Key Points

  • Stroke rates among adults ages 20 to 54 nearly doubled over 27 years in a large U.S. population study, rising from about 34 to 62 cases per 100,000 people per year between 1993 and 2020.
  • Substance use was documented in roughly 40% of younger stroke patients by 2020, up from about 5% in 1993, with much of the increase tied to cannabis. The study could not determine whether substance use caused the increase.
  • A new case report links tirzepatide (ZepBound) to elevated lithium levels in a person with bipolar disorder who was eating less after starting the drug, triggering the kidneys to retain more lithium. It is the fourth reported case of this interaction.
  • People taking lithium alongside any GLP-1 drug should discuss monitoring with their prescriber before starting the medication and should know the warning signs of lithium toxicity: hand tremor, slurred speech, and blurred vision.
  • A study of more than 2 million California deliveries found that people diagnosed with cannabis use disorder during pregnancy were about 40% more likely to have a psychiatric emergency department visit in the year after delivery compared with those without either substance use disorder.
  • Cannabis use disorder diagnoses among pregnant women in California rose by about 40% between 2016 and 2021. Researchers say the findings point to a need for consistent screening and treatment during and after pregnancy.

Addiction News Weekly Episode 1.24

In This Episode:

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction recovery and public health. This week, a long-running study finds strokes are rising among younger adults and substance use now shows up in far more of their medical records, a new case report links a popular weight loss drug to dangerous lithium levels, and a study of more than two million births ties cannabis use disorder in pregnancy to more psychiatric emergencies after delivery. Let’s get into it.

Rising Strokes in Young Adults: What 27 Years of Data Showed

We start with a study in the journal Neurology.1 Researchers at the University of Cincinnati tracked first strokes among adults ages 20 to 54 in Greater Cincinnati and Northern Kentucky from 1993 to 2020. That’s more than 2,000 strokes in all.

Over that time, the stroke rate in this age group nearly doubled, from about 34 to about 62 cases per 100,000 people a year. Most of the rise came from ischemic stroke, the kind caused by a blocked blood vessel. Documented substance use changed more than almost anything else the team tracked.

It appeared in about 5% of younger stroke patients in the early 1990s and about 40% in 2020, with much of the increase tied to cannabis. High blood pressure, diabetes, and an irregular heartbeat called atrial fibrillation also became more common. The study had no comparison group of people who didn’t have strokes, so it can’t show that substance use or anything else caused the increase.

The data also ends in 2020. Lead author Dr. Emily Fisher noted that more younger adults are surviving strokes, which means more people living with the effects for decades. Now remember, a stroke can happen at any age. Sudden face drooping, arm weakness, or trouble speaking is a reason to call 911 right away.

Our second story is about a medication interaction. Researchers at the University of Colorado Anschutz Medical Campus published a case report in the Journal of Clinical Psychopharmacology.2

The case followed a 50-year-old woman with bipolar disorder who had been stable on lithium, a mood stabilizer. She started tirzepatide, sold as ZepBound, for weight management. Three weeks later, she had a tremor in both hands, slurred speech, and blurred vision.

Her blood lithium level had climbed from 0.7 to 1.2 millimoles per liter. She hadn’t changed her lithium dose or started any other drugs, but she was eating smaller meals and feeling full sooner. Her doctors cut her lithium dose in half and her symptoms went away.

According to MedPage Today, it’s the fourth reported case of lithium toxicity linked to ZepBound.3 The leading explanation is that when people eat and drink less, the kidneys hold on to more lithium. Here is Rehab.com Chief Medical Officer Dr. Sylvie Stacy with her take on this.

Lithium is a medication that is really unforgiving. And this report is a good reminder about that, as well as giving us new insight in the context of GLP-1 drugs. So as many listeners probably know, lithium has a very narrow therapeutic window. We aim for a really tight maintenance range of blood levels. And once a patient’s level creeps past that upper threshold, they enter toxic territory. And the reason for this is that the kidneys clear lithium almost entirely unchanged as a molecule. And the kidneys process it nearly identically to sodium. So if a patient drops their fluid or salt intake, the kidneys preserve volume by reabsorbing sodium, and they pull lithium right back along with it.

We know that patients managing bipolar disorder have higher baseline rates of obesity and metabolic syndrome, and that’s often worsened by second-generation antipsychotics. And at the same time, GLP-1s and similar drugs are being studied for and starting to be used for reducing cravings in the setting of an addiction. And of course, mood disorders and substance use disorders often occur together. So when someone starts tirzepatide or semaglutide, they typically get full faster, and they usually start eating and drinking significantly less. And that sudden drop in hydration and sodium intake can then drop renal lithium clearance very quickly, thereby spiking blood levels of lithium. And from there, you have the potential for toxicity.

