By Tom Horvath, PhD
This recently published meta-analysis (a study, using rigorous statistical methods, to summarize the results of a large group of other studies) concludes that “several forms of substance misuse increase stroke risk, particularly cocaine, amphetamines, and cannabis [in that order of risk].” The increase with alcohol was lower. Nicotine and opioids did not increase risk. The study found that the substances themselves, not just the lifestyles associated with them, increased risk. Each drug has its own mechanism of action, such that combining drugs would increase risk.
To place the significance of stroke into context, the metanalysis begins with this sentence: “Stroke is a leading global health challenge, ranking as the third leading cause of death and disability combined, with the global burden rising substantially by 70% from 1990 to 2021.” The metanalysis reviewed 32 studies, which were based on over 100 million subjects.
We already knew that substance use may be “not good for you!” However, this study is most relevant for one group of individuals, those already at risk for stroke. I emphasize “already at risk for stroke” because if your risk were 1 in 400, and doubled to 2 in 400, how much should you be concerned? Probably not much. Look at the link below from the National Safety Council, about the greater risks you already face (and probably ignore). For instance, your risk of dying in an automobile collision is about 1 in 101.
In the US there are 795,000 US strokes per year, from a population of 335 million. Your risk, viewed that way, is about ¼ of one percent, or 1 in 400. However, if you have already had a stroke, have hypertension, atrial fibrillation, diabetes, or high LDL, if you smoke, or if you are over 55, your risk is significantly higher. Over time those risks combine such that, according to the World Stroke Organization, “1 in 4 of us will have a stroke in our lifetime.” As with many aspects of life, if you are younger and in good health, substance use is less risky than later in life.
If you were looking for additional motivations to stop cocaine, amphetamines, or cannabis, that evidence is now available! If you are already at higher risk of stroke, a frank discussion with your healthcare providers might help you move forward without these substances.
The study: https://journals.sagepub.com/doi/10.1177/17474930261418926
A press account of this study: https://thedrugreport.org/2026/03/11/new-data-show-just-how-bad-recreational-drugs-are-for-your-cardiovascular-system/
Risks of dying: https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/