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The use of stimulants with opioids, while historic, has been a seldom-used procedure in contemporary medicine. First, what should the dosage be? Given the plethora of toxic reactions being served up by the methamphetamine-abuse epidemic, caution is advised. No one really knows what methamphetamine dosages are used by street abusers, so it is impossible to compare street dosages with low dose prescription products. A recommended course with a selected stimulant is to start low in dosage and titrate upward over time. For example, I like to start dextroamphetamines at one of the two lowest commercial dosages, 5 or 10mg, two or three times a day. I initially start phentermine at 30 or The second unanswered question is whether we will see long-term toxic complications of stimulants. Reports to date indicate that stimulants have negligible effects on blood pressure, heart rate, or mental abilities. Will patients who find a stimulant-opioid combination to be effective later find out that tolerance sets in and effectiveness vanishes?

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