Which drug most commonly increases stroke risk?

• A. Marijuana
• B. Cocaine
• C. Alcohol
• D. Opiates

Answer: (B)

Cocaine is most strongly linked to acute cerebrovascular events because it triggers intense sympathetic activation that directly stresses cerebral vessels. The surge of norepinephrine and other catecholamines drives a rapid rise in blood pressure and heart rate, which can overwhelm cerebral autoregulation and cause severe vasoconstriction (vasospasm). This vasospasm reduces blood flow to brain tissue, setting the stage for ischemic stroke. At the same time, cocaine promotes a prothrombotic state, increasing platelet activation and the likelihood of clot formation. The combination of vasospasm, hypertension, and hypercoagulability makes cocaine a leading cause of stroke, particularly in younger individuals.

Marijuana can be associated with cerebrovascular events in some cases, but the link is less consistent and not as direct. Alcohol can precipitate hemorrhagic stroke with very heavy or binge use, but the mechanism is less immediate and not as readily the cause of the most common pattern of stroke by itself. Opiates are not typically associated with an increased risk of stroke in the same direct way as cocaine.