Recreational substance abuse is dangerous no matter what the drug is that someone uses. Cotton fever or fever and leukocytosis are a serious risk for IV drug users. However, depending on which substance is used, there are direct effects that can be intense and even life-threatening in some cases. Sometimes, even if there isn’t a life-threatening illness, there may be emaciation, undernourishment, or infectious diseases.
Cotton fever is one condition that is commonly found in those who use IV drugs such as meth, cocaine or heroin. The illness is incredibly unpleasant and dangerous. When someone prepares a drug such as heroin or meth, they often use makeshift materials and supplies, so they can heat, filter and load the syringes with as much of the drug as they can get. One thing that is needed to completely make heroin or other dangerous drugs is cotton. It is used to filter adulterants out of the solution.
The problem with the cotton is that many people will use cigarette filters, the end of q-tips or other pieces of random cotton, instead of actual filters. With these makeshift options, pieces of debris and adulterants can still get into the syringes and end up in the user’s bloodstream, leading to cotton fever.
This condition has been around consistently since the original spike of IV drug use during the 1970s. It has been determined that during the process of preparing the drugs, an infection develops and leads to fever and leukocytosis symptoms. This is just one more reason why professional addiction treatment is so essential.
What are the signs of cotton fever?
Now that you know more about what this fever is or where it comes from, it would be a good idea to learn about some of the common signs of this condition. It is important to know that in many cases the signs of fever and leukocytosis mimic those of heroin withdrawal symptoms. The main fever and leukocytosis symptoms would occur in under half an hour after injecting the drug into the body. Some of the common symptoms that may occur include:
- General malaise
- Muscle pain
- Pain in the bones
- Nausea
- Feelings unwell
- Discomfort
- Chills
- Headaches
- Extreme muscle and joint pain
- Severe kidney and back pain
- Shortness of breath
- Severe tremors and shivering
- Feeling cold
- Anxiety
- Increased resting heart rate to 100 beats or more per minute
Since cotton fever symptoms generally occur shortly after taking the drugs, many users assume the infection happened because cotton went into their syringe during the filtration process and got into their bloodstream after that. That is where the name cotton fever comes from.
However, over time, it has been found that the main cause of this condition was not because cotton got into the user’s bloodstream. Studies show that cotton fever has nothing to do with cotton being in the bloodstream at all. Instead, there are two other scenarios for why it still known as cotton fever. In the 1940s, cotton farmers figured out that endotoxin is released by bacteria and colonizing the cotton plants. Some of the bacteria is left on the cotton which can cause an infection when someone uses that cotton for IV drugs. While the bacteria isn’t generally harmful, when it gets into someone’s bloodstream, the user can experience the symptoms noted above. Another reason why someone may develop an infection, known as cotton fever, is due to an inflammatory blood infection or sepsis. This is caused from unsafe or unsanitary IV drug use. Particularly, it is caused by the use of unsafe syringes. They should be disposed of after each use, but many drug users share or use the needles more than once, leading to mold and bacteria growing inside the IV chambers. Then, that bacteria or mold is shooted into the bloodstream causing cotton fever.
Over the years, IV drug users have developed a range of other infections. Many times, when the symptoms mimic those noted above, they are diagnosed with having cotton fever, even if that is not the case.
What is cotton fever caused by?
As noted above, cotton fever is caused by one of two things – both being something to do with bacteria from IV drug use entering into the bloodstream. Unfortunately, IV drug use is not safe no matter how it is done. There are always going to be risks when it comes to this type of drug use. Sometimes, the risks are higher than others, especially when certain drugs or materials are used.
The problem is that people who are addicted to drugs such as cocaine, heroin or meth can’t put aside their drug use no matter what the negative consequences may be – not until they get help in treating the drug abuse or addiction.
If you are abusing cocaine, heroin, meth or any other IV drugs, there are treatment programs here at ARIA FL that you can get into.
What treatments are available for IV drug abuse?
Do you or someone you know have an addiction to shooting up meth, cocaine, dope, heroin or other IV drugs? If so, it is crucial to know about the many different treatment options available for this type of drug abuse. It is also helpful to know about the many services offered in these drug addiction treatment programs, as well.
Some of the treatments and services avaialble to help those who have IV drug abuse problems or an addiction to these drugs include:
- Inpatient treatment
- Intensive outpatient treatment
- Partial hospitalization programs
- Outpatient treatment
- Yoga
- Mindfulness meditation
- Nature therapy
- Art or music therapy
- Individual or group therapy
- Family therapy
- Cognitive-behavioral therapy
- Dialectical behavior therapy
- 12-step facilitation therapy
- Medication-assisted treatment programs
If you aren’t sure which one of these programs would be best for you, don’t hesitate to let a member of our team know that you need help. We will do our very best to enroll you in a treatment program that offers services you need. Over time, we can adjust the services to continue meeting your addiction recovery needs.
