In recent years, summers have been marked by prolonged heat waves throughout the country, with some areas also experiencing intense humidity. These conditions leave people uncomfortable during the day and unable to sleep at night. But there’s another set of risks that are starting to gain prominence: Drug side effects that can make it difficult to regulate body temperature. Difficulty with thermoregulation happens on top of known complications, like heart health problems and drug-induced depression.
Below, we outline the connection between drug use and the risk of heat sickness and provide some pointers to help keep you safe.
Drug use + heat tolerance
A variety of drugs, both legal and illegal, can impact the body's ability to regulate its temperature. Cocaine—a stimulant—not only increases blood pressure and heart rate, but it can also push up body temperature. In some cases, it can lead to hyperthermia. This increase in body temperature isn't the same as having a fever. When you have a fever, your brain's hypothalamus (the part responsible for temperature regulation) drives up your body's temperature on purpose, usually to fight infection or illness. With hyperthermia, your body's temperature goes above the hypothalamus's set point.
MDMA, also known as ecstasy or molly, likewise drives up body temperature. The drug releases a rush of hormones that interferes with the hypothalamus’s function. MDMA users may be especially at risk of heat-related health issues because the drug is often taken in party settings where people are physically active, like dance clubs or music festivals (which are more frequent in the summer).
Opioids also affect body temperature. These drugs work by binding to the brain's opioid receptors, blocking pain signals and helping reduce perceptions of pain. However, they also reduce perceptions of hot and cold. This puts people who misuse opioids at risk for both hyperthermia in hot weather and hypothermia and related conditions, like frostbite, when it’s cold.
With opioids in particular, danger may arise because medications commonly used to treat comorbid physical and mental health conditions can increase the danger of heat risks. For example, people with opioid use disorder (OUD) are often susceptible to mental health comorbidities, so they may take antidepressants or anti-anxiety medications.
Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, can lead to increased sweating and a greater risk of dehydration. Meanwhile, antipsychotics can interfere with the body's internal thermostat and impair sweating.
Medications for a wide array of physical conditions also affect heat tolerance. Anticholinergic drugs, which are used to treat health issues ranging from overactive bladder to allergies, can reduce blood flow to the skin and affect your ability to sweat. Many common prescription and over-the-counter (OTC) medications—including antibiotics, antihistamines, and pain relievers—increase sensitivity to sunlight, while the diuretics that help treat high blood pressure and heart disease increase the risk of dehydration.
Why it’s important to be aware of heat risks
Hyperthermia and other heat risks are becoming a greater cause for concern as the climate changes. The Environmental Protection Agency reports an increase in heat wave frequency, duration, and intensity, with data going back decades. For instance, in the 1960s, there was an average of two heat waves per year; in the 2010s and 2020s, that number has jumped to six per year.
This dramatic shift makes it more important than ever to spread the word about heat risks and the role that drugs that affect body temperature can play. Heat exhaustion can lead to symptoms like nausea, vomiting, fatigue, and headache, for example. In the case of heatstroke, symptoms may become even more severe and include delirium, abnormally low or high blood pressure, seizures, and even coma, organ failure, and death.
Certain populations are at greater risk for heat-related illnesses, such as the elderly and people experiencing homelessness. In some cases, these at-risk groups overlap with groups that are susceptible to OUD, compounding the threat. For instance, although OUD and homelessness are two different public health crises, they may sometimes be interconnected.
As current climate change trends continue, there is a growing need for better research into thermoregulation and drug use. Much of the research on drug use and body temperature regulation is decades old and doesn’t account for our rapidly heating planet. More current data and public health investment are needed to pinpoint risk factors and reduce threats to vulnerable individuals.
How to stay safe in hot weather
Heat safety is especially important in the summer months. Try these tips to protect yourself when the temperatures start climbing, especially if you take medications or have used drugs that can interfere with temperature regulation:
- Stay hydrated: Drink plenty of water, especially when you're active and sweating more. Avoid drinks that can contribute to dehydration, like coffee, tea, soda, and alcohol.
- Eat healthy: Make sure to eat regularly to help replenish the salt and minerals your body loses when sweating.
- Stay where it's cool: Try to stick to air-conditioned indoor areas and limit time spent outside in the heat. If you are going outside, try to limit activities to early morning or early evening to avoid peak temperatures.
- Dress smart: If you go outside, wear breathable, light-colored, and lightweight clothing. Also, wear sunscreen and protective hats and sunglasses and stay in the shade when possible.
- Avoid heat triggers: Steer clear of activities that drive up your body temperature, like saunas and hot tubs. Hot tubs can also be risky when combined with certain medications, including Suboxone®, which is used in OUD treatment (important safety information).
- Check in: Is there a heat wave underway? Set up a buddy system and check in with each other to ensure you’re safe, comfortable, and managing potential triggers.
If you are living with OUD and taking medications like naltrexone, methadone, or Suboxone as part of your treatment, you may be worried about the potential implications for heat risk. It's important to keep taking medications as prescribed to continue your treatment. Just make sure to exercise the above heat precautions, especially if you are taking other medications that influence body temperature regulation, like antidepressants.
If you're currently seeking OUD treatment, Ophelia is here to help. We connect eligible patients with medications for addiction treatment (MAT) online, providing Suboxone prescriptions and comprehensive clinical support. In addition to routine check-ins with a dedicated care team, you’ll have access to triage nurses who can provide support in real time, so you can get help with your heat-related questions and concerns.
Our clinicians also actively contribute to a growing body of research on opioid use and treatment, and we make our findings available to ensure people get the latest information on treating OUD and the challenges of navigating a major public health issue.
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