**Abstract**

Fear of BBT (beta-blocker therapy) has initiated after a small amount of evidence proposing beta-blockers given during acute stimulant toxicity may create an unopposed alpha-receptor stimulation leading to worse medical outcomes. The objective is to investigate how long-term BBT (both selective and non-selective) affect cardiovascular outcomes compared to no BBT regarding prevention of stimulant-inducedcardiomyopathy. Method is review of most current medical literature. The use of either selective or non-selective beta-blockers to treat the acute effects of cocaine or methamphetamine toxicity demonstrates safety and efficacy. Long-term BBT either selective or non-selective shows success in the prevention of cardiomyopathy in cocaine users by demonstrating a lower rate of death, MI, hospital readmission and improvement of LVEF and NYHA functional class compared to no BBT use. Both selective and non-selective long-term BBT prevent the progression of cardiomyopathy in active cocaine users but not methamphetamine.

**Keywords:** acute coronary syndrome, cocaine, amphetamines, beta-blockers, HFrEF, mortality, alpha-receptor stimulation
