Cocaethylene Levels in Patients Who Test Positive for Cocaine☆,☆☆,★
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INTRODUCTION
Most cocaine users report that they use cocaine concurrently with ethanol.1 The simultaneous use of these two drugs has spawned an epidemic of dual addiction.2 The production of cocaethylene, an active metabolite of the combination of cocaine and ethanol, may sustain this pattern of drug use.2 Cocaethylene is a potent stimulant3, 4 that enhances and extends the effects of cocaine.3
The results of animal studies show that cocaethylene is more toxic than cocaine2, 5, and the findings of studies in
MATERIALS AND METHODS
We carried out this study at the Hospital of the University of Pennsylvania between July 1991 and April 1992. The treatment protocol for patients seen in the ED with major trauma (defined as Injury Severity Score greater than 16) included sampling of blood and urine for toxicology testing. The complete toxicology screen included analysis of serum for volatile alcohols by means of head-space gas chromatography and testing of urine by the use of enzyme-multiplied immunoassay techniques (EMIT
RESULTS
During the study period, 450 patients presented with major trauma; 416 underwent urine toxicology testing. Of the patients tested, 158 (38%) were positive for benzoylecgonine. One hundred fourteen of these patients (72%) had plasma samples adequate for quantitative analysis of cocaine, ethanol, and cocaethylene. The remaining patients had inadequate plasma samples and were excluded from analysis. The Table shows the characteristics of these groups.
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Of the 114
DISCUSSION
We found that more than half of the patients who tested positive for cocaine also tested positive for cocaethylene. Spot levels of cocaine and ethanol were not good predictors of the presence or level of cocaethyelene. Nearly a third of the subjects who tested positive for cocaethylene tested negative for ethanol. It has already been shown that cocaine and cocaethylene do not interfere with the measurement of ethanol in serum.6 We also found that urine screening for benzoylecgonine was a
Acknowledgements
The authors are grateful to Arthur L Kellermann, MD, MPH, and Stephen T Miller, MD, for reviewing the manuscript; and to Bela B Hackman, MD, for help with statistical analysis.
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2021, NeuropharmacologyCitation Excerpt :The overwhelming majority of individuals with substance use disorder report using more than one drug of abuse either simultaneously or at different times. Among individuals with cocaine use disorder (CUD), alcohol represents the most commonly used alternative drug, with estimates of coabuse ranging from 50 to 90% (Anthony et al., 1994; Brookoff et al., 1996; Grant; Harford, 1990; Kedia et al., 2007; Liu et al., 2018; Rounsaville et al., 1991). Indeed, cocaine + alcohol represents the most prevalent 2-drug combination among patients seeking treatment for substance use disorder (12% of treatment seekers), with cocaine + cannabis a distant second (3.4% of treatment seekers; Kedia et al., 2007).
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2012, Critical Care ClinicsCitation Excerpt :These water-soluble metabolites are excreted in the urine. The frequent concomitant use of cocaine and ethanol results in the hepatic formation of the active metabolite, cocaethylene, which has euphoric and sympathomimetic effects similar to cocaine but may also have greater toxicity.6,7 The longer half-life of cocaethylene (2.5 hours) may prolong the euphoric effects of cocaine.
Alcohol-preferring (P) rats are more sensitive than Wistar rats to the reinforcing effects of cocaine self-administered directly into the nucleus accumbens shell
2011, Pharmacology Biochemistry and BehaviorCitation Excerpt :Cocaine and alcohol are frequently co-abused. The majority of cocaine users (up to 90%) report co-administering EtOH during cocaine binges (Brookoff et al., 1996; Magura and Rosenblum, 2000). The high prevalence of co-abuse of alcohol with cocaine in humans has been postulated to be predicated upon both a common genetic factor that predispose an organism to abuse multiple substances, including alcohol, and the interaction of the drugs within the organism (Uhl, 2004, 2006; Uhl et al., 2008).
Elevated cortisol and learning and memory deficits in cocaine dependent individuals: Relationship to relapse outcomes
2009, PsychoneuroendocrinologyCitation Excerpt :CD participants were excluded if they met current or lifetime dependence criteria for any other illicit drug. However, patients with concurrent alcohol and nicotine use disorders were not excluded, due to high rates of alcohol and nicotine abuse comorbidity with cocaine dependence (Brookoff et al., 1996). Participants using any medication and those with current medical problems were also ineligible.
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From the Departments of Medicine*, Surgery‡, Clinical Pathology and Laboratory Medicine§, and Nursing∥, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
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Address for reprints: Daniel Brookoff, MD, PhD, Department of Medical Education, Methodist Hospital, 1265 Union Avenue, Memphis, Tennessee 38104, 901-726-8255, Fax 901-726-8254
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Reprint no. 47/1/70881