Overdosing: A Stroke Risk Factor?

Drug abuse can cause a stroke, even in healthy people with no prior health issues. Illicit drugs such as cocaine, heroin, amphetamines, and opioids have been associated with an increased risk of stroke. These substances can speed up the heartbeat, raise blood pressure, and cause damage to the blood vessels in the brain, ultimately leading to a stroke.

Stimulants like amphetamines and cocaine cause an immediate surge in blood pressure and can constrict or narrow blood vessels in the brain, which can reduce blood flow and cause a blockage. This can lead to both ischemic stroke and a hemorrhage in the brain.

People who inject drugs, including heroin, are at risk of infections such as endocarditis, which can also lead to a stroke.

Cocaine and amphetamines are the most common drugs associated with strokes

Cocaine use can lead to stroke through several mechanisms, including:

• Hypertensive surges: Cocaine can cause a sudden increase in blood pressure, leading to spontaneous bleeding in existing aneurysms or areas of old ischemic strokes.
• Vasospasm: Cocaine has a direct vasoconstrictive effect and can lead to endothelial injury, ultimately occluding vessels.
• Enhanced platelet aggregation: Cocaine increases platelet activation and aggregation, promoting thrombus formation.
• Accelerated atherosclerosis: Cocaine can increase the permeability of cell membranes to atherogenic lipoproteins, promoting the development of atherosclerosis.
• Cardioembolism: Cocaine use is associated with infective endocarditis, arrhythmias, and cardiomyopathy, all of which can lead to cardioembolic strokes.

Amphetamines, including methamphetamine, are weak bases chemically similar to natural neurotransmitters like epinephrine and dopamine. They are sympathomimetics that stimulate the central nervous system and have euphoric effects. Amphetamines can be ingested orally, intravenously, intranasally, or by inhalation.

Amphetamine use is also associated with an increased risk of stroke, particularly hemorrhagic stroke. The mechanisms through which amphetamines can lead to stroke include:

• Hypertensive surges: Amphetamines can cause a sudden increase in blood pressure, leading to spontaneous bleeding.
• Vasospasm: Amphetamines can cause vasoconstriction and endothelial injury, ultimately leading to vessel occlusion.
• Accelerated atherosclerosis: Amphetamine use can lead to blood vessel injury and atherosclerosis.
• Cardioembolism: Amphetamine use is associated with cardiomyopathy, arrhythmias, and thrombosis, which can lead to cardioembolic strokes.
• Vasculitis: There is some evidence of an association between amphetamine use and vasculitis, which can lead to vessel wall necrosis and microinfarcts.

Drug use increases the risk of both ischemic and hemorrhagic strokes

The pharmacological action of methamphetamine, an illegal recreational drug, is well understood. It is classified as a stimulant and is used to achieve a sense of euphoria, temporarily relieve symptoms of low self-esteem, or amplify the user's sex drive. Smoking or injecting the drug triggers an immediate physiological process that results in an unusually elevated blood concentration of dopamine and other potent stimulant neurotransmitters. The excessive concentration of these natural chemicals during methamphetamine use alters a user's heartbeat and blood pressure, leading to dizziness, sweating, and elevated body temperature.

The extreme alterations in blood flow, heart rhythm, or blood pressure caused by methamphetamine use can lead to diminished blood supply to the brain, resulting in a stroke. Precipitously high blood pressure, vasculitis, and direct toxicity to the blood vessels caused by methamphetamine use can cause blood vessels to tear or leak, resulting in dangerous hemorrhagic strokes. Studies have shown that hemorrhagic strokes are more often associated with methamphetamine use. However, methamphetamine can also induce ischemic strokes in otherwise healthy young individuals.

Chronic methamphetamine use can also lead to the acceleration and premature development of atherosclerosis, a hardening of the arteries, which is a known health condition that predisposes individuals to stroke. The substance is highly addictive due to the repetitive experience of euphoria that users seek to achieve. Additionally, when the bloodstream is flooded with excessive dopamine and other chemicals, the body's natural production of these substances slows down, resulting in a relative scarcity and further reinforcing the addictive quality of the drug.

