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Stimulants (cocaine and amphetamines) and cannabis
Stimulant toxicity is a sympathetic storm — high pulse and blood pressure, fever, dilated pupils, agitation and sometimes psychosis or seizures — and the first treatment is benzodiazepines; cannabis is milder, but heavy use brings psychosis and cyclical vomiting.
Why it matters in the exam
Exam questions present a young person with chest pain, tachycardia and hypertension after cocaine use, and ask for the treatment. Benzodiazepines calm the storm, lower pulse and blood pressure and prevent seizures. For chest pain aspirin and nitrates are given, and an ECG and troponin are checked, because cocaine causes coronary spasm and infarction. A beta-blocker alone in the acute phase is a classic trap because of concern about unopposed alpha stimulation. High fever is treated with aggressive cooling.
Amphetamines and methamphetamine act longer and tend to cause psychosis with persecutory delusions; MDMA also causes hyponatraemia, high fever and serotonin syndrome. After prolonged use comes a "crash" — excessive sleep, hunger, fatigue and low mood — during which suicide risk must also be watched. There is no approved drug for stimulant use disorder; the most effective treatment is behavioural (contingency management and CBT). With cannabis: red eyes, increased appetite, fast pulse, dry mouth and anxiety; heavy use in adolescence raises the risk of psychosis. Cannabinoid hyperemesis syndrome — cyclical vomiting relieved by hot showers — resolves only when use stops.
Key points
- Stimulants: sympathetic storm → benzodiazepines first.
- Cocaine chest pain: aspirin and nitrates; no beta-blocker alone in the acute phase.
- MDMA: fever, hyponatraemia, serotonin syndrome.
- Stimulant use disorder: behavioural treatment.
- Cannabis: psychosis with heavy use; hyperemesis syndrome → stop.
Summary table
| Substance | Toxicity | Treatment | Exam notes |
|---|---|---|---|
| Cocaine | Tachycardia, hypertension, fever, dilated pupils, agitation, chest pain | Benzodiazepines; aspirin and nitrates for chest pain; cooling | No beta-blocker alone in the acute phase |
| Amphetamines and methamphetamine | Like cocaine, longer; persecutory psychosis | Benzodiazepines; antipsychotic for psychosis | Dental erosion and skin sores with chronic use |
| MDMA | Fever, hyponatraemia, serotonin syndrome | Cooling, careful sodium correction, benzodiazepines | Heavy water drinking worsens hyponatraemia |
| Crash after stimulants | Excessive sleep, hunger, low mood | Support and suicide-risk monitoring | No life-threatening withdrawal |
| Cannabis — intoxication | Red eyes, appetite, tachycardia, dry mouth, anxiety | Reassurance; benzodiazepine for severe anxiety | Synthetic cannabinoids — more severe toxicity |
| Cannabinoid hyperemesis syndrome | Cyclical vomiting, relief in a hot shower | Stop use; haloperidol or capsaicin cream for relief | Ordinary antiemetics help little |
A free exam question
באיזה מ בין המצבים הבאים מומלץ להימנע מטיפול ב- Stimulants ב ילד הסובל מ ADHD ? (the question as examined, in Hebrew)
- א. מחלת פרכוסים
- ב. סיפור משפחתי של מוות בגיל צעיר מסיבה לא ידועה
- ג. אירועים חוזרים של התפרצויות אלימות על רקע פסיכיאטרי
- ד. עייפות כרונית על רקע מחלה ממושכת
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Sources
- ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder, 2023 — Intoxication, withdrawal and treatment
- AHA Scientific Statement, 2008, updated guidance — Management of cocaine-associated chest pain and myocardial infarction
- Gastroenterology clinical practice update (AGA), 2024 — Cannabinoid hyperemesis syndrome
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Stimulant-Related Disorders; Cannabis-Related Disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.