More people recognize opioid overdoses, but education about stimulant overdoses hasn’t been as clear-cut
Overdoses involving stimulants are on the rise in many parts of the country, according to recently available data from the Centers for Disease Control and Prevention, but experts say recognizing and responding to them is more complex when compared with opioid overdoses.
“The rate of overdose decline was not nearly what we expected” in California, said Dr Taylor Nichols, an emergency and addiction medicine physician based in Sacramento.
Nichols said that stimulants “filled the gap” left by declining fentanyl overdoses. Methamphetamine and cocaine are the most common illicit stimulants.
While fentanyl-involved overdose deaths dropped to pre-pandemic levels nationally for the first time in 2025, per provisional CDC overdose fatality data, deaths involving cocaine went up in 13 states and deaths involving methamphetamine went up in eight states. In some states, like Arizona, non-fatal stimulant overdoses are reaching record highs.
Public health messaging has been effective at teaching people to recognize opioid overdoses and respond to them with naloxone, but education about stimulant overdoses and how to handle them hasn’t been as clear-cut.
“As a bystander, it is a lot more challenging to decide whether something is a stimulant overdose when you compare to how clear-cut a true opioid overdose is,” said Stephen Murray, director of SafeSpot Overdose Hotline, a safety service for people using drugs alone run out of Boston medical center.
A former paramedic, Murray runs overdose response trainings for paramedics across the country. When someone’s breathing has slowed down dramatically or stopped, it’s a clear sign of opioid overdose, but stimulant overdoses vary widely.
“A stimulant overdose can be as simple as releasing too much stimulation into your brain and into your body,” said Nichols. Extreme overstimulation strains the heart and brain, leading to heart attacks and strokes.
Nichols and Murray both recommend learning how to recognize strokes and other stimulant overdose symptoms. The Be Fast mnemonic (Balance loss, Eyesight changes, Face droop, Arm [or leg] weakness, Speech difficulty, Time to call 911) lays out signs of stroke. Stimulant-induced shortness of breath, seizure and chest pain also warrant immediate medical attention.
Calling 911 is advised for any overdose, but bystanders do successfully save lives using naloxone without involving medical professionals. There are no equivalent tools for bystanders witnessing a stimulant-induced heart attack, stroke or seizure. If someone loses consciousness during a stimulant overdose, it could indicate opioids are involved as well, 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 gets too hot, and that can end up resulting in significant brain damage or death,” Nichols explained. People using stimulants sometimes forget to eat or drink, but Murray said that a conscious effort to stay hydrated can prevent overheating.
Dalton Barrett, a paramedic and manager of opioid settlement funds in rural Edgecombe county, North Carolina, recommends getting stimulant overdose patients as calm as possible while waiting for an ambulance to arrive. That means getting rid of external stimulation, like music, bright lights and crowds.
“What we don’t want to happen is we get over there, and now they’re aggressive with the EMS staff, and now law enforcement’s coming, and the person gets tased or maced or put in handcuffs,” Barrett said. These kinds of altercations are distressing for patients, and can also make it harder for emergency responders to treat them.
Prolonged, sleepless stimulant binges can also lead to psychosis and paranoia.
“I have a history of meth and stimulant use, and have been in quasi-meth psychosis before,” Murray said. “Telling someone that [their delusion] is not happening doesn’t make it feel less real.” Murray instead suggests validating that the experience is scary. “If you’re preparing for an EMS arrival for someone you love, just make sure that that person isn’t going to be perceived as being threatening,” Murray said. This can mean calmly looking around the space and clearing anything that might appear incriminating, like a weapon.
Ideally, Murray said, emergency medical services and law enforcement coordinate to keep patients safe, especially when they need to be restrained. One way he recommends advocating for patients who are forcibly restrained is to make sure they’re receiving medical sedatives as well.
Most fatal stimulant overdoses also involve other substances, but Murray notes that older men with heart health problems are most at risk of dying from stimulants alone.
“The people who die have the American diet and lack of exercise sort of stuff going on. Then when you mix in high-potency stimulants, especially if people are injecting them, that is a deadly combination,” he said, adding that he wishes that 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. Still, drug criminalization and abstinence-only messaging make this difficult.
He continued: “It is really challenging for us to study how we could improve people’s health in this situation, because we just tell people not to use drugs, when we know that millions of people every year in the US spend billions of dollars on stimulants.”
