April 2026
Stroke risk associated with recreational drug use
By Melanie Hinze
New evidence supports cocaine, amphetamines and cannabis use as important, modifiable risk factors for stroke, including among younger adults.
Writing in the International Journal of Stroke, the study authors said their findings provided consistent observational and genetic evidence that several forms of substance misuse increased stroke risk.
The authors conducted a systematic review and meta-analysis of studies reporting associations between illicit drug use and stroke. The meta-analysis included 32 studies comprising more than 100 million participants across administrative, hospital-based and population-based datasets. Pooled odds ratios for ischaemic and haemorrhagic strokes were estimated, and associations between seven drug exposures and all stroke subtypes were investigated.
Cannabis was associated with a 37% increased risk of stroke, cocaine with a 96% increased risk of stroke and amphetamines with a 2.2 times increased risk of stroke. No significant associations were seen with opioids.
More specifically, cannabis-use disorder was associated with any stroke and large artery stroke. Cocaine dependence was associated with cardioembolic stroke and intracerebral haemorrhage. Genetically predicted substance-use disorder overall was associated with any stroke and intracerebral haemorrhage.
The authors also found that problematic and dependent alcohol use were linked to large artery and cardioembolic stroke, whereas nicotine dependence showed no significant associations.
Emeritus Professor Shane Darke, from the National Drug & Alcohol Research Centre, UNSW Sydney, said that this was an important paper as, although it had been known for some time that certain drugs were associated with stoke risk, this study provided effect sizes.
‘If someone is using stimulant drugs such as methamphetamine, cocaine or indeed MDMA, they are at increased risk of stroke; however, I think a lot of the people using these drugs are not aware of that,’ he added.
‘I think probably the association that people would be less aware of is cannabis,’ he said. ‘It seems it’s not to do with tobacco being mixed with cannabis, but the acute effects of cannabis itself.’
He told Medicine Today that this study was important in the Australian context, as cannabis use and methamphetamine use were highly prevalent, and cocaine had become increasingly popular.
Emeritus Professor Darke added that although the behavioural and mental health effects of such drugs were widely known, the risk of cardiovascular events and strokes might be less well known, and something patients who use illicit drugs should be aware of.