8 October 2018

Stroke warning for young drug users

Addiction Clinical

Psychostimulant use is responsible for one in five strokes in young Australian adults, a new analysis indicates. 

While the overwhelming majority of these psychostimulant-related deaths were associated with methamphetamine use, cocaine and ecstasy were involved in several, as were the licit drugs DMAA and phentermine – which are used for diet and exercise. 

Speaking ahead of NDARC’s annual symposium this month, researcher Professor Shane Darke discussed findings from their analysis of the National Coronial Information System database. 

Of the 280 fatal strokes experienced by young adults (aged 15 to 45 years) between the start of 2009 and the end of 2016, 50 occurred in known stimulant users.  The average age of death among those adults with stimulant-related strokes was 37. 

“Almost all of those had used the stimulants immediately prior to the fatal stroke,” Professor Darke said. The other five were known to be long-term stimulant users.  

Professor Darke said he had anticipated that only around 5% of these fatal strokes would be associated with stimulant use, making the finding of one in five “astonishingly high”. 

“We do know that there’s an elevated risk of stroke with these drugs,” Professor Darke said, adding the risk of stroke appeared much higher with methamphetamine use than with cocaine use. 

While MDMA-related strokes were rarer, he said it was important to note that these did occur. 

The severity of the stroke was also known to be greater among stimulant users, with around 30% of strokes being fatal compared to about 3% of strokes in non-stimulant using young adults, he said.

The importance of this research is highlighted by the fact there are 76 million psychostimulant users worldwide, “so there’s clearly a large pool of people potentially at risk”, Professor Darke said. 

“We think there are probably 100 other young stimulant users [in Australia] who survived strokes over that time, and 60 of those would have ongoing symptoms,” Professor Darke said.

Using the database, which includes police reports, information on the event, the drug found, witnesses, toxicology, full autopsy results and the conclusions of the coroner, researchers said they were able to better understand these rare events. 

A novel finding from the analysis was the location of strokes, with methamphetamine-related strokes were more likely to be intracerebral. 

“We think this is possibly why they’re more fatal – because they’re more likely to occur right in the middle of the brain and cause enormous damage,” Professor Darke said.

Their analysis also undercut a misconception that these individuals were engaging in other risky behaviour or had other high-risk characteristics. 

For starters, they were far less likely to be obese – the major risk factor for stroke in young people – than non-stimulant users. The only high-risk factor that stimulant users had over non-stimulant users was that they were more likely to be smokers, but this wouldn’t likely impact stroke until decades later, he said. 

“If the stimulants weren’t there, in all probability the strokes would not have occurred,” he said. 

“It’s also the first stroke in all cases. It’s the first stroke, and it kills them.”