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 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 halflife 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.
McCance-Katz
E F
EF
Yale Psychiatric Institute, New Haven, Connecticut, USA.
Kosten
T R
TR
Jatlow
P
P
D000328:Adult; D000339:Affect / Q000187:drug effects; D019973:Alcohol-Related Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D000704:Analysis of Variance; D019540:Area Under Curve; D016739:Behavior, Addictive / Q000523:psychology; D001794:Blood Pressure / Q000187:drug effects; D019970:Cocaine-Related Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D012201:Reward; D013997:Time Factors