That doesn’t mean that patients on lithium should never take GLP-1 drugs. It just means that we have to monitor closely and be cognizant of the risks. We need a baseline metabolic panel. We need to provide counseling about hydration, and we need to check lithium levels as clinically indicated. Patients also need to be educated on warning signs of toxicity, like feeling a new tremor in their hands, slurred speech, clumsy movement, or nausea. Whether someone is on a GLP-1 for diabetes, for weight loss, or for an addiction, or for some combination of those, if they’re also on lithium, the fluid shifts that result from that GLP-1 can change the lithium levels, and it can do so quickly. So early monitoring is really important here.

Cannabis Use Disorder in Pregnancy and Postpartum Mental Health

Our last story looks at pregnancy and mental health. Researchers at UC Merced, Michigan State University, and UCLA studied more than 2 million deliveries in California hospitals from 2016 through 2021. Their findings were published in the Annals of Epidemiology.4

About 1 in 10 women diagnosed with cannabis use disorder during pregnancy went to an emergency department for a psychiatric problem in the year after giving birth. Among women with neither cannabis nor alcohol use disorder, it was 2.7%. After accounting for other factors, cannabis use disorder was tied to about a 40% higher risk. Alcohol use disorder, included for comparison, was tied to an about 80% higher risk.

Over the six years, cannabis use disorder diagnoses among pregnant women in California rose by about 40%. Lead researcher Sidra Goldman-Mellor said the study doesn’t prove that cannabis use disorder causes psychiatric emergencies. She also said that legal doesn’t mean safe.

Her team says the findings point to a need for consistent screening and treatment during and after pregnancy. If you’re pregnant or have recently given birth and you’re struggling, you can call or text the National Maternal Mental Health Hotline at 1-833-852-6262 at any time. For specialized treatment options during and after pregnancy, Rehab for Pregnant and Postpartum Mothers covers what to look for in a program.

Conclusion

All three stories this week come back to one point. The people treating you need the full picture. If you or someone you love is looking for treatment, ask whether a program reviews medical history and medications at intake and treats mental health conditions alongside substance use. Rehab.com lists thousands of verified centers across the country, and free, confidential support is available anytime through the SAMHSA National Helpline at 1-800-662-4357.

If you or someone you love is in crisis or thinking about suicide, call or text 988 at any time.

Those are the top stories in the news. For more, visit Rehab.com. We will be back next week. I’m Kay, and thank you for listening.

You Might Also Like

  1. Marijuana Abuse and Addiction
  2. Rehab for Pregnant and Postpartum Mothers
  3. Dual Diagnosis: Bipolar Disorder and Addiction Treatment
  4. GLP-1 Receptor Agonists for Addiction Treatment

Sources in This Episode

  1. Fisher ER, Ding L, Stanton RJ, et al. Stroke in the Young: Incidence, 30-Day Case
    Fatality Rates, and Risk Factors Over Time in a Population-Based Study. Neurology.
    Published online September 23, 2026. doi:10.1212/WNL.0000000000218622.
    https://www.neurology.org/doi/10.1212/WNL.0000000000218622. Accessed November 10, 2026.
  2. American Academy of Neurology. More Young Adults Are Having Strokes Than Three Decades
    Ago. Press Release. Published September 23, 2026.
    https://www.aan.com/PressRoom/Home/PressRelease/5367. Accessed November 10, 2026.
  3. Davis J, Singhal S, Butterfield A. Tirzepatide-Associated Lithium Toxicity: A Case
    Report. J Clin Psychopharmacol. Published online October 19, 2026.
    doi:10.1097/JCP.0000000000002271.
    https://www.ovid.com/jnls/psychopharmacology/fulltext/10.1097/jcp.0000000000002271~tirzepatide-associated-lithium-toxicity-a-case-report.
    Accessed November 10, 2026.
  4. De Alba L, Margerison CE, Gemmill A, Goldman-Mellor S. Prenatal cannabis use disorder
    and postpartum psychiatric emergency department visits: A retrospective cohort study of
    trends and associations in California, 2016-2021. Ann Epidemiol. 2026:110271.
    PMID: 42674086. https://www.ncbi.nlm.nih.gov/pubmed/42674086. Accessed November 10, 2026.
Dr. Sylvie Stacy Written By: Dr. Sylvie Stacy MD, MPH Chief Medical Officer
Sylvie Stacy, MD, MPH, Medical Officer at Rehab.com, is a board-certified addiction medicine specialist with over a decade of experience treating individuals with addictions in diverse clinical settings including residential treatment programs, detox centers, outpatient clinics, and correctional facilities.