Stroke and spinal cord injury induced by psychoactive substance use in drug addiction: A systematic literature review
DOI:
https://doi.org/10.21134/1009Keywords:
Neurological Impact, Spinal Cord Injury, Psychoactive Substance, Drug Addiction, Substance use disorderAbstract
Introduction: Substance use disorders (SUDs) are chronic brain conditions with significant neurological consequences, yet the specific neurological effects of psychoactive substances remain insufficiently characterized. This systematic review investigates the neurological sequelae and comorbidities associated with psychoactive substance abuse. Methods: Following PRISMA guidelines, we addressed the question: What are the neurological effects and comorbidities of psychoactive substance use in addiction? A search of EBSCO, Web of Science, and PubMed identified 330 articles (1967–2023), with 13 studies meeting inclusion criteria after rigorous screening. Results: Stimulants, opioids, cannabis, and hallucinogens were linked to stroke, with risk modulated by substance purity, administration routes (e.g., intravenous use), and polysubstance combinations. Opioids contributed to ischemic strokes via cardiac arrhythmias and haemorrhagic strokes through vasculitis or hypertension. Current substance users exhibited a 13.8% stroke incidence and higher mortality. Spinal cord injuries (SCIs) were associated with pre-injury opioid, alcohol, and cannabis use, worsening post-injury complications such as infections and poor rehabilitation outcomes. Demographically, younger individuals with SCI reported higher cocaine and hallucinogen use, while older adults showed greater tobacco and alcohol dependence. Conclusions: Psychoactive substance use elevates risks of stroke and SCI through neurotoxic, vascular, and behavioral mechanisms. These findings emphasize the urgent need for integrated clinical models that address addiction and neurological comorbidities simultaneously. Multidisciplinary approaches, combining neurology and addiction care, are critical to mitigating long-term disability. Future research should prioritize longitudinal studies to unravel chronic neurodegenerative outcomes and refine harm-reduction strategies. This work advocates for policy reforms to expand access to evidence-based SUD treatments, particularly in underserved populations.
Downloads
References
Aghenitei, M., & Galatea ñu, O. E. (2023). Global Drug Addiction. EIRP Proceedings, 18(1), 473-488.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Bergemann, N. (2022). Hypnotics: Guidelines and Current References. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-56015-1_77-1
Bersano, A., Kraemer, M., Touzé, E., Zuurbier, S. M., Herzig, R., & Padjen, V. (2021). Drugs associated with ischemic stroke: A review for clinicians. Stroke, 52(3), 647–658. https://doi.org/10.1161/STROKEAHA.120.033272
Caplan, L. R., Hier, D. B., & Banks, G. (1982). Current concepts of cerebrovascular disease--stroke: stroke and drug abuse. Stroke, 13(6), 869-872. https://doi.org/10.1161/01.str.13.6.869
Chelikam, N., Mohammad, Z., Tavrawala, K., Krishnakumar, A. N., Varghese, A., Shrivastav, T. Y., ... & Manjani, L. (2022). Prevalence of cerebrovascular accidents among the US population with substance use disorders: a nationwide study. Cureus, 14(11). https://doi.org/10.7759/cureus.31826
Degenhardt, L., Grebely, J., Stone, J., Hickman, M., Vickerman, P., Marshall, B. D., ... & Larney, S. (2019). Global patterns of opioid use and dependence: harms to populations, interventions, and future action. The Lancet, 394(10208), 1560-1579. https://doi.org/10.1016/S0140-6736(19)32229-9
*DiPiro, N., & Krause, J. (2022). Psychoactive Substance Use Among Individuals With Chronic Spinal Cord Injury: Patterns and characteristics. Archives of Physical Medicine and Rehabilitation, 103(3), 570–573. http://dx.doi.org/10.1016/j.apmr.2021.08.005
