Physical Findings Associated with Methamphetamine Use

Patients with chronic methamphetamine use may present with a variety of physical findings involving the skin, eyes, cardiovascular system, respiratory system, and general appearance. Although these findings may raise suspicion for stimulant use, no single physical finding is diagnostic of methamphetamine use disorder, and clinical findings should always be interpreted in conjunction with the patient's medical history, vital signs, and overall clinical presentation.^3,20,41

One of the more characteristic findings is formication, a tactile hallucination in which an individual perceives insects crawling beneath the skin. Repetitive scratching or skin picking may produce multiple excoriations, ulcerations, and secondary bacterial infections (Figures 1–3). Formication is now recognized as a manifestation of stimulant-induced psychosis and is commonly associated with prolonged wakefulness, repetitive compulsive behaviors, and poor hygiene rather than a direct pharmacologic effect of the drug.^20,41

Individuals with chronic methamphetamine use frequently experience decreased appetite, increased physical activity, and significant weight loss that may result in malnutrition. Additional physical findings may include hyperthermia, diaphoresis, hypertension, tremor, paranoia, hyperactivity, nausea, vomiting, diarrhea, mydriasis, blurred vision, chronic cough, inflamed or eroded nasal septum (with intranasal use), and injection track marks.^3,20,41

Methamphetamine overdose constitutes a medical emergency and may present with severe hyperthermia, seizures, altered mental status, cardiovascular collapse, dysrhythmias, or multisystem organ failure. Because polysubstance use has become increasingly common, clinicians should recognize that additional substances—particularly illicit fentanyl—may contribute to the patient's clinical presentation and significantly increase the risk of fatal overdose.^2,3,30

The oral manifestations of methamphetamine use will be discussed in the following section. Figures 4 and 5 demonstrate several of the characteristic physical findings associated with chronic methamphetamine use.