Overdoses involving stimulants are on the rise in many parts of the country, according to newly available data from the Centers for Disease Control and Prevention, but experts say recognizing and responding to them is more complex than opioid overdoses.
“The rate of decline in overdoses was not what we expected” in California, said Dr. Taylor Nichols, an emergency medicine and addiction physician based in Sacramento.
Nichols said stimulants “fill the void” left by the decline in fentanyl overdoses. Methamphetamine and cocaine are the most common illicit stimulants.
While fentanyl-related overdose deaths fell to pre-pandemic levels nationally for the first time in 2025, according to the CDC’s preliminary overdose death data, cocaine-related deaths increased in 13 states and methamphetamine-related deaths increased in eight states. In some states, like Arizona, non-fatal stimulant overdoses are at record levels.
Public health messages have been effective in teaching people to recognize opioid overdoses and respond with naloxone, but education about stimulant overdoses and how to manage them has not been as clear.
“As a bystander, it’s much harder to decide whether something is a stimulant overdose when you compare how obvious a true opioid overdose is,” said Stephen Murray, director of SafeSpot Overdose Hotline, a safety service for people using drugs alone, run by Boston Medical Center.
A former paramedic, Murray conducts overdose response training for paramedics across the country. When a person’s breathing slows significantly or stops, it’s a clear sign of an opioid overdose, but stimulant overdoses vary widely.
“A stimulant overdose can be as simple as releasing too much stimulation into your brain and body,” Nichols said. Extreme overstimulation puts strain on the heart and brain, leading to heart attacks and strokes.
Nichols and Murray both recommend learning to recognize stroke and other symptoms of stimulant overdose. The mnemonic Be Fast (Loss of balance, Vision changes, Facial drooping, Arm (or leg) weakness, Slurred speech, Time to call 911) presents the signs of a stroke. Stimulant-induced shortness of breath, seizures, and chest pain also warrant immediate medical attention.
It is advisable to call 911 in the event of an overdose, but bystanders have successfully saved lives by using naloxone without involving medical professionals. There are no equivalent tools for bystanders who witness a stimulant-induced heart attack, stroke, or seizure. If a person loses consciousness during a stimulant overdose, this could indicate that opioids are also involved, and it is safe to use naloxone to reverse the possible opioid component.
High doses of stimulants are especially dangerous in hot climates.
“You can develop hyperthermia, where your body becomes too hot, which can lead to significant brain damage or even death,” Nichols explained. People using stimulants sometimes forget to eat or drink, but Murray said a conscious effort to stay hydrated can prevent overheating.
Dalton Barrett, a paramedic and opioid settlement fund manager in rural Edgecombe County, North Carolina, recommends calming patients with stimulant overdoses as much as possible while waiting for an ambulance to arrive. This means getting rid of external stimulation, such as music, bright lights and crowds.
“What we don’t want is for us to get there, and now they’re aggressive with EMS personnel, and now law enforcement comes, and the person is tased or masked or handcuffed,” Barrett said. These types of altercations are distressing for patients and can also make it more difficult for emergency responders to treat them.
Prolonged, sleepless use of stimulants can also lead to psychosis and paranoia.
“I have a history of meth and stimulant use, and I once suffered from near-psychosis,” Murray said. “Telling someone that (their illusion) isn’t happening doesn’t make it any less real.” Murray suggests instead validating that the experience is frightening. “If you’re preparing for the arrival of someone you love, just make sure that person won’t be perceived as threatening,” Murray said. This may mean calmly looking around the space and eliminating anything that might seem incriminating, such as a weapon.
Ideally, Murray said, emergency medical services and law enforcement coordinate to keep patients safe, especially when they need to be restrained. In particular, he recommends defending patients subjected to forced restraint by ensuring that they also receive medical sedatives.
Most fatal stimulant overdoses also involve other substances, but Murray notes that older men with heart problems are most at risk of dying from stimulants alone.
“The people who are dying have the American diet and lack of exercise. Then when you mix very strong stimulants, especially if people are injecting them, it’s a deadly combination,” he said, adding that he wishes people could talk openly with their doctors about their drug use and health, because broader strategies to improve heart health can also help prevent stimulant overdoses, even when someone continues to use stimulants. Yet the criminalization of drugs and abstinence-only messages make this difficult.
He continued: “It’s really difficult for us to study how we could improve people’s health in this situation, because we’re just telling people not to use drugs, when we know that millions of people every year in the United States spend billions of dollars on stimulants. »
Gn Health
