As a new type of abused drug, methamphetamine (METH) has a strong central stimulant effect, and the excitatory pathway involved a series of central higher-level functions, including drug-related rewards and motivation, learning and memory, decision-making and execution, etc. Methamphetamine not only causes neurotoxicity in the body, but long-term use could cause cognitive dysfunction, loss of personality, and serious social violence in addictions. Exosomes, as a new carrier of cell-to-cell communication, were involved in the occurrence and development of drug addiction, and exosome miRNAs were not only important biomarkers for methamphetamine addiction, but also involved in various aspects of methamphetamine induced neurotoxicity, which could be used as a therapeutic carrier to provide new ideas for the diagnosis and treatment of methamphetamine abuse.