The Effects of Stimulants on the Heart

The stimulant class of substances contains several drugs that increase energy, alertness, focus, heart rate, blood pressure, and breathing rate.¹ The class itself encompasses both illicit stimulants, such as methamphetamine (meth) and cocaine, and legally prescribed medications (though these too may be abused illicitly). Some examples of prescription stimulants include Dexedrine, Adderall, Ritalin, and Concerta.² Ecstasy, or MDMA, is a somewhat unique member of the stimulant class due to its entactogenic and mild hallucinogenic properties.

According to the United States Drug Enforcement Administration (DEA), many stimulants, such as pharmaceutical methamphetamine, cocaine, Dexedrine, Adderall, and Ritalin, are Schedule II substances, while MDMA is classified as a Schedule I controlled substance.⁴ Their controlled status means that, despite legitimate medical uses, they have a high potential for abuse and use may result in dependence.⁴ Abusing stimulants can place significant stress on the heart, which increases the user’s risk of experiencing adverse consequences and even death.⁵

List of Popular Stimulants

There are many different types of stimulants that are commonly used or abused. They may be taken alone or in combination with other psychoactive substances, such as alcohol or marijuana. Popular stimulants of abuse include:^1,2,3,6

• Dextroamphetamine (Dexedrine and Adderall) is a medication commonly prescribed for ADHD, although it may also be prescribed for narcolepsy.
• Methylphenidate (Ritalin and Concerta) is another medication commonly prescribed for ADHD and narcolepsy.
• Cocaine is predominantly obtained from the illicit market and has a long history of widespread abuse. When in powdered form it is most often snorted, but it can also be smoked or injected into the veins after being dissolved in water.
• Methamphetamine (meth) can be obtained in various forms, including both powder and pills. Crystal meth more frequently resembles pieces of glass or shiny blue-white rocks of various sizes.³ Meth may be taken orally, smoked, injected, or snorted.
• 3,4-methylenedioxy-methamphetamine (MDMA or Ecstasy) is an illegal substance that shares both chemical structural features and drug effects with both stimulants and some other hallucinogens. It is often encountered on the illicit market as a capsule or tablet, but may also be swallowed in liquid form, or snorted as a powder.

Each one of the above-mentioned stimulants increases the user’s heart rate, blood pressure, and respiratory rate, thus increasing the risk of adverse cardiovascular effects.

Why Do People Abuse Stimulants?

Stimulant use can have some desirable, if ultimately dangerous, effects. For example, stimulant use may lead to feelings of pleasure, sexual arousal, increased confidence, and increased focus.³ It may also promote weight loss by decreasing appetite.⁵ When used therapeutically by those with ADHD, stimulant can increase motivation, cognition, learning, and memory. The allure of such effects helps explain why so many people abuse them in the absence of medical necessity, despite the risks of detrimental and even fatal consequences.⁷

Because stimulants increase focus and motivation and decrease the need for sleep, many students use prescription stimulants as study aids. Research has found that college students are more likely to use prescription stimulants than their non-college-attending peers, potentially due to the need to stay awake to study.⁸ Research has also shown that college students in particular are not only using prescription stimulants as study aids, but also to stay awake longer to drink and party more.⁸ Mixing stimulants and alcohol is particularly risky since stimulant effects may delay or mask the symptoms of increased alcohol intoxication. Therefore, when a person mixes a stimulant with alcohol, they may end up drinking more than they otherwise would because they were not able to read their body’s warning signs, which can increase the risk of alcohol poisoning.⁹ Mixing stimulants with other substances may also put extra stress on the cardiovascular system, leading to dangerously high blood pressure or irregular heart rhythms, which is already a major concern with stimulant use, alone.¹⁰

Cardiac Effects

There are many negative effects associated with stimulant use, but concerns regarding their impact on cardiopulmonary systems are especially significant. Stimulants have been known to cause the following:⁵

• Increased blood pressure
• Increased heart rate
• Increased respiration rate

In excessive doses and long-term use, stimulants have been found to cause the following:^5,6,13

