What Is Cotton Fever? Symptoms, Causes, and Treatment

“Cotton fever,” or benign febrile syndrome, is a condition that occurs among people misusing intravenous (IV) drugs that have a cotton filter. Though it can appear to cause signs of infection, such as a high fever, fast heart rate, and abdominal pain, it tends to go away on its own and isn’t considered dangerous.

Learn more about cotton fever among intravenous drug users, the symptoms and causes, and how it can be treated.

What Is Cotton Fever?

Cotton fever, as the name suggests, is a condition in which there’s a fever after IV drug use, where cotton is used to filter the drugs, such as cotton balls or cigarette filters. It only occurs when using non-medical IV drugs, such as illicit drugs.

Though cotton fever is not considered dangerous, it can be uncomfortable. Worse, it indicates that IV drug abuse has reached a dangerous level and may leave you at risk for serious infections or overdose.

What Causes Cotton Fever?

Cotton fever is common when cotton is used to filter heroin or other IV drugs, but it can occur without cotton. The most widely accepted cause of cotton fever is a reaction to endotoxins, particularly from the Enterobacter species, which can be present in cotton used to filter drugs. When cotton particles are picked up by the IV drug and injected, the immune system may create a temporary response that presents as a fever.[1]

Cotton particles in the bloodstream cause chemical reactions, just like a medication. This can lead to fever, abdominal pain, and other symptoms, such as a general feeling of illness. Another possible cause is an endotoxin response from the Enterobacter agglomerans bacteria that live in cotton.[2] It’s a mild toxin that can be picked up in the drug, causing a reaction.

The endotoxin response is the most widely accepted reason for cotton fever in the medical community, but little research or medical literature exists on what causes it.

Cotton Fever Symptoms

Cotton fever doesn’t have a lot of research, so there’s no established list of symptoms. However, several common symptoms are often reported, including:[3]

• Fever
• Abdominal pain
• Headache
• Chest pain
• Shortness of breath
• Chills
• Fast heart rate

This condition typically has a sudden onset after using an IV drug filtered with cotton. If there are no other possible causes, such as infectious diseases, it is a diagnosis of exclusion.

How Is Cotton Fever Treated?

The presumed cotton fever treatment focuses on reducing the symptoms with supportive care rather than treating the condition itself. It’s usually a self-limiting illness with symptoms that typically go away on their own after about 12 hours without any treatment.[4]

However, other conditions may cause cotton-fever-like symptoms. In that case, supportive care is provided until the symptoms disappear independently. If they don’t, it indicates that something else may be causing the illness.

Is Cotton Fever Life-Threatening?

Though unpleasant, cotton fever is rarely dangerous. Symptoms tend to subside independently, but you may require supportive care to manage intense symptoms and monitor your vital signs like blood pressure and temperature. Some people can manage the symptoms independently at home with fluids, a warm bath, and an anti-inflammatory medication like Tylenol. There can be rare complications with this condition, such as infective endocarditis.

What Is an Injection Drug?

An injection drug or IV drug is any drug that’s injected into a vein. The drugs most often used in IV are heroin, cocaine, methamphetamines, prescription stimulants, and prescription opioids. The latter may be crushed and dissolved into water to inject into a vein.

These drugs have a faster onset of effects than other uses because they go directly into the bloodstream. It typically requires a much smaller dose than if the drug was consumed or inhaled.

Because the drugs enter the bloodstream immediately with injection drug use, they can cause a more intense reaction that’s short-lived. The rapid and intense effects can make the drug more dangerous, as it encourages repeated use.

Recreational IV drugs are dangerous in their own right. Using an IV substance leaves you vulnerable to not only the adverse effects of the drug but also possible complications, such as bloodborne infectious diseases like HIV or hepatitis, injection site reactions, and a higher risk of overdose.

When to Seek Medical Treatment

It’s not unusual to develop a cotton fever after using IV drugs. Though benign febrile syndrome is a self-limiting illness, other complications can arise that are more severe, including addiction.

Generally, IV drug use is a severe form of addiction that significantly increases the risks of misusing drugs.[5] If you inject drugs to the point of experiencing cotton fever, it may indicate a serious addiction.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), addiction is a substance use disorder with the following criteria:[6]

• The substance is taken in larger amounts or over longer periods than intended
• A persistent desire or unsuccessful effort to cut down or control substance use
• A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
• Craving to use the substance
• Recurrent use of the substance failing to fulfill major role obligations at work, home, or school
• Continued use of the substance despite having persistent or recurrent social or interpersonal problems
• Important social, occupational, or recreational activities given up or reduced because of substance use
• Recurrent substance use in situations in which it is physically hazardous
• Substance use is continued despite knowledge of having persistent or recurrent physical or psychological problems

Treating an Addiction to IV Drugs

Addiction is difficult to overcome, no matter the drug or the way it’s used. However, comprehensive addiction treatment can address the physical, mental, emotional, and social aspects of addiction to help you reach recovery.

Typically, the first step in addiction treatment is medical detox. Withdrawal from some substances can be extremely unpleasant, if not dangerous, but detox provides a medical team to monitor your health, prevent complications, and keep you as safe and comfortable as possible,

Once detox is complete, it’s followed by a full addiction treatment program on an inpatient or outpatient basis. While the treatment is individualized based on your unique history, it may include individual and group counseling, peer support groups, behavioral therapies, medication-assisted therapy, and more.

Get Help for Addiction

Cotton fever is an uncomfortable condition that’s associated with intravenous drug abusers, but it’s not usually dangerous. However, experiencing cotton fever can be an indication that IV drug use has reached dangerous levels and requires treatment. The sooner you get help for your addiction, the less likely you are to experience dangerous effects.

Frequently Asked Questions