Concurrent use of cocaine and alcohol is more potent and potentially more toxic than use of either alone—A multiple-dose study

• Published in: Biological psychiatry (1969) Vol. 44; no. 4; pp. 250 - 259
• Main Authors: McCance-Katz, Elinore F, Kosten, Thomas R, Jatlow, Peter
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-08-1998; Elsevier Science
• Subjects: Adult; Affect - drug effects; alcohol; Alcohol-Related Disorders - complications; Alcohol-Related Disorders - physiopathology; Alcohol-Related Disorders - psychology; Analysis of Variance; Area Under Curve; behavior; Behavior, Addictive - psychology; Biological and medical sciences; Blood Pressure - drug effects; cocaethylene; Cocaine; Cocaine-Related Disorders - complications; Cocaine-Related Disorders - physiopathology; Cocaine-Related Disorders - psychology; Dose-Response Relationship, Drug; Double-Blind Method; Drug addictions; drug interactions; Drug Synergism; Female; Heart Rate - drug effects; Humans; Male; Medical sciences; Reward; Time Factors; toxicity; Toxicology; alcohol; toxicity; Cocaine; drug interactions; cocaethylene; behavior; Human; Alcoholic beverage; Drug addiction; Poison interaction; Abuse; Toxicity; Alcoholism; Dependence; Psychological effect; Toxic association
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/S0006-3223(97)00426-5

Background: Simultaneous abuse of cocaine and alcohol is widespread and increasingly detected in patients seeking emergent care. This double-blind, randomized, within-subjects study used a paradigm more closely approximating practices of drug abusers to better understand the pathogenesis of cocaine–alcohol abuse.
Methods: Subjects meeting DSM-IV criteria for cocaine dependence and alcohol abuse participated in three drug administration sessions: four doses of intranasal cocaine (1 mg/kg every 30 min) with oral alcohol (1 g/kg) administered following the initial cocaine dose and a second dose (120 mg/kg) at 60 min calculated to maintain plasma alcohol concentration at approximately 100 mg/dL during cocaine administration; four doses of cocaine/placebo alcohol; four doses of cocaine placebo/alcohol. Pharmacokinetic, physiological, and behavioral effects were followed over 8 hours.
Results: Cocaine–alcohol produced greater euphoria and increased perception of well-being relative to cocaine. Heart rate significantly increased following cocaine–alcohol administration relative to either drug alone. Cocaine concentrations were greater following cocaine–alcohol administration. Cocaethylene had a longer half-life with increasing concentrations relative to cocaine at later time points.
Conclusions: Enhanced psychological effects during cocaine–alcohol abuse may encourage ingestion of larger amounts of these substances over time placing users at heightened risk for greater toxicity than with either drug alone.