Substance Use and Toxicology Screening in Young Adults With Acute Ischemic Stroke

Substance use is rising among young adults with stroke. We aimed to assess the prevalence of substance use, and the use of toxicology screening in the diagnostic evaluation, for young individuals with acute ischemic stroke (AIS) at a single comprehensive stroke center.

This retrospective study was conducted at a single comprehensive stroke center in individuals ages 18 to 55 years old with AIS from 2020-24. Cases of AIS and recent substance use, or the use of cocaine, methamphetamine, marijuana, opioids, or other illicit substances within 30 days of admission, were compared to those with AIS and no substance use. Descriptive statistics and least absolute shrinkage and selection operator (LASSO) modeling were completed to evaluate predictors of toxicology screening.

Of 425 encounters screened, 307 were eligible for inclusion. Recent substance use was documented in 21.5% of encounters. Individuals with recent substance use were younger (median age 46 vs 51 years old in controls). Toxicology screens were ordered for 29.3% of all encounters, and in 27.9% of cryptogenic strokes. Models did not identify a variable that predicted the performance of toxicology screening.

Recent substance use was documented in about 1 in 5 young individuals with AIS. Further research is needed to understand the relationship between AIS and substance use, and the appropriate use of toxicology screening in stroke care.