Prescribing Psychostimulants for the Treatment of Stimulant Use Disorder: Navigating the Federal Legal Landscape

Stimulant use disorder (StUD) is a rapidly growing concern in the United States, with escalating rates of death attributed to amphetamines and cocaine. No medications are currently approved for StUD treatment, leaving clinicians to navigate off-label medication options. Recent studies suggest that controlled prescription psychostimulants such as dextroamphetamine, methylphenidate, and modafinil are associated with reductions in self-reported stimulant use, craving, and depressive symptoms. Despite this positive initial evidence, prescribing rates of these medications for StUD treatment remain low, possibly because some clinicians believe that they are subject to the restrictions federal law imposes on medications for opioid use disorder. This is not the case. Rather, at the federal level, these medications are subject only to the general requirement that prescriptions be issued for a legitimate medical purpose within the usual course of professional practice, criteria that are buttressed by recent national guidelines that include controlled prescription psychostimulants as an option within a comprehensive treatment plan for StUD. In this commentary, we review the federal legal landscape regarding the prescription of psychostimulants for StUD and recommend strategies for increasing the utilization of this promising approach. Professional organizations, addiction clinicians, and researchers can reinforce this practice through publishing expert recommendations, developing clinician education materials, and disseminating their real-world experiences and well-documented treatment plans.