Stroke in Young Adults Who Abuse Amphetamines or Cocaine: A Population-Based Study of Hospitalized Patients | Adolescent Medicine | JAMA Psychiatry | JAMA Network
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Sloan  MAKittner  SJFeeser  BRGardner  JEpstein  AWozniak  MAWityk  RJStern  BJPrice  TRMacko  RFJohnson  CJEarley  CJBuchholz  D Illicit drug-associated ischemic stroke in the Baltimore-Washington Young Stroke Study.  Neurology 1998;501688- 1693PubMedGoogle ScholarCrossref
Levine  SRWelch  KM Cocaine and stroke.  Stroke 1988;19779- 783PubMedGoogle ScholarCrossref
Buxton  NMcConachie  NS Amphetamine abuse and intracranial haemorrhage.  J R Soc Med 2000;93472- 477PubMedGoogle Scholar
Lichtenfeld  PJRubin  DBFeldman  RS Subarachnoid hemorrhage precipitated by cocaine snorting.  Arch Neurol 1984;41223- 224PubMedGoogle ScholarCrossref
Levine  SRBrust  JCFutrell  NHo  KLBlake  DMillikan  CHBrass  LMFayad  PSchultz  LRSelwa  JFWelch  KMA Cerebrovascular complications of the use of the “crack” form of alkaloidal cocaine.  N Engl J Med 1990;323699- 704PubMedGoogle ScholarCrossref
Kibayashi  KMastri  ARHirsch  CS Cocaine induced intracerebral hemorrhage: analysis of predisposing factors and mechanisms causing hemorrhagic strokes.  Hum Pathol 1995;26659- 663PubMedGoogle ScholarCrossref
Delaney  PEstes  M Intracranial hemorrhage with amphetamine abuse.  Neurology 1980;301125- 1128PubMedGoogle ScholarCrossref
Yen  DJWang  SJJu  THChen  CCLiao  KKFuh  JLHu  HH Stroke associated with methamphetamine inhalation.  Eur Neurol 1994;3416- 22PubMedGoogle ScholarCrossref
Citron  BPHalpern  MMcCarron  MLundberg  GDMcCormick  RPincus  IJTatter  DHaverback  BJ Necrotizing angiitis associated with drug abuse.  N Engl J Med 1970;2831003- 1011PubMedGoogle ScholarCrossref
Nolte  KBBrass  LMFletterick  CF Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study.  Neurology 1996;461291- 1296PubMedGoogle ScholarCrossref
Nunez  BDMiao  LRoss  JNNunez  MMBaim  DSCarrozza  JP  JrMorgan  JP Effects of cocaine on carotid vascular reactivity in swine after balloon vascular injury.  Stroke 1994;25631- 638PubMedGoogle ScholarCrossref
Rumbaugh  CLBergeron  RTScanlan  RLTeal  JSSegall  HDFang  HCMcCormick  R Cerebral vascular changes secondary to amphetamine abuse in the experimental animal.  Radiology 1971;101345- 351PubMedGoogle Scholar
Rumbaugh  CLFang  HCHiggins  REBergeron  RTSegall  HDTeal  JS Cerebral microvascular injury in experimental drug abuse.  Invest Radiol 1976;11282- 294PubMedGoogle ScholarCrossref
Rumbaugh  CLBergeron  RTFang  HCMcCormick  R Cerebral angiographic changes in the drug abuse patient.  Radiology 1971;101335- 344PubMedGoogle Scholar
Bostwick  DG Amphetamine induced cerebral vasculitis.  Hum Pathol 1981;121031- 1033PubMedGoogle ScholarCrossref
Harrington  HHeller  HADawson  DCaplan  LRumbaugh  C Intracerebral hemorrhage and oral amphetamine.  Arch Neurol 1983;40503- 507PubMedGoogle ScholarCrossref
Brust  JC Vasculitis owing to substance abuse.  Neurol Clin 1997;15945- 957PubMedGoogle ScholarCrossref
Konzen  JPLevine  SRGarcia  JH Vasospasm and thrombus formation as possible mechanisms of stroke related to alkaloidal cocaine.  Stroke 1995;261114- 1118PubMedGoogle ScholarCrossref
Center for Drug Evaluation and Research, US Food and Drug Administration, Phenylpropanolamine (PPA) information page. 21, 2006
US Food and Drug Administration, Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk. 21, 2006
Gardiner  H Judge's decision lifts ban on sale of Ephedra in Utah. 18, 2007
NPI Center, Appeals court rules for FDA in Ephedra ban: overturns lower court finding in Nutraceutical v von Eschenbach. 18, 2007
Kaku  DALowenstein  DH Emergence of recreational drug abuse as a major risk factor for stroke in young adults.  Ann Intern Med 1990;113821- 827PubMedGoogle ScholarCrossref
Petitti  DBSidney  SQuesenberry  CBernstein  A Stroke and cocaine or amphetamine use.  Epidemiology 1998;9596- 600PubMedGoogle ScholarCrossref
