight loss, or to "get high." Stimulants can be misused and addictive. Chronic prescription stimulant misuse and illicit stimulant use can lead to a substance use disorder and other serious health consequences such as increased cardiovascular and stroke risk, mental health problems (such as hallucinations, paranoia, and anxiety), sleep deprivation, weight loss, accidental overdose, and death.

Learn more by downloading the CDC Stimulants Guide (PDF).

There are two general groups of stimulant drugs, prescription stimulants and illicit stimulants. ​
  • ​​Prescription Stimulants: Prescription stimulants are medications legally obtained through a healthcare provider. They are used to treat medical conditions such as attention deficit hyperactivity disorder (ADHD), narcolepsy, and sometimes depression or obesity. Examples of prescription stimulants include amphetamines (e.g., Adderall), methylphenidate (e.g., Ritalin), and modafinil (e.g., Provigil). Prescription stimulants can help improve an individual's health and quality of life when they are taken as prescribed. However, people can misuse prescription stimulants by taking higher doses than prescribed, taking them more frequently than prescribed, or taking someone else's prescription.
    • Amphetamines: Typically pill type medications that are commonly prescribed by a medical provider to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy.

​The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory in June 2024 related to potential disruption to access to prescription stimulants. Patients with disrupted access to their prescriptions may seek medication outside of the regulated healthcare system. This may significantly increase their risk of overdose due to the prevalence of counterfeit pills in the illicit drug market.


  • ​​Illicit Stimulants:     Illicit stimulants include illegal substances like cocaine, methamphetamine (meth), ecstasy (MDMA), and synthetic cathinones (e.g., bath salts). Using illicit stimulants can put people at risk of drug-related harms, stimulant use disorder, and overdose.
    • Methamphetamine: is an extremely potent illicit stimulant that has a stronger and more prolonged effect on the brain and body than other amphetamines. Methamphetamine is typically in a pill or powder form and can be smoked, snorted, or injected when dissolved in a liquid, or swallowed. Common names include "meth," "speed," and "crank."
    • Cocaine: A powerful stimulant derived from the coca plant, cocaine is known for its rapid onset of euphoria and increased energy. Cocaine is manufactured and consumed in various ways. It is typically a white, crystalline powder or rock. Cocaine can be snorted, smoked, swallowed, or dissolved in a liquid to be injected into a vein. Common names of powder cocaine include "coke," "snow," and "flake." Common names of rock type cocaine include "rocks," "candy," and "nuggets." It is often misused recreationally and can lead to the development of a use disorder and various health risks.
    • MDMA: (3,4-methylenedioxy-methamphetamine), also known as ecstasy or "Molly," is a synthetic drug that has both stimulant and hallucinogenic effects. MDMA is typically swallowed in tablet, capsule, or liquid form. It can also be found in powder form and snorted. It is often considered a "party drug" because it is popular in nightclubs and festivals. Common names include "lover's speed," "hug drug," and "x."
    • Synthetic cathinones: also known as "bath salts," are synthetic stimulants that derive from plant food, jewelry cleaner, glass cleaner, research chemicals, bath salts, and labeled "not for human consumption." They often look like a white or brown crystal-like powder and are typically marketed as cheaper substitutes for other stimulants or sold as "Molly." Synthetic cathinones can be snorted, smoked, ingested, or dissolved in liquid to be injected. Other names include "vanilla sky," "cloud nine," and "white lightning."

 

​​​​​Counterfeit pills sold as 'stimulants' are extremely dangerous because people purchasing them may think they are purchasing legitimate prescription medications. However, these fake pills may contain lethal amounts of methamphetamines, other stimulants or fentanyl. With a rise in counterfeit stimulant pills across Oregon since 2019 that are contaminated with fentanyl​ it is important to take harm-reduction measures to reduce the risk of an opioid related overdose (see prevention section below).

Stimulant Overdose in Oregon

From 2020 to 2022, among all reported fatal overdoses in Oregon there were 1,953 Oregonians that lost their lives to an unintentional fatal overdose involving a stimulant. (Data source: CDC SUDORS Dashboard: Fatal Drug Overdose Data​) ​

In 2022, methamphetamine was identified as the cause of death in 58% of all unintentional and undetermined drug overdose deaths in Oregon, and cocaine was identified as the cause of death in 9% of unintentional and undetermined drug overdose deaths. (CDC SUDORS Dashboard: Fatal Drug Overdose Data​) ​

Unintentional stimulant related overdoses are likely underreported, and disproportionately impact communities of color and tribal communities in Oregon. More information can be found about overdose disparities in Oregon in the 2022 OHA publication: Opioids and the Ongoing ​Drug Overdose Crisis in Oregon 2022 (PDF).

Methamphetamine is commonly identified in overdose deaths with more than one substance causing the death of the person, also called “polysubstance overdoses​." About 1/3 of all unintentional and undetermined drug overdoses in Oregon during 2022 had both methamphetamine and fentanyl as a cause of death. ​(CDC SUDORS Dashboard: Fatal Drug Overdose Data​)


Fatal Overdose Trends Involving Stimulants in OR 2010-2022.png


Source: Oregon Center for Health​ Statistics, Death certificates, 2010-2022

​
Stimulants can also cause nonfatal overdoses which sometimes need hospitalization or are seen in the Emergency Department (ED). In 2022, there were 831 stimulant overdose related hospitalizations and 471 ED visits related to a stimulant overdose in Oregon facilities​. Stimulant use, especially methamphetamine, can cause other health issues​ that may need medical treatment other than a nonfatal overdose.

