Cocaethylene: When Cocaine and Alcohol Are Taken Together.

Peter Magnusson,Joseph Pergolizzi,Jo Ann K Lequang,Frank Breve,Giustino Varrassi

doi:10.7759/cureus.22498

Abstract

Cocaine is taken frequently together with ethanol and this combination produces a psychoactive metabolite called cocaethylene which has similar properties to the parent drug and may be more cardiotoxic. Cocaethylene has a longer half-life than cocaine, so that people who combine cocaine and ethanol may experience a longer-lasting, as well as more intense, psychoactive effect. Cocaethylene is the only known instance where a new psychoactive substance is formed entirely within the body. Although known to science for decades, cocaethylene has not been extensively studied and even its metabolic pathways are not entirely elucidated. Like its parent drug, cocaethylene blocks the reuptake of dopamine and increases post-synaptic neuronal activity; the parent drug may also block reuptake of serotonin as well. Cocaethylene has been studied in animal models in terms of its pharmacology and its potential neurological effects. Since the combination of cocaine and alcohol is commonly used, it is important for clinicians to be aware of cocaethylene, its role in prolonging or intensifying cocaine intoxication, and how it may exacerbate cocaine-induced cardiovascular disorders. Most cardiac-related risk assessment tools do not ask about cocaine use, which can prevent clinicians from making optimal therapeutic choices. Greater awareness of cocaethylene is needed for clinicians, and those who use cocaine should also be aware of the potential for polysubstance use of cocaine and ethanol to produce a potentially potent and long-lasting psychoactive metabolite.

Highlights

BackgroundCocaine is a sympathomimetic that affects a variety of receptors in the body, releasing specific catecholamine and blocking their reuptake at certain sites
Greater awareness of cocaethylene is needed for clinicians, and those who use cocaine should be aware of the potential for polysubstance use of cocaine and ethanol to produce a potentially potent and long-lasting psychoactive metabolite
While cocaethylene is often encountered in clinical work, it has not been the subject of extensive investigation and there may be a lack of clinical understanding of this metabolite and its role in overdose toxicity, cocaineinduced heart disease, and drugged driving [3]

Summary

Introduction

Cocaine is a sympathomimetic that affects a variety of receptors in the body, releasing specific catecholamine and blocking their reuptake at certain sites. A prospective study of 417 trauma patients ≥13 years found that 8.9% had cocaethylene metabolites in their system, indicating the concurrent use of cocaine plus ethanol. In terms of this central stimulatory effect, cocaine and cocaethylene appear to be equipotent [13], but cocaethylene’s longer half-life makes its effects more persistent [25] This ability to prolong the cocaine high may help explain why many cocaine users drink alcohol while using cocaine, even if they are unaware of extending cocaine’s psychoactive effects by consuming ethanol [26]. While many cocaine users take ethanol together with cocaine, few understand that it produces a new potent metabolite in the body that has a longer half-life and potentially more dangerous cardiotoxic effects. Such information, when available from the patient or others, may be helpful for the emergency team [47]

Conclusions

Disclosures

Andrews P

30. Landry MJ

Findings

37. Gage FH