Qureshi  AIAkbar  MSCzander  ESafdar  KJanssen  RSFrankel  MR Crack cocaine use and stroke in young patients.  Neurology 1997;48341- 345PubMedGoogle ScholarCrossref
Qureshi  AISuri  MFGuterman  LRHopkins  LN Cocaine use and the likelihood of nonfatal myocardial infarction and stroke: data from the Third National Health and Nutrition Examination Survey.  Circulation 2001;103502- 506PubMedGoogle ScholarCrossref
Kernan  WNViscoli  CMBrass  LMBroderick  JPBrott  TFeldmann  EMorganstern  LBWilterdink  JLHorwitz  RI Phenylpropanolamine and the risk of hemorrhagic stroke.  N Engl J Med 2000;3431826- 1832PubMedGoogle ScholarCrossref
Morgenstern  LBViscoli  CMKernan  WNBrass  LMBroderick  JPFeldmann  EWilterdink  JLBrott  THorwitz  RI Use of Ephedra-containing products and risk for hemorrhagic stroke.  Neurology 2003;60132- 135PubMedGoogle ScholarCrossref
American Hospital Association, AHA Guide to the Health Care Field.  Chicago, Ill: American Hospital Association; 2004;
Texas Department of State Health Services, Center for Health Statistics, Texas Hospital Inpatient Discharge Public Use Data file, calendar years 2000 to 2003. 17, 2007
Romano  PSMark  DH Bias in the coding of hospital discharge data and its implications for quality assessment.  Med Care 1994;3281- 90PubMedGoogle ScholarCrossref
 Guide to Inpatient Quality Indicators: quality of care in hospitals—volume, mortality, and utilization. 21, 2006
Broderick  JBrott  TKothari  RMiller  RKhoury  JPancioli  AGebel  JMills  DMinneci  LShukla  R The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke among blacks.  Stroke 1998;29415- 421PubMedGoogle ScholarCrossref
Centers for Medicare and Medicaid Services, Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2003 rates. 21, 2006
US Census Bureau, Current lists of metropolitan and micropolitan statistical areas and definitions. August 21, 2006
US Census Bureau, Percent changes: American Community Survey. 18, 2007
Bruzzi  PGreen  SBByar  DPBrinton  LASchairer  C Estimating the population attributable risk for multiple risk factors using case-control data.  Am J Epidemiol 1985;122904- 914PubMedGoogle Scholar
O’Connor  ADRusyniak  DEBruno  A Cerebrovascular and cardiovascular complications of alcohol and sympathomimetic drug abuse.  Med Clin North Am 2005;891343- 1358PubMedGoogle ScholarCrossref
National Association of Counties, The Meth epidemic in America: two surveys of US counties: the criminal effect of Meth on communities: the impact of Meth on children. 21, 2006
Community Epidemiology Work Group, Epidemiologic Trends in Drug Abuse 18, 2007
Wang  YHayashi  TChang  CFChiang  YHTsao  LISu  TPBorlongan  CLin  SZ Methamphetamine potentiates ischemia/reperfusion insults after transient middle cerebral artery ligation.  Stroke 2001;32775- 782PubMedGoogle ScholarCrossref
Kelley  PASharkey  JPhilip  RRitchie  IM Acute cocaine alters cerebrovascular autoregulation in the rat neocortex.  Brain Res Bull 1993;31581- 585PubMedGoogle ScholarCrossref
Stier  BGHennekens  CH Phenylpropanolamine and hemorrhagic stroke in the Hemorrhagic Stroke Project: a reappraisal in the context of science, the Food and Drug Administration, and the law.  Ann Epidemiol 2006;1649- 52PubMedGoogle ScholarCrossref
Substance Abuse and Mental Health Services Administration, Overview of findings from the 2004 National Survey on Drug Use and Health. 18, 2007
Substance Abuse and Mental Health Services Administration, The NSDUH report: methamphetamine use, abuse, and dependence: 2002, 2003, and 2004. August 21, 2006
Watson  WALitovitz  TLKlein-Schwartz  WRodgers  GC  JrYouniss  JReid  NRouse  WGRembert  RSBorys  D 2003 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.  Am J Emerg Med 2004;22335- 404PubMedGoogle ScholarCrossref
Mateo  IPinedo  AGomez-Beldarrain  MBasterretxea  JMGarcia-Monco  JC Recurrent stroke associated with cannabis use.  J Neurol Neurosurg Psychiatry 2005;76435- 437PubMedGoogle ScholarCrossref
Geller  TLoftis  LBrink  DS Cerebellar infarction in adolescent males associated with acute marijuana use. Pediatrics. 2004;113:e365-e370. January 18, 2007
