We did a global review to synthesise data on the prevalence, harms, and interventions
for stimulant use, focusing specifically on the use of cocaine and amphetamines. Modelling
estimated the effect of cocaine and amphetamine use on mortality, suicidality, and
blood borne virus incidence. The estimated global prevalence of cocaine use was 0·4%
and amphetamine use was 0·7%, with dependence affecting 16% of people who used cocaine
and 11% of those who used amphetamine. Stimulant use was associated with elevated
mortality, increased incidence of HIV and hepatitis C infection, poor mental health
(suicidality, psychosis, depression, and violence), and increased risk of cardiovascular
events. No effective pharmacotherapies are available that reduce stimulant use, and
the available psychosocial interventions (except for contingency management) had a
weak overall effect. Generic approaches can address mental health and blood borne
virus infection risk if better tailored to mitigate the harms associated with stimulant
use. Substantial and sustained investment is needed to develop more effective interventions
to reduce stimulant use.