Complete Guide to Cotton Fever – Symptoms & Treatment

what is cotton fever header
Last Edited: August 26, 2021

Claudia Rose

Clinically Reviewed
Edward Jamison, MS, CAP, ICADC, LADC

All of the information on this page has been reviewed and certified by an addiction professional.

What is Cotton Fever?

Cotton Fever is a condition known by many long-term Heroin addicts and some Meth addicts, who use cotton to filter the drugs when shooting up. Cotton Fever comes from an endotoxin that is released by a bacteria called Pantoea agglomerans which colonize in cotton plants prior to being processed.

It is commonly thought that Cotton Fever was contracted by pieces of cotton getting into the bloodstream during injection. This myth is still perpetuated in the community of active addiction. The true cause of this condition is the bacteria known as Pantoea agglomerans.

There are instances where Cotton Fever can be contracted without the use of a cotton filter. This is generally due to re-using a needle that may have the bacteria residue still on the needle from prior use.

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Another cause of Cotton Fever is an inflammatory infection in the blood, also known as sepsis. This can happen when an intravenous drug user is using an unclean syringe, something intended for a single use. If the needle is used repeatedly then mold and other bacteria can grow increasing the likelihood of sepsis and/or cotton fever.

Sepsis occurs when bacteria enters the blood or tissue, often via a wound. The body responds to fight the infection and the immune reaction can cause life-threatening and extremely damaging complications. Organ failure and death are just some of the possible complications caused by sepsis.

“Cotton Fever was the worst thing I’ve ever experienced. It was worse than withdrawal, to be honest” – anonymous

The Symptoms of Cotton Fever

symptoms of cotton fever infographic

For someone who is struggling with a Heroin or heavy Meth users, Cotton Fever could be one of the worst experiences he or she will ever face. Also known as a dirty shot. When the bacteria gets into the bloodstream it can cause a wide variety of extremely unpleasant symptoms.f

  • Abdominal pain
  • Abnormally fast heartbeat (tachycardia)
  • Chills
  • Elevated white blood cell count (leukocytosis)
  • Fever
  • Headache
  • Mild distress
  • Muscle aches and pain
  • Nausea
  • Shortness of breath
  • Vomiting

“Cotton Fever was the worst thing I’ve ever experienced. It was worse than withdrawal, to be honest,” said an anonymous source who had experienced Cotton Fever during active addiction. Let’s face it, there are a lot of things that can go wrong with IV drug abuse. There are blood clots, collapsed veins, hitting arteries, and more that can be quite painful and make life unpleasant.

Known to strike within a half an hour of injection, in some cases, it takes as little as five minutes to set in. The pain of this condition is borderline torturous. The bones ache, muscles can spasm, accompanied by cold and severe migraines the body will also shake, sometimes violently. Of course, there is also a fever on top of everything else going on, which, in turn, brings about nausea and vomiting. This can last for hours. You may feel like your dying.

The severity of symptoms is so intense that cotton fever is often described as the worst experience of one’s life, by a long shot. Whether from sepsis or cotton plant-born bacteria, the presence of such symptoms demands immediate medical attention.

It can be difficult for an individual to determine the source of the symptoms. Cotton fever has many of the same symptoms as a bad flu or other issues. The tell-tale sign is how the symptoms are clustered. The severity of symptoms, such as tremors, is also an indication of cotton fever over another type of infection.

How Long Does Cotton Fever Last?

Symptoms begin 15–30 minutes following injection, and are often accompanied by shortness of breath, chills, headache, myalgia, abdominal pain, nausea, vomiting and tachycardia. Although cotton fever is self-limited and normally lasts 6 to 12 hours, it can continue for up to 24 to 48 hours.

Can You Die From Cotton Fever?

This is an infection and can lead to a life threatening situation if it goes untreated.

Other Infections Facing Drug Users

HIV/AIDS: The virus attacks the immune system, making it difficult for the body to fight off other infections and disease. HIV is mainly spread by contaminated needles or injection paraphernalia including syringes, cookers, and cottons used to prepare or inject drugs. Unsafe sexual practices also put drug users at risk.

Hepatitis: This disease or infection that attacks the liver. The name hepatitis comes from the Greek for liver (hep), and swelling (itis), literally meaning swelling of the liver. Exposure to hepatitis occurs most typically from contaminated food or drink, but can happen during close person-to-person contact, sexual activity, and from unsanitary conditions, including using unsterile cooking, smoking, or injection equipment when using drugs.

Infective Endocarditis: Generally occurs when bacteria or fungi enter the bloodstream and spread to the heart. Exposure to the bacteria that cause endocarditis can be caused by certain dental procedures or oral activity, infection, catheters, needles used for tattoos or piercings, and injection drug use.

Treating Cotton Fever

Are you looking for a remedy for cotton fever? We understand what it’s like to feel trapped in this endless loop of on-again-off-again. We know how hard it can be to hit rock bottom. The symptoms of Cotton Fever can last for hours and knowing the source of the problem may prevent this from happening again.

Ultimately, the best solution is to get help in the form of treatment through detox and therapy. You don’t have to take our word for it, take it from someone who has walked several miles in your shoes:

“Withdrawal wasn’t easy by any means, but Cotton Fever was so much worse. It felt like I was being stabbed by jagged knives: I hurt everywhere, I felt sick to my stomach, and the whole time I had cold sweats. If you can get through Cotton Fever, you can get through withdrawal,” said an anonymous person in recovery.

You deserve a healthier, better life than one enslaved to Heroin. When you’re ready, speak to a professional on the matter and learn how you can end this vicious cycle and start fresh.

Within the first year after completing a treatment program, 40 to 60 percent of addicts relapse.

How to Avoid Cotton Fever

Cotton fever can be avoided altogether. Obviously, detox and a drug rehab program are the best and only long-term solutions to any and every aspect of drug use-related problems.

As sepsis is caused by transmission of bacteria from a dirty needle, using a needle only once and using a new, sterile needle every time will prevent cotton fever. Typically, people who use dirty needles would prefer and try to use clean needles, however, it is just not always possible. Unfortunately, there is no simple way to ensure the sterilization of an already used needle.

In order to sterilize a needle, it must be exposed to an excess of 340-degree Fahrenheit for at least an hour for full destruction of bacteria, fungi, and other microorganisms. This, however, is not an assured method and the only reliable method of verifying sterility is done commercially.

Cotton fever caused by bacteria from the cotton plant may be more problematic in preventing. Any method to sterilize cotton that may contain the bacteria would likely turn the cotton toxic and possibly deadly in another manner. Toxins used to sterilize cotton may also be more difficult to treat and the damage done may be impossible to treat.

Pregnancy and Cotton Fever

In the case of pregnant women who develop cotton fever, the prognosis is not necessarily good. Without medical attention, the strain on the system can prove deadly for mother or child, or both.

Cotton fever, whichever the origin of the infection, a high fever during the earlier stages of pregnancy can lead to miscarriage. The baby needs a stable and healthy environment, which includes temperature, hydration, and nutrients.

When the body is fighting desperately to handle the cotton fever, it may not be able to handle the pregnancy as usual. The presence of an infection can throw anyone’s system into crisis and instigate the death of either one or both.