Both illicit substances and certain legal medications can increase a person’s risk of experiencing a stroke. Understanding these potential links is important for public health.
The Basics of Stroke
A stroke occurs when the blood supply to a part of the brain is interrupted. This prevents brain cells from receiving oxygen and nutrients, causing them to die within minutes. There are two primary types of stroke.
An ischemic stroke, the more common type, happens when a blood clot blocks an artery supplying blood to the brain. About 87% of all strokes are ischemic. A hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures, causing bleeding into the brain tissue. This bleeding can increase pressure on brain cells, damaging them. While less common, accounting for about 13% of all strokes, hemorrhagic strokes can be particularly severe.
Illicit Substances and Stroke
Illicit drugs can significantly increase stroke risk through various mechanisms, sometimes even with a single use. Cocaine, for instance, is a potent stimulant that can cause sudden increases in blood pressure and heart rate. This can lead to both ischemic strokes, by narrowing blood vessels (vasospasm) and promoting clot formation, and hemorrhagic strokes due to the sudden rise in blood pressure and potential vessel rupture. Cocaine use has also been linked to cardiac arrhythmias and endocarditis, which can contribute to stroke risk.
Amphetamines and methamphetamines, also stimulants, similarly elevate heart rate and blood pressure, which can damage blood vessels. Methamphetamine use is strongly associated with an increased risk of stroke, with hemorrhagic strokes being more common than ischemic strokes in this context. These drugs can induce vasospasm, weaken vessel walls, accelerate atherosclerosis, and contribute to heart problems that lead to clots.
Heroin and other opioids, especially when injected, carry a risk of infective endocarditis, an infection of the heart’s inner lining. This condition can lead to the formation of infected blood clots, known as septic emboli, which can travel to the brain and cause ischemic strokes. Synthetic cannabinoids (“Spice” or “K2”) and “bath salts” can cause acute ischemic strokes, even in young, otherwise healthy individuals, possibly by inducing transient vasospasm or a prothrombotic state.
Prescription and OTC Medications
Legal medications, when misused or in susceptible individuals, can contribute to stroke risk. Oral contraceptives containing estrogen, for example, increase the risk of blood clots, which can lead to ischemic strokes. This risk is particularly noted in women with additional risk factors like smoking or migraines with aura.
Decongestants, such as pseudoephedrine and phenylephrine, work by constricting blood vessels. This vasoconstrictive property can lead to elevated blood pressure, potentially triggering a stroke, especially in individuals with pre-existing hypertension or other cardiovascular conditions.
Nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used for pain and inflammation, have also been linked to an increased cardiovascular risk, including stroke, particularly with long-term or high-dose use. These medications can affect blood pressure and influence clot formation. The risk can begin as early as the first few weeks of daily NSAID use and increases with prolonged use.
Blood thinners, including anticoagulants and antiplatelet medications, are often prescribed to prevent ischemic strokes by reducing clot formation. However, these medications significantly increase the risk of hemorrhagic stroke if not carefully managed or in the event of injury, due to their effect on blood clotting.
Recognizing and Responding to a Stroke
Recognizing the signs of a stroke and acting quickly is important for improving outcomes. The F.A.S.T. acronym helps identify common stroke symptoms.
F stands for Face drooping, where one side of the face might droop or feel numb. A stands for Arm weakness, indicating that one arm may be weak or numb, and a person might struggle to raise both arms equally. S stands for Speech difficulty, which can manifest as slurred speech or trouble understanding what is being said. T stands for Time to call 911 immediately if any of these signs are observed.
Stroke is a medical emergency, and prompt medical attention is important for minimizing brain damage. For every minute that passes without treatment, millions of brain cells can be lost, highlighting why “time is brain” in stroke care. Waiting or attempting self-treatment can lead to more severe and lasting disabilities.