Impact of Stimulant and Sedative Use Disorders on Subarachnoid Hemorrhage Outcomes

Introduction: Non-traumatic subarachnoid hemorrhage (SAH) occurs in 10 to 14 out of 100,000 individuals per year in the United States. Although there is a well-documented association between the use of sympathomimetic agents and the development of SAH, there exists a gap in understanding regarding the clinical outcomes of SAH patients with use of other substances. This retrospective cohort study investigates the clinical outcomes of SAH in patients with stimulant use and sedative use disorders.

Methods: The TriNetX Research Network was used to analyze data from SAH patients (≥18 years old). Patients were further stratified into substance use disorder groups, specifically cocaine related disorders, other stimulant related disorders, opioid related disorders, cannabis related disorders, and sedative, hypnotic, or anxiolytic related disorders. Cox proportional hazard models assessed the hazards of mortality, vasospasm, hydrocephalus, cerebral infarction, and cerebral ischemia.

Results: Of the 209,970 patients with SAH, 7,795 patients with stimulant use disorders and 14,901 patients with sedative use disorders were included. Disorders involving cocaine (HR=1.43; 95% CI: 1.30, 1.58) and other stimulants (HR=1.62; 95% CI: 1.44, 1.82), and opioids (HR=1.57; 95% CI: 1.44, 1.70), cannabis (HR=1.22; 95% CI: 1.12, 1.33), and sedatives (HR=1.41; 95% CI: 1.21, 1.66) all increased hazards of mortality. Hazards of cerebral ischemia were increased by cocaine (HR=1.50; 95% CI: 1.16, 1.93), and opioids (HR=1.64; 95% CI: 1.32, 2.03) and cannabis (HR=1.43; 95% CI: 1.16, 1.77).

Conclusion : The findings of this study illuminate the long-term neurological impact of stimulant and sedative use disorders in patients with SAH, and can help guide clinical decision-making and public health education measures to target substance use disorders in the general population.