Dogra, S., Putnam, J., & Conn, P. J. (2022). Metabotropic glutamate receptor 3 as a potential therapeutic target for psychiatric and neurological disorders. Pharmacology Biochemistry and Behavior, 221, 173493. https://doi.org/10.1016/j.pbb.2022.173493
Dua, T., Barbui, C., Clark, N., Fleischmann, A., Poznyak, V., van Ommeren, M., ... & Saxena, S. (2011). Evidence-based guidelines for mental, neurological, and substance use disorders in low-and middle-income countries: summary of WHO recommendations. PLoS Medicine, 8(11), e1001122. https://doi.org/10.1371/journal.pmed.1001122
*Eldridge, L. A., Piatt, J. A., Agley, J., & Gerke, S. (2019). Relationship between substance use and the onset of spinal cord injuries: A medical chart review. Topics in Spinal Cord Injury Rehabilitation, 25(4), 316-321. https://doi.org/10.1310/sci2504-316
Estévez-Lamorte, N., Foster, S., Gmel, G., & Mohler-Kuo, M. (2021). Routes of administration of illicit drugs among young Swiss men: their prevalence and associated socio-demographic characteristics and adverse outcomes. International Journal of Environmental Research and Public Health, 18(21), 11158. https://doi.org/10.3390/ijerph182111158
Fathi, H. R., Yoonessi, A., Khatibi, A., Rezaeitalab, F., & Rezaei-Ardani, A. (2020). Crosstalk between sleep disturbance and opioid use disorder: a narrative review. Addiction & Health, 12(2), 140. https://doi.org/10.22122/ahj.v12i2.249
*Glazier, R. E., & Kling, R. N. (2013). Recent trends in substance abuse among persons with disabilities compared to that of persons without disabilities. Disability and Health Journal, 6(2), 107-115. https://doi.org/10.1016/j.dhjo.2013.01.007
*Graupensperger, S., Corey, J. J., Turrisi, R. J., & Evans, M. B. (2019). Individuals with spinal cord injury have greater odds of substance use disorders than non-sci comparisons. Drug and Alcohol Dependence, 205, 107608. https://doi.org/10.1016/j.drugalcdep.2019.107608
*Harper, A. E., Krause, J. S., Terhorst, L., & Leland, N. E. (2022). Differences in functional improvement based on history of substance abuse and pain severity following spinal cord injury. Substance Abuse, 43(1), 267-272. https://doi.org/10.1080/08897077.2021.1941507
*Hawkins, D. A., & Heinemann, A. W. (1998). Substance abuse and medical complications following spinal cord injury. Rehabilitation Psychology, 43(3), 219. https://doi.org/10.1080/08897077.2021.1941507
*Heinemann, A. W., Mamott, B. D., & Schnoll, S. (1990). Substance use by persons with recent spinal cord injuries. Rehabilitation Psychology, 35(4), 217. https://doi.org/10.1037/h0079065
Higgins, J. P., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions. The Cochrane Collaboration. London, UK. Retrieved from https://handbook-5-1.cochrane.org on 17 April of 2024.
*Kolakowsky-Hayner, S. A., Gourley, E., Kreutzer, J. S., Marwitz, J. H., Cifu, D. X., Mckinley, W. O. (1999). Pre-injury substance abuse among persons with brain injury and persons with spinal cord injury. Brain Injury, 13(8), 571-581. https://doi.org/10.1080/026990599121313
*Kolakowsky-Hayner, S. A., Gourley, E., Kreutzer, J. S., Marwitz, J. H., Meade, M. A., & Cifu, D. X. (2002). Post-injury substance abuse among persons with brain injury and persons with spinal cord injury. Brain Injury, 16(7), 583-592. https://doi.org/10.1080/02699050110119475
Maghsoudi, N., Tanguay, J., Scarfone, K., Rammohan, I., Ziegler, C., Werb, D., & Scheim, A. I. (2022). Drug checking services for people who use drugs: a systematic review. Addiction, 117(3), 532-544. https://doi.org/10.1111/add.15734
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097
National Institute on Drug Abuse. (2020). Substance Use Disorder defined by NIDA and SAMHSA. Wyoming Legislature. https://wyoleg.gov/InterimCommittee/2020/10-20201105Handoutfor6JtMHSACraig11.4.20.pdf
Nutt, D. (2020). Drugs without the hot air: Making sense of legal and illegal drugs. Bloomsbury Publishing.