Finsterer  JChristian  PWolfgang  K Occipital stroke shortly after cannabis consumption.  Clin Neurol Neurosurg 2004;106305- 308PubMedGoogle ScholarCrossref
Mesec  ARot  UGrad  A Cerebrovascular disease associated with marijuana abuse: a case report.  Cerebrovasc Dis 2001;11284- 285PubMedGoogle ScholarCrossref
Cole  JWPinto  ANHebel  JRBuchholz  DWEarley  CJJohnson  CJMacko  RFPrice  TRSloan  MAStern  BJWityk  RJWozniak  MAKittner  SJ Acquired immunodeficiency syndrome and the risk of stroke.  Stroke 2004;3551- 56PubMedGoogle ScholarCrossref
Qureshi  AIJanssen  RSKaron  JMWeissman  JPAkbar  MSSafdar  KFrankel  MR Human immunodeficiency virus infection and stroke in young patients.  Arch Neurol 1997;541150- 1153PubMedGoogle ScholarCrossref
Patel  VBSacoor  ZFrancis  PBill  PLBhigjee  AIConnolly  C Ischemic stroke in young HIV-positive patients in Kwazulu-Natal, South Africa.  Neurology 2005;65759- 761PubMedGoogle ScholarCrossref
Connor  MDLammie  GABell  JEWarlow  CPSimmonds  PBrettle  RD Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV Autopsy Cohort.  Stroke 2000;312117- 2126PubMedGoogle ScholarCrossref
Piriyawat  PSmajsova  MSmith  MAPallegar  SAl-Wabil  AGarcia  NMRisser  JMMoye  LAMorgenstern  LB Comparison of active and passive surveillance for cerebrovascular disease: the Brain Attack Surveillance in Corpus Christi (BASIC) Project.  Am J Epidemiol 2002;1561062- 1069PubMedGoogle ScholarCrossref
Jencks  SFWilliams  DKKay  TL Assessing hospital-associated deaths from discharge data: the role of length of stay and comorbidities.  JAMA 1988;2602240- 2246PubMedGoogle ScholarCrossref
Ohta  KMori  MYoritaka  AOkamoto  KKishida  S Delayed ischemic stroke associated with methamphetamine use.  J Emerg Med 2005;28165- 167PubMedGoogle ScholarCrossref
Rothrock  JFRubenstein  RLyden  PD Ischemic stroke associated with methamphetamine inhalation.  Neurology 1988;38589- 592PubMedGoogle ScholarCrossref
Wolf  PAAbbott  RDKannel  WB Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.  Stroke 1991;22983- 988PubMedGoogle ScholarCrossref
Weimar  CRoth  MPZillessen  GGlahn  JWimmer  MLBusse  OHaberl  RLDiener  HCGerman Stroke Data Bank Collaborators, Complications following acute ischemic stroke.  Eur Neurol 2002;48133- 140PubMedGoogle ScholarCrossref
Heckbert  SRKooperberg  CSafford  MMPsaty  BMHsia  JMcTiernan  AGaziano  JMFrishman  WHCurb  JD Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the Women's Health Initiative.  Am J Epidemiol 2004;1601152- 1158PubMedGoogle ScholarCrossref
Hollander  JETodd  KHGreen  GHeilpern  KLKarras  DJSinger  AJBrogan  GXFunk  JPStrahan  JB Chest pain associated with cocaine: an assessment of prevalence in suburban and urban emergency departments.  Ann Emerg Med 1995;26671- 676PubMedGoogle ScholarCrossref
Ostrea  EM  JrKnapp  DKTannenbaum  LOstrea  ARRomero  ASalari  VAger  J Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis.  J Pediatr 2001;138344- 348PubMedGoogle ScholarCrossref
Kon  AAPretzlaff  RKMarcin  JP The association of race and ethnicity with rates of drug and alcohol testing among US trauma patients.  Health Policy 2004;69159- 167Google ScholarCrossref
Romano  PS Asking too much of administrative data?  J Am Coll Surg 2003;196337- 338PubMedGoogle ScholarCrossref
Substance Abuse and Mental Health Services Administration, 2004 National Survey on Drug Use and Health: detailed tables. August 21, 2006
Vega  WAKolody  BHwang  JNoble  A Prevalence and magnitude of perinatal substance exposures in California.  N Engl J Med 1993;329850- 854PubMedGoogle ScholarCrossref
Latkin  CAVlahov  DAnthony  JC Socially desirable responding and self-reported HIV infection risk behaviors among intravenous drug users.  Addiction 1993;88517- 526PubMedGoogle ScholarCrossref
Magder  LSSloan  MADuh  SHAbate  JFKittner  SJ Utilization of multiple imperfect assessments of the dependent variable in a logistic regression analysis.  Stat Med 2000;1999- 111PubMedGoogle ScholarCrossref
Original Article
April 2007

