Cotton Fever: Understanding the Hidden Dangers of IV Drug Use

DISCLAIMER: Cotton fever is not a discrete disease but a term used among illicit drug users for symptoms sometimes associated with intravenous drug use. This condition is not widely supported by the medical community and has not been confirmed by medical science or research. Some studies examining cotton fever do exist, but there is limited information available, and providers must continue to study and understand this condition and its impact on patients.

My medical review does not constitute acceptance or validation of this condition as a discrete disease. I have no opinion regarding the accuracy of the material. I make no recommendations regarding the condition. Intravenous use of illicit drugs or IV misuse of prescribed drugs always carries a significant risk for adverse reactions and complications, including death. – Dr. Coleman

Considering the potentially life-threatening consequences of intravenous (IV) drug use, cotton fever is less concerning. However, when left untreated, this secondary condition can become a serious threat.

Cotton fever is a rapidly developing and potentially dangerous complication associated with intravenous drug use. This condition can strike within hours of your most recent injection, causing a dramatic increase in body temperature and other symptoms [1].

Knowing how to recognize and quickly address the signs of cotton fever can make a major difference in preventing serious consequences. If you or anyone you know uses intravenous drugs, safety should be the primary concern. Seek professional treatment support as soon as possible to pursue recovery.

What Is Cotton Fever?

Cotton fever is an acute illness that occurs after the injection of drugs filtered through cotton or cotton-like materials. The condition gets its name from the cotton balls, cigarette filters, and similar materials used to strain drug solutions before they are injected. Substances are usually dissolved in water first when being prepared for injection. Then, the mixture is passed through cotton or a different material to filter out any adulterants.

Unlike materials used in a sterile environment, cotton or other materials left out in the open harbor dangerous bacteria. The filtration process described above provides an opportunity for these bacteria to enter the drug from the cotton fibers. Reusing cotton filters can increase your chances of developing cotton fever.

Enterobacter agglomerans is the most likely culprit when cotton fever occurs [2]. This bacterium is naturally found on cotton plants and thrives in the warm environment of used cotton filters.

How Cotton Fever Differs from Other Substance Use Complications

Other substance-use-related complications include endocarditis and abscesses [3]. Endocarditis, or inflammation of the lining of the heart, is potentially life-threatening. Abscesses may not be as immediately life-threatening, but they can cause serious complications when neglected.

Neither of the above conditions strikes as quickly as cotton fever, which typically begins exerting its effects within fifteen minutes to a few hours after injection [4]. Cotton fever does not discriminate based on the drug being injected. Whether the substance in question is heroin, cocaine, meth, or even a sterile prescription drug, cotton fever can still occur.

Added Consequences of Reusing or Sharing Cotton

Cotton fever isn’t the only potential health risk associated with reusing or sharing cotton. Hepatitis C virus can be spread among people who share cotton balls [5]. Unlike cotton fever, hepatitis C does not resolve within a few hours, though it is curable with the proper medication.

Sharing “drug preparation equipment,” as this study found, is a strong predictor of HIV infection risk as well [6]. The study clarifies that all equipment, not just syringes, increases this risk, implying a greater need for initiatives targeting both syringe and equipment sharing.

What Are the Symptoms of Cotton Fever?

The telltale sign of cotton fever is a rapidly elevated body temperature. The fever can reach temperatures of 102°F or higher, and is often extremely distressing [7].

Along with the fever itself comes a wide variety of potential symptoms, including the following [8]:

• Violent chills: Sometimes so powerful that they cause muscle spasms or chattering teeth. Heavy sweating usually follows as the body strains to control temperature.
• Elevated heart rate (tachycardia): The heart may beat over 100 times per minute as the body reacts to infection.
• Powerful headaches: Often described as worse than a severe migraine.
• Muscle aches: Deep, throbbing pain in muscles and joints, often resistant to mild treatment.
• Nausea and vomiting: Intense nausea may lead to severe dehydration and abdominal cramping.
• Breathing difficulties: Shortness of breath and persistent coughing may occur.
• Psychological effects: Anxiety, confusion, and fear are frequently reported.

Despite these debilitating symptoms, cotton fever typically runs its course within 24 hours [9]. It is sometimes mistaken for an overdose or withdrawal symptoms, which is why professional diagnosis is key.

Even though cotton fever usually resolves on its own, seeking medical treatment is essential. Both vulnerable and otherwise healthy patients can develop life-threatening complications without timely care.

How Is Cotton Fever Recognized and Treated?

There is no specific test that can clearly differentiate cotton fever from similar conditions. Blood tests may show elevated white blood cell counts, but this is only a general indicator of infection.

Medical professionals rely on patient history and a detailed evaluation of symptoms to make a diagnosis. They may ask screening questions about the patient’s drug use and whether reused cotton filters were involved.

Because cotton fever develops rapidly and resolves within a day, recognizing the timing of symptom onset is vital for effective treatment. Rapid symptom onset within a few hours of injection gives healthcare providers a major clue.

Responsive Treatment Is Crucial

Once diagnosed, healthcare providers closely monitor body temperature and other vital signs. Treatment focuses on symptom management and supportive care.

Antibiotics are not usually effective against cotton fever. Fever reduction is the primary goal, with medications like acetaminophen or ibuprofen used under medical supervision. Intravenous fluids may be administered to treat dehydration, and anti-nausea medication can improve comfort.

While most patients recover within 24 hours, immediate medical attention is still important. Temperatures exceeding 105°F or signs of sepsis require emergency intervention.

You Don’t Have to Fight Alone

Cotton fever is one of many serious health risks linked to intravenous drug use. Every injection carries life-threatening potential, but recovery is always possible. Professional treatment programs offer evidence-based therapies that address addiction at its root. Reach out for help today and begin your path toward lasting recovery.