*Sheikh Andalibi, M. S., Rezaei Ardani, A., Amiri, A., Morovatdar, N., Talebi, A., Azarpazhooh, M. R., & Mokhber, N. (2021). The association between substance use disorders and long-term outcome of stroke: results from a population-based study of stroke among 450,229 urban citizens. Neuroepidemiology, 55(3), 171-179. https://doi.org/10.1159/000514401
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
*Paur, R., Wallner, C., Hermann, P., Stöllberger, C., & Finsterer, J. (2012). Neurological abnormalities in opiate addicts with and without substitution therapy. The American Journal of Drug and Alcohol Abuse, 38(3), 239-245. https://doi.org/10.3109/00952990.2011.644001
Petroff, O. A. C. (2002). GABA and glutamate in the human brain. The Neuroscientist, 8(6), 562–573. https://doi.org/10.1177/1073858402238515
*Shin, J. W., Chung, D., Oh, S. H., Kim, H. S., Kim, W. C., & Kim, O. J. (2020). Medical hypnotic management associated with drug dependence in patients with insomnia and neurological disorders. Neurology Asia, 25(4).
Sun, Y., Yao, Y., Bao, Y., Sun, Y., Shi, L., Shi, J., & Lu, L. (2019). The effect of changes in society, economy and public health on the disease burden of neurological, mental and substance use disorders: a global longitudinal study. The Lancet, 394, S54. https://doi.org/10.1016/S0140-6736(19)32390-6
*Tate, D. G., Forchheimer, M. B., Krause, J. S., Meade, M. A., & Bombardier, C. H. (2004). Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates. Archives of Physical Medicine and Rehabilitation, 85(11), 1837-1847. https://doi.org/10.1016/j.apmr.2004.02.022
Winstanley, E. L., Mahoney III, J. J., Castillo, F., & Comer, S. D. (2021). Neurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic review. Drug and Alcohol Dependence, 226, 108838. https://doi.org/10.1016/j.drugalcdep.2021.108838
Yoon, S. Y., Leigh, J. H., Lee, J., & Kim, W. H. (2020). Comparing activity and participation between acquired brain injury and spinal-cord injury in community-dwelling people with severe disability using whodas 2.0. International Journal of Environmental Research and Public Health, 17(9), 3031. https://doi.org/10.3390/ijerph17093031
Yiu, C. H., Vitharana, N., Gnjidic, D., Patanwala, A. E., Fong, I., Rimington, J., ... & Penm, J. (2022). Patient risk factors for opioid?related adverse drug events in hospitalized patients: a systematic review. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 42(3), 194-215. https://doi.org/10.1002/phar.2666
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Diana Moreira, Celina Pereira, Marta Cruz, Paulo C. Dias, Ângela Leite
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors publishing in this journal agree to the journal's statement of ethical principles and to the following terms:
The rights of the published material shall belong to their respective authors. Articles published in HAAJ may be used under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license, and may be read, copied, distributed, printed, searched, or linked to in the full text of this journal without prior permission from the publisher or author, provided that HAAJ and the authors are acknowledged and not used for commercial purposes.
Authors may include the work in institutional repositories or other publications as long as this journal is acknowledged and properly cited.
The HAAJ editorial team encourages authors to disseminate their published work through any means (conferences, classes, lectures, talks, etc.) and/or platforms (social networks, repositories, websites, etc.).
HAAJ follows the Core Practices of COPE (Committee on Publication Ethics).
How to Cite
