Cocaethylene: When Cocaine and Alcohol Are Taken Together

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 cocaineinduced 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.

Iron Supplementation in the Treatment of Cocaine Use Disorder

“…Additionally, this phenomenon alleviated the impact of cocaine cessation, including the worsening of his RLS. Another reason that individuals use the two substances together is to alleviate the anxiety, depression, and pain that occur after the high [6]. This polysubstance use is not well-studied but warrants future research due to its high appeal and many risks.…”

Classical stimulants in Dallas County: A retrospective review of toxicological, seized drug, and demographical data from 2017 to 2022

“…This study is unable to determine whether the combined use of cocaine and opioids is from adulterated cocaine or from intentional co-use. It is not surprising that ethanol was most concurrently identified drug with cocaine as it is well known that ethanol is frequently used with cocaine to enhance the effects of cocaine or prolong the cocaine high, with the formation of the psychoactive metabolite cocaethylene [32].…”

The Key Role of a Psychoactive Substance Use History in Comprehensive Cardiovascular Risk Assessment, Diagnosis, Treatment, and Prevention

“…Alcohol can indeed facilitate drug taking (by fueling, e.g., a state of euphoria that prompts the person to take substances) with the risk of also enhancing and prolonging the action of sympathomimetic drugs. Alcohol allows a faster and more complete absorption of the snorted substances through vasodilation of the nasal mucosa [13] and promotes the transformation of cocaine into its most potent and long-acting metabolite: coca-ethylene [14]. The stimulating effect of caffeine and other substances in energy drinks encourages people to stay awake longer and drink more as well.Information on the psychoactive substances (drugs) used and mode of assumption: For individuals who respond positively to the initial question if they have ever tried psychoactive substances, especially if they are habitual users or have cardiovascular disease or symptoms, the anamnesis should continue with the questions summarized in Table 2, whose importance is testified by the following practical examples. What substances are (or were) you taking?…”

“…Alcohol can indeed facilitate drug taking (by fueling, e.g., a state of euphoria that prompts the person to take substances) with the risk of also enhancing and prolonging the action of sympathomimetic drugs. Alcohol allows a faster and more complete absorption of the snorted substances through vasodilation of the nasal mucosa [13] and promotes the transformation of cocaine into its most potent and long-acting metabolite: coca-ethylene [14]. The stimulating effect of caffeine and other substances in energy drinks encourages people to stay awake longer and drink more as well.…”