There are no overdose reversal medications for stimulants like there are for opioids. However, if someone is unconscious and experiencing an overdose, it is always recommended to administer naloxone if an opioid is involved or suspected (see below for more information on how to respond to a stimulant overdose). 



Illicit Stimulant Prevalence in Oregon

The most common illicit stimulants in Oregon are methamphetamine and cocaine. The Oregon-Idaho High Intensity Drug Trafficking Area (HIDTA) indicates that the Oregon illicit stimulant drug market is increasing as drug seizures of cocaine and methamphetamines have increased in recent years. Methamphetamine remains the most seized stimulant drug in Oregon. (Oregon-Idaho HIDTA Performance Management Process 2024)

 

Title: Total of Methamphetamine & Cocaine Seized by Oregon HIDTA Designated Enforcement Initiatives

Total of Methamphetamine and Cocaine Seized by OR HIDTA Designated Enf Initiatives.PNG​

Stimulant Overdose Prevention

Follow the recommendations below to prevent a stimulant related overdose.

  • Unless a pharmacist or your healthcare provider directly hands you a prescription pill, assume it is counterfeit and contains fentanyl and other substances, including a stimulant.
  • Assume any pills from friends, social media, or the internet are counterfeit and contain fentanyl and other substances, including stimulants.
  • When using substances, start low and go slow, checking the strength and the effects of the substance.
  • Never use alone.
  • Always carry naloxone with you.
  • When using substances, have naloxone where it can be seen in case of overdose so that someone can use the naloxone on you.
  • Test all the substances you are planning to use with fentanyl test strips​ (FTS). However, FTSs are not always one hundred percent accurate so always assume that any substance has fentanyl. You may be able to get drug testing strips at local syringe services or harm reduction program sites. Ask syringe service and harm reduction service providers how to safely use stimulants. Please contact your local public health authority to learn more about services nearest to you.
  • If you call the police or 911 to get help for someone having a drug overdose, Oregon's Good Samaritan law protects you and the person who has overdosed from being arrested or prosecuted for drug-related charges or parole/probation violations based on information provided to emergency responders. Read The Good Samaritan Law (pdf)
​Recognizing a Stimulant Overdose
  •  A stimulant overdose occurs when someone is experiencing effects of stimulants so severe that their health or safety may be at risk. The effects of stimulants on the body can vary greatly based on multiple factors such as underlying health issues, type of stimulant, route of administration, and dose, Therefore, not all stimulant overdoses look the same. Due to the variable nature of stimulant overdoses, some refer to potentially life-threatening emergencies as “stimulant toxicity" or as “overamping." Overamping can include a variety of negative or uncomfortable physical and psychological effects from stimulant drugs listed below.

    Signs and Symptoms: The signs and symptoms of a stimulant overdose can vary depending on the specific drug, dose, and individual factors. Not all stimulant overdoses are fatal, but even in non-fatal cases, they may be serious and require medical attention.

    Common signs and symp​toms of a stimulant overdose that needs medical attention may include:

    • Dilated pupils​​
    • Dizziness
    • Tremor
    • Irritability
    • Confusion
    • Mood swings
    • Nausea or vomiting
    • Rapid breathing, fast heart beat, or arrhythmia
    • Overheating or excessive sweating
    • Hypertension (high blood pressure)
    • Chest pains or tightness
    • Panic or extreme anxiety
    • Hallucination
    • Psychosis
    • Persistent seizures


​​​Responding to a Stimulant Overdose
  •  If someone is demonstrating the signs of a stimulant overdose, or any other substance overdose, call 9-1-1 immediately. You can also take the following steps to support them:

    • Call 9-1-1.
    • If someone is unconscious always administer naloxone. Refer to the Save Lives Oregon "Reverse Opioid Overdose with Naloxone Nasal Spray" guide (pdf) for the six steps to reverse an opioid overdose.
    • Try to keep the person awake and breathing.
    • In the case of a stimulant overdose someone could be overheating or have “hyperthermia." Therefore, try to slow down any agitated movements and try to cool them down with ice packs, a cool or wet cloth under their armpits on the back of the knees, and/or on the forehead. If water or sports drink is accessible, have them hydrate.
    • Stay with the person until emergency assistance arrives.
​The following tips can help with providing support to someone who may be experiencing a stimulant overdose and is not unconscious.
    • Stay Calm and Non-Threatening: Approach the person calmly and speak in a calm and reassuring tone to try to de-escalate any tension.
    • Maintain Distance: Do not crowd or corner them.
    • Listen and Validate: Listen to the person's concerns or feelings without judgment. Validate their emotions by acknowledging their experience.
    • Avoid Confrontation: Refrain from arguing, shouting, or engaging in confrontational behavior.
    • Offer Help: Ask if someone needs help and avoid forcing help if the person is not receptive.

If you or someone you care about is struggling with substance use, please reach out for help. Speak with a healthcare provider or visit the links below for support and treatment resources. You are not alone.
 
If you have additional questions about stimulants, please contact the Injury & Violence Prevention Program at IVPP.General@odhsoha.oregon.gov.