• Extremely rapid heartbeat
• Erratic heartbeat
• Chest pain
• Respiratory failure
• Congestive heart failure
• Cardiomyopathy (enlarged, weakened, inefficiently functioning heart muscle)
• Stroke
• Heart attack

Furthermore, intravenous stimulant users have an increased risk of contracting bacterial endocarditis, an infection of the heart lining.¹³ Bacterial endocarditis, if left untreated, can damage heart valves, leading to an inability to effectively pump blood to the body. This can progress to congestive heart failure. Additionally, pieces of myocardial vegetation (bacterial overgrowth and resulting blood clotting and immune system deposition) located at the site of infection can break off and travel through the blood vessels to the extremities and vital organs, which can lead to embolic damage to the lungs, kidneys, spleen, brain, intestines, and liver.¹⁴

Other serious consequences of stimulant abuse can include malnourishment, dental problems, suicidal ideation or behaviors, psychotic features such as paranoia and delusions, cerebral hemorrhaging (bleeding into the brain), brain damage, coma, seizures, and death. MDMA abuse can result in kidney, liver, or heart failure. The abuse of stimulants in general is associated with risky sexual behaviors, which increases the risk of sexually transmitted diseases (STDs) and other communicable diseases, such as HIV and hepatitis.⁵ MDMA, in particular, elicits feelings of emotional warmth and trust, which could also put the user at risk of engaging in unsafe sexual practices.⁶ Due to these potentially serious consequences, it is important to get treatment if you or a loved one is struggling with stimulant use or any kind.

Quitting Stimulant Abuse

The sooner you quit abusing stimulants, the lower your risk of experiencing significant harmful, long-term mental and physical consequences, particularly to the heart. Damage to the heart can negatively impact many other organs as well, thus causing significant impairment and harm. Completing an initial detoxification period and engaging in comprehensive substance abuse treatment can help you achieve and maintain sobriety.

Detoxification is the process by which the body rids itself of a substance.¹¹ While the body eliminates the drug, withdrawal symptoms may occur. Stimulant withdrawal symptoms may include:¹²

• Drug cravings.
• Hypersomnia (excessive sleepiness).
• Insomnia (inability to sleep or stay asleep).
• Irritability.
• Depression.
• Anxiety.
• Fatigue.
• Impaired concentration.
• Slowed movements and cognition.
• Paranoia.

Some people may be more susceptible to cardiovascular complications during stimulant withdrawal than others. Studies have shown that patients who abuse alcohol and cocaine may experience persistent problems associated with the heart, such as irregular heart beat and heart attacks due to the production of a deadly chemical, called cocoethylene.¹² Professional detox can help to mitigate possible cardiovascular complications and enhance your safety.

There are several settings where this detoxification process may take place, including in a hospital, an inpatient setting, a physician’s office, or an outpatient setting. More information on them:¹²

• Hospital: Medically monitored detoxification takes place in a hospital. Although stimulant withdrawal is not typically associated with medical complications, there are a few things to look out for. Seizures are a potential complication of stimulant abuse that may also occur during detoxification and should therefore be monitored. Depression and suicidal thoughts are other major concerns related to stimulant withdrawal that may require close supervision.
• Inpatient: Inpatient settings may or may not be medically monitored, but the patient receives around-the-clock support from professional staff members. The complications described above should also be considered in these settings.
• Physician’s Office: This setting is appropriate if someone has been taking prescription stimulants for an extended period of time and would like to quit them with a doctor’s assistance. The physician can create a gradual tapering schedule in which a person is slowly weaned off of the drug to minimize the chance of significant withdrawal issues.
• Outpatient: Outpatient detox is an appropriate setting for someone with relatively mild addiction issues who can’t commit to 24-hour detox treatment and wants to return home after scheduled meetings. All of the same withdrawal concerns described above should be regularly assessed for in outpatient settings. If depression and suicidal thoughts should arise, a step up to a more intensive level of care may be required.

It is important to note that many stimulant detox programs are very short-term, typically lasting several days. While the detoxification process is an important part of the journey to stopping stimulant use, it is important to continue the journey with longer-term substance abuse treatment.

