The Dangers of Snorting, Injecting, and Smoking Stimulants

Common Stimulants

Stimulants cover a broad category of prescription medications, such as those used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy, as well as substances like cocaine that are widely used illicitly. To be sure, even legally prescribed stimulants can be diverted and misused for non-medical purposes.^3,4

Commonly prescribed stimulants include:^4,5

•   Amphetamines (Adderall, Dexedrine, and Vyvanse).
•   Methylphenidate (Concerta and Ritalin).

Illicit stimulants include:^1,4

•   Illicitly manufactured cocaine/crack.
•   Illicitly manufactured methamphetamine/crystal meth.
•   Khat, which contains cathine (norpseudoephedrine) and cathinone (β-keto-amphetamine).
•   Synthetic cathinones, sometimes sold under the name “bath salts.”

Dangers of Smoking Stimulants

Inhalation of drug vapors–via smoking–rapidly delivers the stimulant to the brain and bloodstream, causing an individual to feel the effects more intensely than some other routes of administration, such as oral. One of the greatest dangers associated with smoking stimulants is the risk of addiction, which research indicates may be of particular concern due to how rapidly certain substances take effect and wear off when smoked. This can increase the likelihood that an individual smokes more to return to the high quickly and frequently.⁶

Smoking stimulants may result in lung and airway damage.² Acute and chronic respiratory symptoms and other health problems associated with smoking stimulants include:⁷

• Dyspnea, or shortness of breath.
• Wheezing and coughing.
• Blackened sputum or phlegm.
• Hemoptysis or blood or blood-stained mucus.
• Sinusitis and bronchitis.
• Acute bronchoconstriction, or narrowed airways.
• Pleuritic chest pain.
• Pulmonary hypertension.
• Barotrauma, or pressure injuries to the lung and surrounding structures.
• Barotrauma related pneumothorax, pneumopericardium, and pneumomediastinum, conditions where air leaks into a variety of extrapulmonary spaces.
• Pulmonary hemorrhage, or bleeding in the lungs.
• Respiratory tract infections.
• Pulmonary edema, or fluid buildup in the lungs.
• Airway burn injuries.

Additionally, smoking certain stimulants come with their own risks.

• Smoking meth is associated with pneumonia, acute respiratory distress, and non-cardiac pulmonary edema, or fluid in the lungs.⁸
• Smoking crack cocaine is associated with worsening of asthma, an increased risk of pneumonia and other lung infections, reduced lung function, impaired ability to force air out, abnormal collection of gas between the lungs and chest wall, muscle necrosis (severe tissue injury) and neurological problems, such as seizures and brain hemorrhage.^9,10

Dangers of Snorting Stimulants

Snorting stimulants like cocaine and meth or crushing and snorting prescription stimulant pills means that much of the substance bypasses the digestive system and liver and is instead absorbed into the bloodstream through the nasal tissues.⁹ While the relative risk of developing dependence and addiction from snorting stimulants may be relatively lower than other methods of use—namely smoking or injecting—it can still contribute to the development of a substance use disorder.¹¹

Additionally, snorting stimulants can cause inflammation and irritation of the nostrils, nasal passages, and sinuses. Chronically snorting substances can have other long-term effects, including:^2,7,10,12

• Loss of smell.
• Hoarseness.
• Frequent nose bleeds.
• Esophageal inflammation.
• Problems swallowing.
• Bronchial pneumonia.
• Damage to the nasal cavity.
• Cartilaginous vascular necrosis, a condition that occurs when tissue loses its blood supply, breaks down, and dies.
• Progressive tissue injury and possible perforation of the nasal septum.
• Noncardiogenic acute pulmonary edema, or fluid in the lungs not caused by heart issues.

Additionally, there can be unique effects associated with snorting certain stimulants. For example:

• Snorting Adderallor other prescription stimulants by grinding up the pills and snorting the powder produce a more rapid onset of effects than taking them orally, resulting in greater reinforcing effects and increasing the potential of developing addiction.¹³
• Snorting cocaine can lead to loss of sense of smell, nosebleeds, nasal damage, and trouble swallowing.¹⁴Though rare, snorting cocaine may also pose a risk for developing subcutaneous emphysema—when air becomes trapped in the tissues underneath the skin—or pneumomediastinum, a condition where air gets in the chest between the lungs.¹⁵
• Snorting methhas been associated with the symptoms mentioned above as well as chronic dry mouth (xerostomia)—though not more so than other methods of use.¹⁶

Dangers of Injecting Stimulants

Injecting stimulants results in near instantaneous delivery of the substance into the bloodstream, resulting in a quicker and more potent high.¹⁷ Intravenous or IV drug use presents risks that are associated with a range of diseases and other health issues, including:^10,14,18

• An increased risk of HIV/AIDS, hepatitis B and C, and other infectious diseases.
• Vascular injuries like scarred and collapsed veins.
• Skin and soft tissue infections, such as abscesses, cellulitis, and wound botulism.
• Cardiovascular infections, including infectious endocarditis, an infection of the heart’s inner lining or heart valves.
• Lung infections, such as pneumonia and tuberculosis.
• Other lung-related complications may include pulmonary edema—a condition caused by too much fluid in the lungs—pulmonary embolism, and emphysema.

