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

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 DISM-IV criteria for cocaine dependence and alcohol abuse participated in three drug administration sessions: forts doses of intranasal cocaine (1 mg/kg every 30 min) with oral alcohol (1 g/kg) administered following the initial cocaine close 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; forts 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 cocentrations 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, Biol Psychiatry 1998;44:250-259 (C) 1998 Society of Biological Psychiatry.