If You Use Stimulant Drugs, Talk to Your Doctor about Heart Health
Michelle Gamage,
Local Journalism Initiative Reporter
People with heart disease who use cocaine or methamphetamine are at higher risk of death by accidental overdose.
A recent study examined the health records of people who had fatal overdoses in British Columbia and found that people who use unregulated stimulants and who had been diagnosed with chronic diseases such as hypertension, ischemic heart disease, heart failure and strokes that required hospitalization were more likely to die by overdose than people who use unregulated stimulants and did not have heart disease.
The study, published in BMC Medicine, highlights the need for doctors to speak with their patients about stimulant use and heart health, said lead author Heather Palis.
Palis is a senior scientist with the BC Centre for Disease Control and an assistant professor in the school of population and public health at the University of British Columbia.
The ongoing unregulated toxic drug crisis, which the BC Coroners Service says has killed more than 16,895 British Columbians since the start of 2016, is mainly driven by potent opioids like fentanyl and its analogues.
But stimulants are a growing part of the picture.
One 2019 study found that half of all Canadians dying of overdose had both stimulants and opioids in their systems and that B.C. harm reduction sites report more stimulant use than opioid use.
In 2023 half of the people who died from unregulated drugs had detectable levels of methamphetamines or another amphetamine in their system, and 41 per cent had cocaine detected, according to the BC Coroners Service. More than 80 per cent had fentanyl in their systems and just under one-fifth had alcohol. Data for 2024 has not yet been released.
Palis’s study looked at overdose fatalities that occurred from Jan. 1, 2015, to Dec. 31, 2019, whether opioids, stimulants or both were relevant to the person’s death, and what chronic diseases — mental health diagnoses, substance use, circulatory, respiratory, inflammatory or musculoskeletal, diabetes and kidney disease — people had been diagnosed with between Jan. 1, 2010, and Dec. 31, 2019.
There were 3,788 deaths that could be analyzed for this study. Research focused on patterns that emerged between drug types and diseases but also checked people’s age, sex, whether they were receiving social assistance and how their neighbourhood impacted their quality of life.
The most common chronic diseases diagnosed were mental health related, with the majority of opioid users having mood and anxiety disorders or depression. Roughly one-tenth of those who used stimulants only, or both stimulants and opioids, had schizophrenia or delusional disorders.
One-quarter of stimulant users had some form of diagnosed circulatory disease, such as hypertension, ischemic heart disease, heart failure or hospitalized stroke. That number dropped to less than 15 per cent if the person used both stimulants and opioids or just opioids.
People with polysubstance use — meaning they use more than one type of drug — were less likely to be prescribed opioid agonist treatment but represented more than 60 per cent of overdose deaths.
OAT has been shown to reduce people’s mortality, including their risk of dying from drug toxicity.
Reducing barriers to treatment
People’s reasons for using drugs are always complex, but it’s a common strategy for people dealing with homelessness to use stimulants to help them stay awake and alert at night to protect themselves from being robbed, and then to use fentanyl to help them sleep when they find a safe time and place to do so, said Beth Haywood, co-author of the study and the Vancouver Island representative for the Peer Engagement and Evaluation Project.
The study’s authors recommend that clinicians reduce barriers to treatment for people who use stimulants and have heart disease, hypertension or heart failure, and suggest more broadly that more attention be given to circulatory diseases for people who use drugs.
There needs to be more communication between doctors and patients about substance use in general, Haywood said.
This should start with doctors building a trusting relationship with their patients because people who use drugs know how much the health-care industry stigmatizes drug use, she said.
Haywood said she knows two people who had to have limbs amputated because they refused to get medical care due to how they’d previously been treated by a medical professional.
“People are so distrustful of the medical system,” she added. “It’s scary now.”
Haywood recalls being in extreme pain one night back when she used substances and needing to be transported to the hospital in an ambulance. When she saw a doctor, they dismissed her as drug-seeking and left her in pain for hours before giving her a shot for her pain and discharging her. She was in her pyjamas, didn’t have shoes on, was woozy from the medication and didn’t have a way to get home, she said. No one checked in to ask if she’d made it home safely.
Another time, Haywood said, she broke her arm and was open with the ER doctor that she had previously used substances but was now sober and taking prescribed opioid agonist treatment. She said the doctor refused to send her home with pain medication, which meant she went over 15 hours with nothing for the pain.
“Stuff like that can’t happen. I needed pain medication; I had a broken arm,” Haywood said.
To rebuild a trusting relationship, Haywood said she’d like doctors to ask patients how they’re doing, instead of asking, “Why are you here?”
Taking the time to be present, look people in the eye, actively listen and share what is being written down on their chart can also go a long way, she said.
In hospitals, she said, she’d like security guards to take several steps back so that when a patient is brought in after an overdose, the first thing they see is their care team, not security.
“They’ve just gone through a horrible experience and just want to feel better,” she said.
And don’t make assumptions just because of how someone looks, she added.
There’s a lot of misunderstanding around stimulants out there, and people can be judged as being “violent” if they use meth, crack or cocaine, Haywood said.
People who use substances are just people, Haywood said. They’re friends, family, aunties, co-workers, cousins and “besties” who have “been through some pretty intense trauma and need something to help them not think of that trauma on a daily basis, or use stimulants or opioids to help them not feel their pain and the pain caused by those memories.”
Supporting people shouldn’t focus on abstinence, Haywood said, as abstinence works well for some people but not for others. People should be able to get the support they need when they need it, which could include timely admission into a regulated treatment program, but could also include working to keep families together, or just have a doctor take the time to listen to you, Haywood added.
Michelle Gamage,
Local Journalism Initiative Reporter
The Tyee
