Stimulants
Last updated June 2025
Stimulants (or “uppers”) are a class of drugs that increase activity in the body’s central nervous system. Stimulants exist on a spectrum - from a cup of coffee to a prescription such as Adderall, to street drugs such as cocaine, crack, or meth.
Stimulants can cause desired effects like increased alertness, focus, and euphoria (feeling of intense happiness). However, they can also cause unwanted effects like increased heart rate, blood pressure, and body temperature, which can lead to medical emergencies. Frequent use of stimulants can lead to a physical dependence that requires people to continue using to prevent withdrawal symptoms.
This page is currently under development. Currently, most of our stimulant-related resources are for healthcare providers. However, resources for community members and non-medical organizations are in development and will be available here in the near future. If you have any questions about information or material on this page, reach out to Shelby Kehoe at shelby.kehoe@phila.gov.
Frequently asked questions
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Stimulants on their own do not cause overdose in the way opioids do (when someone stops breathing), but they are increasingly being found in combination with opioids during overdose. In 2023, 70% of overdose deaths in Philadelphia involved a stimulant – primarily cocaine.
Overdose deaths involving both a stimulant and an opioid can be a result of intentional mixing or because of a contamination of the stimulant drug supply. If you are using a substance of any kind – even if it is not an opioid – you should carry naloxone (Narcan) in case the drug contains an opioid.
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Naloxone (Narcan) reverses overdoses caused by opioids. A majority (55%) of overdose deaths in Philly in 2023 involved a combination of opioids and stimulants. They are often used together, both on accident and on purpose.
If someone who has been using a substance is not breathing, they may be experiencing an overdose, and you should give them naloxone. Other symptoms such as racing heartbeat, overheating, or uncontrolled muscle movements cannot be controlled using naloxone.
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Overamping (or “fishing out”) is an unplanned, negative physical or mental effect from stimulant use. Below, we’ll describe what overamping looks like, how to manage the symptoms, and how to know when it’s time to go to the hospital.
Overamping can look and feel different for different people. The symptoms and seriousness of overamping depend on several factors, including the type and dose of substance, the route of use (e.g. injection, snorting), the health status of the person using, and the environment they’re using in.
What are signs of overamping?
Physical signs/symptoms include: nausea and/or vomiting; falling asleep/passing out (but still breathing); irregular breathing or shortness of breath; convulsions, tremors, limb jerking or rigidity; severe headache; seizures; chest pain; focal weakness (e.g. facial droop).
Mental symptoms include: panic; paranoia; hallucinations; increased aggressiveness; restlessness or irritability.
How to respond to a non-emergency situation:
Hydrate with water or a sports drink.
Cool down with a cold/cool shower.
Eat something.
Try to sleep or rest.
Take deep breaths, take a walk, or move to a quieter location if possible.
Call 911 if you, or the person you’re with, are experiencing signs of:
Hyperthermia (body temperature at or above 104 F, confused, or unconscious).
Heart attack (elevated heart rate along with chest pain, shortness of breath, dizziness, nausea, or unusual fatigue).
Stroke.
Seizures.
Hallucinations or delusions.
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Fentanyl test strips (FTS) and Xylazine test strips (XTS) can be used to see if those drugs are present in the substance you’re testing - here are instructions on how to use test strips.
While test strips are a great tool, they are not 100% accurate. Use universal precautions to stay safe.
Resources for the public
Harm reduction for stimulant use
If you or someone you know uses street stimulants, there are things you can do to use them more safely and prevent further risk of overdose or illness.
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Stay hydrated.
Take breaks. The use of cocaine, crack, and any stimulant can lead to insomnia and sleep deprivation.
Test your drugs. Remember, the drug supply is often unreliable and potency can change from batch to batch, seller to seller, and city to city. The same dose can feel different.
Different ways of using cocaine are associated with different risks. Generally, snorting has less risks than smoking or injecting, and injecting has most risks.
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Avoid mixing cocaine or crack with other drugs or alcohol. If you do, use less of each drug.
Start with a small amount and go slowly.
Avoid using when alone.
Carry naloxone, a medication that can reverse an overdose if an opioid, like fentanyl, is mixed in.
Talk with your doctor about how to prevent serious health problems associated with overdose, such as heart attack, stroke, abnormal heart rhythm, very high blood pressure and death.
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Add a mouthpiece to your pipe to reduce risks of burns to the lips, mouth, and throat.
Use a wire screen, Chore boy or brillo as a filter and let the pipe cool down between hits to prevent inhaling hot particles. See a doctor if you feel any pain when breathing after using.
Keep lips hydrated with lip balm to reduce risk of cuts.
Avoid using homemade crack pipes. Homemade crack pipes may get too hot, give off toxic fumes, or break while in use, which can lead to burns, cuts, or infections.
Avoid sharing your pipe to prevent the spread of infectious diseases, including HIV and hepatitis C. If you do need to share, use different mouthpieces.
If smoking with foil (chasing), use real tinfoil and not foil from packaged foods like candy bars. This type of foil can be contaminated.
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Grind cocaine to remove clumps and hard pieces that can be painful while snorting and increase risk of injury to the nasal cavity.
Use your own sterile straw and scooping spoon and avoid sharing to prevent the spread of infectious diseases, including HIV and hepatitis C.
Alternate snorting sessions between both nostrils. This can help reduce risk of tissue damage in the nose.
Use a water or saline nasal spray or sniff up water immediately after snorting to dissolve the remaining coke. This will reduce potential damage to your nose.
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Clean your injection site with an alcohol pad before injecting.
Use a sharp, sterile syringe each time you inject.
Use sterile water when preparing your solution.
Pull up the solution by inserting the syringe into a filter (such as a cotton ball - avoid cigarette filters).
Rotate where you inject and make sure you’re in a vein before you inject.
Do not inject over a skin ulceration or wound.
Do not share equipment (such as syringes and cookers) to avoid the spread of infectious diseases, including HIV and hepatitis C.
Dispose of your syringes in a safe place after using.