How long does cotton fever last?
If someone develops cotton fever, they can expect the symptoms to be quite unpleasant. However, these symptoms will generally subside in about 24 hours. If the infection is more severe, the condition may last longer. However, there are usually treatments offered in hospitals and other facilities such as drug detox programs to help a person overcome cotton fever. Here at ARIA FL, we can help you get the treatment you need.
Is there a cure for cotton fever?
How do you get rid of cotton fever? Is there even a cure? While cotton fever is very uncomfortable, there are ways to get over it. Most of the time there are antibiotics prescribed by a doctor or emergency room services that can help to ease the symptoms. If you attend a drug detox program, you can get help handling and overcoming cotton fever, as well. There are many ways that our ARIA FL team can help you or someone you know to treat and overcome this condition.
In addition to the tips mentioned to the left, you can also take a warm bath, use warm compresses, wrap in a warm blanket or take long naps.
If you think that you or someone you know has cotton fever, but you aren’t sure, you may want to think about going into a detox center or emergency room for symptom relief. In the first 24 hours, symptoms can be quite intense. However, for some people, the symptoms only last a few hours.
Get Into a Professional Addiction Treatment Program Today
Do you want to know how to prevent cotton fever and other addiction-related infections and illnesses? If so, our ARIA FL team can help you. It all starts with admitting you have a drug abuse problem or addiction. From there, we can get you into a treatment program that helps you to get clean and stop using IV drugs and other substances. Without shooting up these drugs, you won’t be able to get cotton fever.
Contact us today to get started in a professional addiction treatment program. It could be the difference between a healthy future and a terrible, dangerous infection.
FAQs About What is Cotton Fever and How Long Does it Last?
Q: What is cotton fever?
Cotton fever is a self-limiting systemic inflammatory reaction that occurs after intravenous (IV) drug use, caused by bacterial endotoxins entering the bloodstream during the injection process. When IV drug users prepare substances like heroin, methamphetamine, or cocaine for injection, they typically use cotton — such as cotton balls, cigarette filters, or Q-tip ends — to filter the drug solution before drawing it into a syringe. These makeshift filters can harbor bacteria, most commonly Pantoea agglomerans (formerly Enterobacter agglomerans), a bacterium that naturally colonizes cotton plants. When the endotoxins released by this bacteria are injected into the bloodstream, they trigger an intense immune response that produces sudden high fever, severe chills, muscle and joint pain, headache, nausea, and rapid heart rate. The condition gets its name from the cotton used in the filtration process. Cotton fever typically begins within 15 to 30 minutes of injection and, while extremely unpleasant, usually resolves within 6 to 24 hours. However, the real danger lies in the fact that cotton fever symptoms are nearly identical to life-threatening conditions like sepsis and endocarditis, making medical evaluation essential to rule out serious bloodstream infections.
Q: How long does cotton fever last?
Cotton fever typically lasts between 6 and 24 hours, with most symptoms resolving on their own within that window as the body clears the bacterial endotoxins from the bloodstream. In milder cases, symptoms may subside in as few as 2 to 4 hours. In more severe cases, cotton fever can persist for up to 48 hours, particularly if the individual is dehydrated, malnourished, or has a weakened immune system — all of which are common in people with active IV drug addictions. The most intense symptoms — including high fever, uncontrollable shivering (rigors), severe muscle and bone pain, and rapid heart rate — usually peak within the first few hours and gradually diminish. However, the critical concern is that if symptoms continue to worsen or do not improve after 24 hours, the illness may not be cotton fever at all. It could be a more serious and potentially fatal bloodstream infection such as sepsis or bacterial endocarditis, both of which require immediate hospital treatment with intravenous antibiotics. Because there is no way to distinguish cotton fever from these life-threatening conditions based on symptoms alone, medical professionals strongly recommend seeking emergency care for any fever that follows IV drug use rather than assuming it will pass on its own.
Q: What are the cotton fever symptoms?
Cotton fever symptoms appear rapidly — typically within 15 to 30 minutes after injecting drugs using a contaminated cotton filter — and can be intense and frightening. The hallmark symptoms include sudden onset of high fever (often exceeding 101°F/38.3°C), severe and uncontrollable chills with violent shivering (known as rigors), intense muscle and joint pain throughout the body, severe headache, nausea and sometimes vomiting, general malaise and feelings of being extremely unwell, bone pain, tachycardia (resting heart rate exceeding 100 beats per minute), shortness of breath, anxiety, kidney and lower back pain, and extreme fatigue and discomfort. These symptoms closely mimic the onset of heroin withdrawal, which can make it difficult for IV drug users to determine whether they are experiencing cotton fever or the beginning of withdrawal. They also closely resemble the symptoms of sepsis and infectious endocarditis — two life-threatening conditions that require immediate medical intervention. Because cotton fever is considered a “diagnosis of exclusion,” meaning it can only be confirmed after more serious infections have been ruled out through blood cultures and laboratory testing, anyone experiencing these symptoms after IV drug use should seek emergency medical care rather than attempting to self-diagnose.
