What Dose of Methamphetamine Do Regular Consumers Use Daily? Estimating Milligrams of Oral Amphetamine Equivalent

We estimate that consumers of methamphetamine in Los Angeles use an average daily stimulant dose (>1,500 MOAE) that is 25-fold higher than the maximum typical recommended clinical dose of mixed amphetamine salts (60mg). This may help explain the limited efficacy of prescription stimulant treatment for methamphetamine use disorder, which typically employs considerably lower quantities. Given this high dose, these findings shed light on the rising incidence of methamphetamine-related sequalae, such as psychosis, cardiovascular complications, and sudden death. Although exposure quantification is commonplace for alcohol and tobacco use disorders, uncertainties in illicit drug markets has complicated this practice for most illicit drugs. This study supports leveraging emerging information from drug checking programs so that clinicians can approximate exposure quantification.