Substance abuse treatment may include education about the risks and consequences associated with drug use, along with strategies regarding how to prevent relapse. It also includes addressing deeper, underlying issues that trigger substance use. Formal substance abuse treatment is offered in a number of settings and each program is likely to utilize a somewhat unique therapeutic approach. These treatment varieties include inpatient, outpatient, luxury, executive, holistic, and population-specific.

• Inpatient: Many inpatient programs take place in a residential setting in which you stay at the treatment location the entire duration of the program (which tend to be 30, 60, or 90 days long) and have the opportunity to engage in a variety of services including group counseling, individual therapy, family therapy, peer support meetings, and healthy social activities.
• Outpatient: Outpatient programs involve regular attendance of group therapy or individual counseling sessions led by substance abuse counselors. Like inpatient therapy, these sessions will focus on education about substance use and related consequences, and help those in recovery to recognize the underlying issues and triggers that lead to substance use. There may also be a peer support component to outpatient settings.
• Luxury: As a luxury variant of residential treatment, luxury programs offer upscale amenities, such as gourmet meals, massage therapy, and spas.
• Executive: Also an inpatient/residential option, executive programs cater to working professionals who don’t want to take the time off of work to enter rehab. They offer internet access and private workrooms.
• Holistic: Holistic approaches include looking at the person as a whole, including the mind, body, emotions, and spirit. Finding balance within all of these areas is important for holistic healing.
• Population-Specific: These treatment programs specialize in addressing the unique needs of special populations. They may include male-only, female-only, teens, veterans, or LGBT.

Although they are not considered formal substance abuse treatment, many people find 12-step programs, such as Narcotics Anonymous (NA), to be helpful as an adjunct to formal treatment or as ongoing support after the recovery program has been completed.

It is important to remember that even after you have completed substance abuse treatment, aftercare and ongoing support is key to preventing relapse. Having the support of others and knowing which resources you can use when you experience triggers and feel like using can help guide you to stay clean and sober in the long run, and thus prevent damage to the heart and other organs.

Sources

1. National Institute on Drug Abuse. (2016). Which classes of prescription drugs are commonly misused?
2. National Institute on Drug Abuse. (2016). How Do Stimulants Affect the Brain and Body?
3. Substance Abuse and Mental Health Services Administration. (2016). Stimulants.
4. United States Drug Enforcement Administration. Drug Scheduling.
5. Substance Abuse and Mental Health Services Administration. (1999). Treatment for Stimulant Use Disorders. (Treatment Improvement Protocol (TIP) Series, No. 33.) Chapter 2—How Stimulants Affect the Brain and Behavior. Rockville, MD: Center for Substance Abuse Treatment.
6. National Institute on Drug Abuse. (2016). MDMA (Ecstasy/Molly).
7. National Institute on Drug Abuse. (2016). Which Classes of Prescription Drugs Are Commonly Misused?
8. Arria, A. M., & Wish, E. D. (2006). Nonmedical Use of Prescription Stimulants Among Students. Pediatric Annals, 35(8), 565-571.
9. Egan, K. L., Reboussin, B. A., Blocker, J. N., Wolfson, M., & Sutfin, E. L. (2013). Simultaneous Use of Non-medical ADHD Prescription Stimulants and Alcohol Among Undergraduate Students. Drug and Alcohol Dependence, 131(0), 71-77.
10. National Institute on Drug Abuse. (2016). Is It Safe to Use Stimulants with Other Medications?
11. National Institute on Drug Abuse. (2016). Treatment Approaches for Drug Addiction.
12. Schwart, B.G., Rezkalla, S., & Klonger, R.A. (2010). Cardiovascular Effects of Cocaine. Contemporary Reviews in Cardiovascular Medicine, 122: 2558-2569.
13. Cabell, C.H., Abrutyn, E., & Karchmaer, A.W. (2003). Bacterial Endocarditis: The Disease, Treatment, and Prevention. Cardiology Patient Page, 107: 185-187.