Background Methamphetamine use is associated with a range of cardiovascular conditions including hypertension and heart failure. Beta blocker use is commonly avoided when treating patients intoxicated with methamphetamines due to a fear of inducing unopposed alpha stimulation and worsening hypertension. Methods We performed a retrospective review of medical records in a county hospital in California with a high prevalence of methamphetamine users. We included adults who tested positive for methamphetamine use on urine toxicology and were admitted to the hospital or stayed in the ER for over 24 hours. Subjects who tested positive for methamphetamines and received beta blockers within 48 hours of their arrival to the ER were assigned to cases, subjects who tested positive for methamphetamines and received a non-beta blocker antihypertensive or no antihypertensive were assigned to the control group. We compared length of stay (LOS), readmission rate within 30 days and systolic (SBP) and diastolic blood pressures (DBP) between the groups at admission and 24 hours. Results 130 cases and 117 controls were analyzed for LOS, 30 day readmission rate and SBP and DBP. Subjects were predominately male (60-70%) in both groups, with an average age of 52 for cases and 45 for controls. There was no significant difference between LOS and 30 day readmission rates between subjects who received beta blockers and subjects who did not. Subjects who received carvedilol were compared to subjects in the control group who received another antihypertensive, there was no significant difference in LOS between these groups. SBP at admission and 24 hours was significantly higher in the case group, however the effect size diminished over 24 hours. When comparing subjects who received carvedilol to those who received another antihypertensive, SBP was significantly higher at admission, but showed no significant difference after 24 hours. Conclusion Our results indicate that beta-blockers, particularly carvedilol, are an effective and safe treatment modality in methamphetamine users. Treatment with beta-blockers in the case group did not increase length of stay or re-admission rates compared to the control group, and treatment with carvedilol effectively reduced systolic blood pressure in patients with hypertension and cardiomyopathy. However it may be prudent to treat patients acutely intoxicated with methamphetamines with a combination of antihypertensives, including beta blockers, particularly in patients with cardiac comorbidities.