Q: Can cotton fever kill you?
Cotton fever itself is generally not considered fatal — it is classified as a self-limiting inflammatory reaction that typically resolves within 6 to 24 hours without specific medical treatment. However, cotton fever can be indirectly deadly for several important reasons. The greatest risk is misdiagnosis. Because cotton fever symptoms — high fever, chills, rapid heart rate, shortness of breath — are virtually identical to those of sepsis (a life-threatening blood infection) and infectious endocarditis (an infection of the heart valves), it is impossible to tell the difference without medical testing including blood cultures and inflammatory markers. If someone assumes their symptoms are “just cotton fever” when they are actually experiencing sepsis or endocarditis, the delay in treatment can be fatal. Endocarditis is particularly common among IV drug users and can cause permanent heart damage, stroke, and death if not treated promptly with antibiotics. Additionally, the practice that most commonly causes cotton fever — reusing contaminated cotton filters (“shooting the cottons”) — also carries risks for bacterial bloodstream infections, abscesses, and transmission of blood-borne viruses like HIV and Hepatitis C. Repeated episodes of cotton fever may also indicate a pattern of unsafe injection practices that significantly increases the risk of a eventually fatal infection. The safest approach is to treat any post-injection fever as a medical emergency.
Q: What causes cotton fever?
Cotton fever is caused by bacterial endotoxins — toxic substances released by bacteria — that enter the bloodstream during IV drug injection. There are two primary mechanisms through which this occurs. The first and most well-documented cause involves the bacterium Pantoea agglomerans, which naturally colonizes cotton plants. When IV drug users use cotton balls, cigarette filters, or Q-tip ends as makeshift filters to strain drug solutions, trace amounts of this bacteria (and the endotoxins it produces) can contaminate the solution. When injected, these endotoxins trigger a powerful immune response — the body essentially goes into “attack mode,” producing the high fever, chills, and inflammation that characterize cotton fever. The risk is dramatically higher when users engage in a practice called “shooting the cottons” — reusing previously used, damp cotton filters to extract residual drug trapped in the material. These old, moist filters provide an ideal environment for bacterial growth, multiplying the endotoxin load many times over. The second cause is broader septic contamination from unsafe injection practices, including reusing or sharing needles, injecting in unsanitary environments, failing to properly clean injection sites, and using non-sterile water to dissolve drugs. Any of these practices can introduce various bacteria into the bloodstream, causing inflammatory reactions that are clinically similar to cotton fever.
Q: How is cotton fever treated?
Cotton fever treatment is primarily supportive, meaning it focuses on managing symptoms and keeping the person comfortable while the body clears the bacterial endotoxins naturally. Because cotton fever is a reaction to bacterial toxins rather than an active growing bacterial infection, antibiotics are generally not effective and are not the standard treatment. However, doctors may prescribe antibiotics if they cannot immediately rule out a more serious bacterial infection like sepsis or endocarditis — a precautionary measure until blood culture results come back. Key treatment measures include rest (allowing the body time to fight off the inflammatory response), aggressive hydration (drinking plenty of water, electrolyte drinks, or clear broth to combat dehydration from fever and sweating), over-the-counter fever and pain management using acetaminophen (Tylenol) or ibuprofen to reduce fever and alleviate muscle and joint pain, and comfort measures such as warm baths, warm compresses, wrapping in blankets, and sleep. In a hospital or emergency room setting, treatment may include IV fluids for severe dehydration, blood cultures to rule out sepsis or endocarditis, monitoring of vital signs (heart rate, blood pressure, temperature), and in some cases, empiric antibiotic therapy until serious infections are excluded. For people experiencing cotton fever in the context of active IV drug addiction, the most important long-term treatment is entering a professional addiction treatment program to stop IV drug use entirely — eliminating the root cause and preventing future episodes.
Q: How is cotton fever different from sepsis?
