Stimulant-induced Psychosis: A Comparative Systematic Review and Meta-analysis of Psychotic Outcomes from Therapeutic and Non-therapeutic Use of Stimulants

Stimulant-induced Psychosis: A Comparative Systematic Review and Meta-analysis of Psychotic Outcomes from Therapeutic and Non-therapeutic Use of Stimulants

Published: November/December 2026
Journal Article

Overview

This one-hour, journal article-based activity examines stimulant-induced psychosis associated with therapeutic and non-therapeutic stimulant use. Learners will explore differences in the prevalence, clinical characteristics, and course of psychosis across these contexts of stimulant exposure, including factors that may contribute to psychotic outcomes. The article also examines implications of these findings for clinical assessment and risk management across therapeutic and non-therapeutic stimulant use. 

The target audience for this intermediate continuing education activity includes physicians, nurse practitioners, physician assistants, and other clinicians, researchers, students, and policymakers. 

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, and Practice-Based Learning and Improvement. 

Abstract

Aims 

Stimulant medications are increasingly prescribed for conditions including stimulant use disorders, yet both therapeutic and nontherapeutic use have been linked to stimulant-induced psychosis. Despite extensive literature, no prior systematic review has compared psychotic outcomes across these 2 contexts of use.

Methods

Following PRISMA guidelines, we systematically searched PubMed, Embase, and Scopus through April 2025 and registered the protocol in PROSPERO (CRD420251049204). Eligible studies examined stimulant-induced psychosis among therapeutic (prescribed) and nontherapeutic (illicit, recreational, or misused) users. Data were extracted on demographics, stimulant type, dosage, route, comorbidities, clinical characteristics, and outcomes. Meta-analyses were conducted for incidence and prevalence where data permitted. Risk of bias was assessed using RoB 2.0, ROBINS-I, and JBI tools.

Results

Seventy-seven studies (n = 687,912) were included: 9 therapeutic and 68 nontherapeutic. Therapeutic stimulants were primarily oral methylphenidate or amphetamine at guideline doses, while nontherapeutic use commonly involved high-dose methamphetamine or mixed stimulants through intravenous or smoked routes. The pooled incidence of stimulant-induced psychosis in therapeutic use was 0.6% (95% CI: 0.3–0.9). Prevalence estimates differed markedly: 0.2% (95% CI: 0.0–0.3) in therapeutic users versus 32.8% (95% CI: 25.5–40.2) in non-therapeutic users. Nontherapeutic psychosis was characterized by higher dosages, acute onset, persecutory delusions, hallucinations, and greater recurrence risk, whereas therapeutic cases often resolved with dose reduction or discontinuation. Evidence on treatment effectiveness, neurobiology, and genetic factors was limited and heterogeneous.

Conclusion

Stimulant-induced psychosis occurs in both therapeutic and nontherapeutic contexts but at vastly different prevalence rates. While prescribed stimulants pose a low but clinically relevant risk, particularly in individuals with psychiatric vulnerability, nontherapeutic use carries a substantial burden of psychosis with significant public health implications. These findings underscore the need for careful monitoring in clinical practice, risk profiling, and targeted harm-reduction strategies in nonmedical use settings.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Differentiate psychotic outcomes associated with therapeutic and non-therapeutic stimulant use.  
2. Characterize clinical features and factors associated with stimulant-induced psychosis across therapeutic and non-therapeutic contexts.
3. Determine appropriate considerations for risk assessment and monitoring based on evidence regarding stimulant-induced psychosis. 

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

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Refunds & Cancellations

All ASAM eLearning Center refund requests must be made in writing to [email protected] within 90 days of purchase. Those requesting refunds for courses that are in progress will receive partial refunds or eLearning Center credit. Automatic full refunds will be made for any course with a live-course component that has been canceled.

Open Registration: 11/03/2026 - 02/10/2029

Close Access Date: 02/10/2029

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click Download Journal Article in the box titled Journal Article and read the journal article in its entirety. 
3. Click Complete Post-Test to answer multiple-choice questions. You will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete Evaluation to provide valuable activity feedback. Scroll down on all questions, as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Interprofessional Continuing Education: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered
   American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures