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man with thermometer suffering from cotton fever

What is Cotton Fever: Myths, Facts & Treatment Options

Cotton fever is a benign syndrome reasonably common among people who inject drugs. It happens when bacteria from reused cotton or needles are injected into the body. When an intravenous (IV) injection drug user prepares their drug of choice, they may have to filter the substance before they fill the syringe with it.

Associated with IV drug use, it’s thought to result from injecting tiny particles from whatever is used as a filter. These are things like cotton balls, Q-Tips, and cigarette filters that intravenous drug users use to filter their drugs. Although injecting particles from these filters is a genuine concern for active addicts, they’re not the condition’s cause.

If someone is using IV drugs, they require immediate addiction treatment. Injection drug users are at a higher risk for overdose, bloodborne illnesses, and infections that can all be life-threatening.

What’s Cotton Fever?

The first thing we must understand about cotton fever is its inability to be passed from person to person. Cotton fever is not an illness but a byproduct of using used or unsterile cotton, filters, and syringes. It can happen to someone getting a tattoo, for example, or just going for a regular blood test.

Additionally, cotton fever can be the response to an infection brought on by Pantoea agglomerans. This is a bacterium found in cotton plants, not in cotton itself. In fact, in the 1940s, cotton pickers began to exhibit similar symptoms. They weren’t IV drug users but rather people who had frequent contact with cotton plants.

Cotton fever hits a user 20 minutes after injection, with symptoms typically subsiding in 12 hours.

In recent years, there’s been new evidence that suggests cotton fever is a form of sepsis. This is mainly because the symptoms of cotton fever are incredibly similar to sepsis and infective endocarditis symptoms. Cotton fever can cause many symptoms, including:

  • Fever (usually lasting no longer than twenty-four hours)
  • Extreme Shakes
  • Nausea & Vomiting
  • Muscle aches & Bone Pain
  • Chills
  • Migraines


Among intravenous drug abusers, whenever someone comes in contact with infected cotton fibers, they can be at risk of struggling with cotton fever. As of today, three different theories try to explain cotton fever onset, including:

  • Immunologic theory: When a drug user has antibodies for the cotton, which causes a reaction minutes after the injection.
  • Pharmacologic theory: When the drug enters a person’s bloodstream and contains substances from the cotton, it causes fever. These substances are water-soluble, so the liquid form of the drug tends to dissolve them. 
  • Endotoxin theory: Some gram-negative bacteria live on cotton plants. These bacteria produce an endotoxin that carries through to drugs and then to someone, causing fever. Blood cultures support this theory, too, as certain bacteria linked to the illness have been found in the used cotton. 

The endotoxin theory is by far the most probable of these theories. Even though cotton fever can resolve itself, seeking medical attention to confirm the diagnosis is critical. 

To prevent cotton fever, intravenous drug users must understand the options available to them. Ideally, they’d start treatment for their addiction. However, if they’re not there yet, looking for needle exchange programs that provide access to clean syringes and materials can reduce the risk of cotton fever and other bloodborne illnesses. 

How to Get Rid of Cotton Fever

The first step is to complete blood tests and cultures to analyze a patient’s blood results. Then, broad-spectrum antibiotics may help ease the symptoms and calm any other triggers caused by another condition.

Depending on the severity of someone’s addiction, they may need detox and withdrawal management at this time. To control symptoms, over-the-counter fever reducers like Acetaminophen and Ibuprofen may help. If a person has become severely dehydrated, they may also receive IV fluids.

Some of the most common methods of treatment include:

  • Seeking Emergency Medical Help – This should be obvious! If you’re experiencing symptoms, go to the hospital. While it usually isn’t deadly, there’s no way to tell the exact outcome. If cotton fever is a mild form of sepsis, then medical attention is necessary.
  • Taking a Hot Shower – Many heroin addicts use this to help ease withdrawal symptoms. The symptoms mimic opiate withdrawal, so taking a hot shower may help mitigate some cotton fever symptoms.
  • Drinking a Lot of Water – Like taking a hot shower, this is more to help ease the symptoms. However, drinking a lot of water won’t do much to rid the body of any infection.
  • Letting it Run its Course – while I don’t endorse doing anything, this is an option. Many addicts view cotton fever as an unfortunate side effect of active addiction and won’t attempt any treatment unless they have to. Addiction treatment help is always available if you or a loved one are ready to start your road to recovery.

Getting Addiction Treatment Help

Anytime you experience a high fever for more than 24 hours, it is wise to seek medical attention. Luckily, fever is a benign and non-life-threatening condition that can be treated. Still, if you or someone you know is struggling with drug addiction, that can be fatal. Reach out for help today and learn how to get the treatment you need to start your addiction recovery journey.

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