Stroke in Young Adults Who Abuse Amphetamines or Cocaine: A Population-Based Study of Hospitalized Patients

Author Affiliations

Author Affiliations: Department of Psychiatry (Dr Westover), Division of Epidemiology and Preventive Medicine, Department of Internal Medicine (Dr Haley), and Department of Clinical Sciences (Dr Haley), The University of Texas Southwestern Medical Center at Dallas; and Dallas–Fort Worth Hospital Council, Irving, Tex (Dr McBride).

Arch Gen Psychiatry. 2007;64(4):495-502. doi:10.1001/archpsyc.64.4.495

Context  The abuse of stimulant drugs is increasing in the western United States. Although numerous case reports and animal studies suggest a link with stroke, epidemiologic studies have yielded conflicting results.

Objective  To test the hypothesis that young adults who abuse amphetamines or cocaine are at a higher risk of stroke.

Design, Setting, and Participants  Using a cross-sectional design and from a quality indicators' database of 3 148 165 discharges from Texas hospitals, we estimated the secular trends from January 1, 2000, to December 31, 2003, in the abuse of various drugs and of strokes. We developed separate logistic regression models of risk factors for hemorrhagic (n = 937) and ischemic (n = 998) stroke discharges of persons aged 18 to 44 years in 2003, and for mortality risk in patients with stroke.

Main Outcome Measure  Incidence of stroke using definitions from the Agency for Healthcare Research and Quality's stroke mortality Inpatient Quality Indicator.

Results  From 2000 to 2003, the rate of increase was greatest for abuse of amphetamines, followed by cannabis and cocaine. The rate of strokes also increased, particularly among amphetamine abusers. In 812 247 discharges in 2003, amphetamine abuse was associated with hemorrhagic stroke (adjusted odds ratio [OR], 4.95; 95% confidence interval [CI], 3.24-7.55), but not with ischemic stroke; cocaine abuse was associated with hemorrhagic (OR, 2.33; 95% CI, 1.74-3.11) and ischemic (OR, 2.03; 95% CI, 1.48-2.79) stroke. Amphetamine, but not cocaine, abuse was associated with a higher risk of death after hemorrhagic stroke (OR, 2.63; 95% CI, 1.07-6.50).

Conclusion  Increases in stimulant drug abuse may increase the rate of hospital admissions for strokes and stroke-related mortality.