Cotton Fever: What It Is And Avoiding It

Cotton fever may or may not be life-threatening depending on the general health of the individual suffering from the temporary disease.

Cotton Fever Explanation, Dangers, and Avoidance

Cotton fever is a street term used to describe the fever, nausea, reduced white blood cell count, and other medical complications arising from cotton being injected into the bloodstream. 

Cotton fever primarily occurs when cotton balls are used or reused during the injection of drugs, and some microscopic bits of cotton are accidentally injected along with the drug.  Cotton fever can also be caused by reusing old needles or “works.” 

The most common symptoms of this syndrome are fever and severe body aches.  Cotton fever is said to have a “benign, self-limiting” course, meaning that it probably won’t kill you, but it is incredibly uncomfortable.

The cause of cotton fever is not well understood by doctors.  According to researchers: “Although its etiology is not well understood, cotton fever seems to be a self-limited, febrile response to the intravenous administration of a drug filtered through cotton1.”

This assessment is further corroborated by comments from researcher T. Shragg who said: ” Although the causative mechanisms are unknown, the syndrome does appear to have a benign, self-limiting course2.”

Patients who have experienced cotton fever say it is similar to withdraw but without the vomiting or diarrhea.  One patient stated that the body aches were slightly less intense than those experienced during withdrawal from heroin or other opiates.  With that said, the condition of cotton fever is severe enough to prompt most who get it to go to the hospital.

Who gets cotton Fever?

Diagram of the most common cause of cotton fever
Diagram Of The Most Common Cause Of Cotton Fever

Cotton Fever is common with about half of IV drug users acquiring the illness at least once. Over half of I.V. drug users have gotten cotton fever based on one 2015 study in France, which included over 550 self-reported I.V. drug users3

In that study, researchers used a logistic regression model to assess which factors led to an increased cotton fever rate.  Researches discovered that I.V use of crack cocaine, longer duration of opiate use, and the use of cotton filters instead of membrane filters are all factors that can cause or lead to cotton fever.

How To Avoid Cotton Fever

Avoid cotton fever by not “washing” your old cotton balls or engaging in “cotton shooting.”  Instead, use a cotton ball once and dispose of it.  Using a membrane type filter would also help. 

There is something called an Injection drug use syringe filter (IDUSF).  These syringes are designed to prevent various complications relating to IV drug use, including cotton fever.  For example, the Sterifilt has been available in France for the last five years.  It is unclear when this new technology might be available in the U.S.  Until then, avoid reusing cotton balls when injecting drugs to avoid cotton fever.

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  1.  Zerr AM, Ku K, Kara A. Cotton Fever: A Condition Self-Diagnosed by IV Drug Users. J Am Board Fam Med. 2016 Mar-Apr;29(2):276-9. doi: 10.3122/jabfm.2016.02.150267. PMID: 26957385.
  2. Shragg T. “Cotton fever” in narcotic addicts. JACEP. 1978 Jul;7(7):279-80. doi: 10.1016/s0361-1124(78)80339-6. PMID: 671940.
  3. Mezaache S, Briand-Madrid L, Laporte V, Mora M, Moudachirou K, Rojas Castro D, Carrieri P, Roux P. Correlates of Self-Reported Cotton Fever Experience among People Who Inject Opioids. Subst Use Misuse. 2020;55(6):1021-1027. doi: 10.1080/10826084.2020.1720247. Epub 2020 Feb 3. PMID: 32009485.

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