Cotton fever and sepsis share nearly identical initial symptoms — sudden high fever, severe chills, rapid heart rate, muscle pain, shortness of breath, and general malaise — which is why cotton fever is considered a “diagnosis of exclusion” that can only be confirmed after serious infections like sepsis have been ruled out through medical testing. The key differences between the two are their underlying cause, severity, and trajectory. Cotton fever is an inflammatory reaction to bacterial endotoxins (dead bacterial toxins) that enter the bloodstream through contaminated cotton filters during IV drug injection. It is typically self-limiting, meaning the immune response resolves on its own within 6 to 24 hours without specific medical intervention. Sepsis, on the other hand, is caused by live bacteria actively multiplying in the bloodstream, triggering a systemic inflammatory response that escalates rapidly. Without aggressive treatment — including IV antibiotics, fluid resuscitation, and intensive medical monitoring — sepsis can progress to septic shock, organ failure, and death within hours to days. The critical distinction is trajectory: cotton fever symptoms plateau and begin to improve within several hours, while sepsis symptoms worsen progressively. However, because both conditions look identical at onset, there is absolutely no safe way to distinguish between them without hospital-based blood cultures and laboratory testing. This is why every fever following IV drug use should be treated as a potential medical emergency until proven otherwise.
Q: What is “shooting the cottons” and why is it dangerous?
“Shooting the cottons” is a slang term that describes the practice of reusing previously used cotton filters to extract residual drug solution that remains trapped in the material. When IV drug users prepare drugs for injection, they draw the dissolved solution through a small piece of cotton to filter out particulates before injecting. A small amount of the drug always remains absorbed in the cotton. When a person runs out of drugs — particularly during withdrawal — they may collect these used cotton filters, re-soak them in water, and attempt to extract and inject whatever trace amounts of drug remain. This practice is extremely dangerous for several reasons. Used cotton filters that have been sitting in a moist, room-temperature environment become breeding grounds for bacteria — particularly Pantoea agglomerans and other gram-negative organisms. The bacterial load in a reused filter is exponentially higher than in a fresh piece of cotton, dramatically increasing the risk of cotton fever, bacteremia (bacteria in the bloodstream), sepsis, infectious endocarditis (infection of the heart valves), and localized abscesses. If filters are shared between individuals, the risk extends to transmission of blood-borne viruses including HIV, Hepatitis B, and Hepatitis C. Harm reduction organizations and medical experts universally advise against ever reusing cotton filters and recommend using sterile, single-use micron or wheel filters whenever possible.
Q: Can you get cotton fever more than once?
Yes, you can get cotton fever multiple times — and many IV drug users who continue unsafe injection practices experience repeated episodes. There is no immunity or protective effect from having had cotton fever previously. Each time contaminated cotton filters or unsanitary injection equipment are used, there is a risk of introducing bacterial endotoxins into the bloodstream and triggering another episode. In fact, repeated episodes of cotton fever are a significant warning sign that the individual is engaging in consistently high-risk injection behaviors — such as reusing old cotton filters (“shooting the cottons”), sharing needles, or preparing drugs in unsanitary conditions — that also put them at elevated risk for far more serious infections like sepsis, endocarditis, HIV, and Hepatitis C. Each episode also represents a potential missed diagnosis, since the symptoms of cotton fever and sepsis are clinically identical, and assuming that recurring fevers are “just cotton fever” without medical evaluation increases the risk of a truly dangerous infection going untreated. Recurring cotton fever episodes should be viewed not as a minor inconvenience but as a clear medical signal that IV drug use is creating ongoing, life-threatening health risks. The only reliable way to prevent cotton fever from recurring is to stop IV drug use entirely through professional addiction treatment.
Q: How can you prevent cotton fever?
The only guaranteed way to prevent cotton fever is to stop using IV drugs altogether — which eliminates the root cause entirely. For individuals who are not yet ready or able to enter treatment, harm reduction strategies can significantly reduce the risk, though they cannot eliminate it completely. Key harm reduction practices include never reusing cotton filters (the single most common cause of cotton fever is “shooting the cottons”), using sterile, medical-grade micron or wheel filters instead of makeshift materials like cotton balls, cigarette filters, or Q-tip ends, using a new sterile syringe for every injection and never sharing needles, preparing drugs in as clean an environment as possible, using sterile water rather than tap water or other non-sterile liquids to dissolve drugs, cleaning the injection site with an alcohol swab before injecting, and disposing of used filters and syringes immediately after use. Many communities offer needle exchange programs and harm reduction centers that provide free sterile syringes, filters, cookers, alcohol swabs, and other supplies specifically designed to reduce infection risk among IV drug users. However, even with perfect harm reduction practices, IV drug use always carries inherent risks that no preventive measure can fully eliminate. The safest and most effective path is professional addiction treatment. At ARIA in West Palm Beach, Florida, individualized treatment programs — including medically supervised detox, inpatient treatment, and medication-assisted therapy — are designed to help each client safely stop using IV drugs and build a foundation for lasting recovery.