What Is Cotton Fever? Drug Injection Complications and Symptoms

“Cotton fever” is a condition that can happen if you inject drugs that have been filtered with cotton. Fever is the most notable symptom of cotton fever, but other signs that mimic infection, such as a rapid heart rate and malaise, can occur. Most cases of cotton fever are self-limiting, but it’s possible to have complications.

What Is Cotton Fever?

Cotton fever is a temporary reaction that occurs when particles from a cotton filter or bacteria associated with cotton are introduced into the bloodstream during IV drug use. The condition earned its name from the method often used to filter drugs: pulling the liquid through a cotton ball before injecting it.

While cotton fever isn’t generally considered medically dangerous in most cases, it can mimic more serious conditions. It’s also uncomfortable for the person experiencing it.

Why Does Cotton Fever Happen?

Although the exact cause of cotton fever is unclear, there are two theories regarding its potential causes. The main theory is an immune reaction to cotton fibers, which occurs when the fragments of cotton enter the bloodstream during injection.[1] The body then initiates a temporary immune response, similar to its response to any foreign substance, resulting in fever and other flu-like symptoms.

Another theory is connected to Enterobacter agglomerans, bacteria naturally found in cotton.[2] When this bacterium or its endotoxins are introduced into the bloodstream, they can cause a mild toxic response that resembles a bacterial infection.

Cotton fever typically resolves on its own without intervention. However, it can be uncomfortable and may mimic a serious infection, leading to misdiagnosis or unnecessary anxiety.

What Are the Symptoms of Cotton Fever?

Cotton fever has a rapid onset, often within minutes or an hour after IV drug injection. It typically presents with symptoms such as a sudden high fever, chills or shivering, rapid heartbeat, muscle aches, abdominal discomfort, headache, chest pain, and nausea or general malaise.[3]

These symptoms are similar to more serious conditions like endocarditis or sepsis, so it’s crucial to rule out more dangerous causes, especially if symptoms persist.

How Is Cotton Fever Treated?

In many cases, cotton fever resolves on its own, with or without medical treatment, within 6 to 12 hours.[4] Basic self-care measures, such as resting, staying hydrated, drinking electrolyte-rich drinks, and managing pain and fever with over-the-counter medications like ibuprofen or acetaminophen, are often sufficient.

If the symptoms last longer than a day, worsen, or include signs of a severe infection, such as low blood pressure, breathing difficulty, or confusion, it’s essential to seek medical attention.

Is Cotton Fever Dangerous?

While cotton fever can feel intense, it’s not usually life-threatening. However, getting cotton fever at all indicates high-risk behavior – specifically, unsafe IV drug use practices. There’s a lot more at stake than just cotton fever, including collapsed veins, bloodborne infections, overdose, or other injection complications. Cotton fever can be an early warning sign of escalating substance abuse.

Intravenous drug use is a serious type of substance use.[5] IV drugs are injected directly into the vein, delivering rapid and potent effects. Heroin, methamphetamine, cocaine, and crushed or dissolved prescription opioids or stimulants are often used intravenously.

These drugs enter the bloodstream instantly, causing quick, intense highs. It’s also a fast way to build physical dependence, meaning withdrawal will occur if you stop. There are many risks with IV drug use, including possible overdose, vein damage, and exposure to contaminated supplies, which is how cotton fever and other complications arise.

Should I See a Doctor for Cotton Fever?

Most cases of cotton fever are mild and self-limiting. It’s essential to know when to seek medical attention instead of relying solely on at-home care. An extremely high fever, confusion or lethargy, or symptoms that last longer than 24 hours may warrant medical attention.

You should also seek help if you have signs of sepsis, a potentially life-threatening condition in which the body responds excessively to an infection and attacks its tissue and organs. Some of the symptoms of sepsis include fever or shivering, extreme pain or discomfort, pale, discolored, or sweaty skin, shortness of breath, and confusion.[6]

Whether cotton fever resolves or not, if you find yourself using IV drugs repeatedly or experiencing effects like cotton fever, especially more than once, it may be time to consider getting help for substance use.

Signs of IV Drug Addiction

Experiencing cotton fever is just one sign that your drug use is becoming more dangerous. Based on the criteria for a substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the warning signs include:[7]

• Using more of a substance than intended
• Failed attempts to quit or cut back on substance use
• Spending excessive time obtaining, using, or recovering from substance use
• Cravings or urges to use substances
• Neglecting responsibilities or social obligations
• Continued use despite negative outcomes
• Using in hazardous situations
• Developing tolerance or withdrawal symptoms

Treatment for IV Drug Abuse or Addiction

Overcoming an addiction, especially to IV drugs, can be a long and arduous process, but recovery is possible with the right care and support. Depending on the drugs involved, treatment often begins with medical detox for supervised withdrawal in a safe, medically supportive environment.

Once you’re stabilized, you may need a full addiction treatment program in an inpatient or outpatient setting to address the underlying causes of compulsive drug use. This may include traditional therapies, such as individual counseling, support groups, and group therapy, as well as evidence-based therapies like cognitive behavioral therapy (CBT) and motivational interviewing (MI), to learn healthier coping strategies.

Avoid Injection Complications Like Cotton Fever

Cotton fever is a mild and self-resolving condition, but it’s not harmless. If you get cotton fever, it could be a symptom of deeper concerns around unsafe drug use, addiction, and dangerous complications. Whether you have cotton fever or you’re worried about the risks of IV drug use, there’s no better time to seek help than now.