The use of other illicit drugs, such as cocaine, amphetamines, ecstasy, heroin, phencyclidine, lysergic acid diethylamide, and marijuana, has also been linked to an increased risk of both ischemic and hemorrhagic strokes. Cocaine, in particular, has a strong association with stroke, with up to 80% of strokes attributed to the use of cocaine hydrochloride being hemorrhagic. Amphetamines, including ecstasy, have also been found to increase the odds of stroke by almost four times compared to non-users. Heroin-associated strokes are most often due to cardioembolism in the setting of infective endocarditis.

Drug use can damage blood vessels in the brain and heart

Drug abuse can cause damage to blood vessels in the brain and heart, which can lead to a stroke. This is because many drugs can alter vascular tone, or the degree of constriction in blood vessels. When the blood vessels tighten, blood pressure increases, and when it is too high, it can lead to a stroke.

Some drugs, like amphetamines, cocaine, and phencyclidine, cause a sympathetic surge with elevated blood pressure and vasospasm. This can lead to an abnormal and irregular heart rhythm, which can then cause a stroke.

Methamphetamine, for example, is a stimulant that can be smoked or injected. It triggers an immediate physiological process that results in an unusually high level of dopamine, a natural substance that maintains life-sustaining actions such as steady breathing and stable heart and brain function. The excessive concentration of these natural chemicals during methamphetamine use can alter a user's heartbeat and blood pressure while speeding up their breathing and producing dizziness, sweating, and an elevated body temperature.

Cocaine, another stimulant, also prevents neurotransmitters such as dopamine, norepinephrine, serotonin, and acetylcholine from being reabsorbed at presynaptic nerve terminals, thereby increasing their amounts and triggering the release of catecholamines. This results in smooth muscle contraction by acting on several receptors in the vessel walls.

Heroin, a semi-synthetic derivative of opium, binds to endogenous opioid receptors located throughout the body, including the brain and spinal cord. However, unlike morphine, heroin can easily cross the blood-brain barrier. Heroin tends to cause hypotension by decreasing peripheral vascular resistance, bradycardia by inhibiting the baroreceptor reflex, and respiratory depression by slowing the brain's response to high carbon dioxide and low oxygen levels.

Overall, drug abuse can damage blood vessels in the brain and heart by altering vascular tone, causing sympathetic surges, and affecting the release and reabsorption of natural substances and neurotransmitters in the body. This can lead to increased blood pressure, abnormal heart rhythms, and other issues that can ultimately result in a stroke.

Drug-induced strokes have the same symptoms as strokes caused by other issues

• Face drooping or slumping
• Weakness or numbness in the arms and legs
• Slurred speech or trouble speaking
• Confusion or memory problems
• Sudden vision changes
• Loss of balance or difficulty walking

The symptoms of a stroke can be identified using the FAST method:

• F: Face Drooping
• A: Arm Weakness
• S: Speech Difficulty
• T: Time to Call 911

People who inject drugs are at risk of infections that can lead to a stroke

Injecting drugs, such as heroin, can put people at risk of infections that may lead to a stroke. Injecting drugs with non-sterile needles can cause infective endocarditis, which is an infection of the heart's inner lining. In people with endocarditis, bacteria enter the blood and begin to grow over the heart's valves and vessels. A clump of bacteria can break off, leave the heart, and travel to the brain, where it can block a blood vessel and cause a stroke.

In addition to the risk of infection, people who inject drugs are also at risk of other complications that can lead to a stroke. For example, substances such as cocaine and amphetamines can speed up the heartbeat, raise blood pressure, and cause damage to the blood vessels in the brain. This can lead to conditions like high blood pressure, which is the leading risk factor for stroke.

The risk of stroke is present even with the first use of a substance, but long-term drug use can also increase the risk. It is important for people who use drugs to recognize the symptoms of a stroke, as it is a medical emergency and requires immediate attention to prevent long-term complications or death.

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