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Stroke remains one of the world’s leading health problems and is the third-largest cause of death and disability combined. While many risk factors can be modified through lifestyle changes, including diet and physical activity, growing evidence suggests that recreational drug use may also increase the risk of stroke.
In 2024, 8.8% of adults aged 16 to 59 in England and Wales—around 2.9 million people—reported using a legal or illegal recreational drug in the previous year. Recent US data also indicate that more than half of people aged 12 and above have used substances such as cocaine, cannabis or opiates at least once.
Previous studies have increasingly pointed to a possible link between recreational drug use and stroke. However, much of the evidence has been observational and varied in quality, making it difficult to establish whether drug use itself raises stroke risk or whether the association is influenced by other characteristics and behaviours.
To investigate the connection more closely, researchers from the University of Cambridge’s Department of Clinical Neurosciences conducted a meta-analysis involving studies covering more than 100 million participants.
The findings, published in the International Journal of Stroke, showed significant differences in stroke risk among users of several recreational drugs.
Cocaine use was associated with a 96% higher risk of stroke, while amphetamine use was linked to a 122% increase. Cannabis use was associated with a 37% higher risk. In contrast, opioid use was not found to have a statistically significant association with stroke.
The researchers also examined people under the age of 55 separately and found particularly strong associations for some drugs.
Among younger people, amphetamine use was linked to a 174% higher risk of stroke—nearly three times the risk. Cocaine use was associated with a 97% increase, while cannabis use was linked to a more modest 14% increase.
The researchers also sought to determine whether these associations could indicate a causal relationship rather than simply a correlation.
They used Mendelian randomization, a statistical technique that analyses naturally occurring genetic variations associated with particular risk factors. By examining these genetic differences, researchers can assess whether there is evidence that a specific risk factor may directly contribute to a health outcome.
The findings add to growing evidence that recreational drug use, particularly cocaine and amphetamines, may represent an important and potentially preventable risk factor for stroke.