Additionally, risks associated with injecting certain substances may include:

• Injecting cocaine or meth can cause skin lesions from picking at the skin. Both may also be associated with rhabdomyolysis, which involves the rapid breakdown of muscle tissue that can result in the toxic spillage of muscle fiber content into the blood, which may increase the risk of kidney injury.¹⁸
• Injecting cocainecan lead to cardiovascular complications, including vasculitis (inflammation of the blood vessels) and myocarditis/myocardial ischemia (diminishedblood supply to the heart muscle) as well as serious gastrointestinal issues such as perforated gastric or duodenal ulcers, and splenic infarct (when blood flow to the spleen is compromised).¹
• Injecting meth can lead to elevated serum transaminase and bilirubin levels.¹⁸

Stimulant Addiction Treatment

All methods of stimulant use can lead to addiction, which is diagnosed as a stimulant use disorder. Stimulant use disorder involves continued, compulsive substance use and substance-seeking behaviors despite the negative consequences of such drug use behaviors. Treatment can help an individual recover from a stimulant use disorder and allow them to lead a healthier, drug-free life.²

Medications Used to Treat Stimulant Addiction

Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) to treat stimulant withdrawal symptoms or addiction.¹⁹ However, some medications are currently being used on an off-label basis—and based on the specific substance used—to help individuals reduce use and promote abstinence.²⁰ 

Medical detox is not usually required for stimulant-only use; however, it may be recommended when other drugs are involved such as alcohol, opioids or benzodiazepines, as these drugs have severe withdrawal symptoms that may complicate detox. Medical detox may also be an option if you’re suffering from psychiatric symptoms that complicate withdrawal.¹⁹

Levels of Care for Stimulant Addiction

Evidence-based interventions help individuals address the underlying issues associated with stimulant addiction and learn coping skills necessary for sustained recovery.¹⁹ There are various levels of care for stimulant addiction, which may include inpatient rehab or different types of outpatient care.²¹

Inpatient treatment means that you live and sleep onsite at a rehab facility for the duration of treatment, where you receive 24/7 care, support, and monitoring.²¹ Inpatient rehab may be beneficial if your addiction is severe or you haveco-occurring substance use and mental health disorders.²

Outpatient treatment involves different levels of care, including partial hospitalization programs (PHPs), sometimes referred to as day treatment programs, or intensive outpatient programs (IOPs). Both programs offer a similar structure that’s provided by inpatient programs, but in either outpatient program, you can return home or to a sober living environment after each scheduled treatment session, allowing you to continue to fulfill responsibilities at home, work, or school while receiving treatment. Additionally, both PHPs and IOPs have different requirements in terms of scheduled counseling and therapy sessions each week—with PHPs generally requiring more time in treatment than IOPs.²¹

Less intensive forms of outpatient treatment may only require attendance 1 to 3 times per week.²¹

Behavioral Therapies Used to Treat Stimulant Use Disorder

Behavioral therapies are the cornerstone of treatment for stimulant use disorder and may include:^2,22

• Cognitive-behavioral therapy (CBT). CBT is a short-term, goal-oriented therapy that helps people examine then thoughts, behaviors, and feelings associated with substance use and teaches skills that are necessary to remain sober.
• Contingency management (CM).CM offers positive reinforcement and rewards to people who achieve target goals in treatment.
• Community reinforcement approach (CRA).CRA is commonly used in combination with CM and offers a comprehensive method that involves different interventions, such as an analysis of a person’s substance use, relationship counseling, vocational guidance, and job skills training.
• Motivational interviewing (MI). MI helps people examine and strengthen their internal motivation to make positive life changes and reduce substance use.
• The Matrix Model. This model is another comprehensive approach that involves a variety of interventions, such as relapse prevention, family and group therapies, drug education, and mutual-help group participation.

If you or a loved one struggle with stimulant addiction, American Addiction Centers is here to help. Reach out to connect with a knowledgeable admissions navigator, who can answer your questions, explain your treatment options, and help you begin your recovery journey.