Cocaethylene: A Compound Formed by Cocaine and Alcohol

Cocaine and alcohol are increasingly being used together. Some people use substances such as these when interacting socially to lower inhibition, reduce social anxiety, or extend their nights out. While many feel that engaging in occasional substance use is safe, combining different substances, especially cocaine and alcohol or the other most dangerous drug combinations, can have deadly consequences.

When these two substances are consumed together, the body produces a psychoactive compound known as cocaethylene.  This substance poses significant health risks, including seizures, liver damage, and heart attacks. Each substance carries its own risks and potential for addiction, but their combined effects greatly increase their psychoactive and euphoric effects. Polysubstance use is not only dangerous, but it also increases the chances of developing substance use disorder and experiencing long-term health complications. Addiction is a chronic relapsing disorder that often requires comprehensive treatment programs to overcome.

What Is Cocaethylene?

Cocaethylene is a unique metabolite that is produced in the body when alcohol and cocaine are used together. It’s common for cocaine users to also drink alcohol alongside it as a way to continue with more alcohol and lessen the comedown of cocaine. Cocaethylene not only lasts longer, but it is also more toxic than cocaine on its own. While this metabolite produces roughly the same euphoric effects as cocaine, they are significantly more intense and longer lasting.

Combining cocaine and alcohol is a frequent choice for many users, as many feel it helps them stay up when drinking alcohol and enhances their mood. However, the dangers of mixing these substances are often overlooked, leading to serious health risks, including:

• Increased toxicity.
• Higher levels of alcohol and cocaine consumption.
• Greater impulsiveness.
• Elevated risk of cardiovascular issues.
• Potential for sudden death.

 

How Is Cocaethylene Formed?

Cocaethylene is formed in the liver when the methyl group of cocaine interacts with an ethyl group through a process called transesterification, as detailed in the Encyclopedia of Forensic and Legal Medicine. Essentially, the natural metabolic processing of cocaine in the liver is altered by the presence of alcohol, producing the byproduct cocaethylene. The liver, which plays a primary role in detoxifying the body, can only handle a limited amount of toxic substances at a time. Normally, a healthy liver can clear out one alcoholic beverage per hour. This limitation explains why excessive alcohol consumption can lead to heightened levels of intoxication, as the alcohol remains in the bloodstream longer.

Approximately two hours after ingesting cocaine and alcohol together, the liver stops processing cocaine and shifts to creating cocaethylene. Metabolization of both substances is significantly slowed down, and the effects of cocaine are felt for much longer. As the liver is not able to process all the cocaethylene, it bypasses the liver and goes directly into the bloodstream, reaching the brain. Once in the brain, it accesses the same receptor sites as cocaine, triggering roughly the same euphoric effect. When combined with the effects of alcohol, cocaethylene results in much more intense effects than alcohol or cocaine alone.

According to the Journal of Addictive Diseases, cocaethylene toxicity exhibits similar pharmacological properties to that of cocaine but has a plasma half-life of three to five times that of cocaine. This extended half-life means that the effects of cocaine linger longer when it is consumed along with alcohol.

Using cocaine and alcohol together can cause the substances to mask the effects of the other, which can lead people to misjudge their level of intoxication. This misjudgment may result in increased consumption of one or both substances, increasing the risk of overdose. The combination of cocaine, a stimulant, and alcohol, a depressant, sends mixed signals to the cardiovascular system, significantly increasing the likelihood of heart attack or stroke compared to using cocaine alone. Another risk to consider is the fact that cocaine is often cut with other substances, including fentanyl, and there is a risk of drug interaction with those substances and alcohol as well.

 

What Are the Cardiovascular Effects of Cocaethylene?

Cocaethylene has a significant impact on heart function in two primary ways. First, cocaethylene slows down the breakdown of cocaine; the effects are felt much longer, including increasing heart rate by over 200% more than cocaine would on its own. Second, cocaethylene interferes with the heart’s ability to contract normally while pumping by blocking the flow of sodium and potassium ions in the heart muscles. This combination of increased heart rate, blood pressure, and myocardial contractility raises the risk of experiencing a heart attack. Cocaethylene can also lead to cerebral infarction, a form of stroke that causes bleeding inside the brain.

Chronic use of alcohol and cocaine abuse can also result in various cardiovascular issues, whether taken together or alone. Excessive alcohol use can contribute to hypertension and obesity, both of which are risk factors for cardiovascular disease, such as heart failure or heart attacks. Similarly, long-term cocaine use puts a strain on the heart and can promote hypertension, arterial hardening, and thickening of the heart wall. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What Is the Production of Cocaethylene?

When a person ingests alcohol while using cocaine, the liver stops the breakdown of cocaine and instead produces the metabolite cocaethylene. This substance produces stronger euphoric effects than cocaine alone. Once the chemical production begins, the liver continues to pump out the chemical for several hours, and it remains in the body three times longer than cocaine alone. Users may experience cocaethylene toxicity within minutes or hours and include symptoms such as irregular heartbeat, extreme drowsiness, slow or shallow breathing, and unconsciousness. Cocaethylene toxicity is often thought to be linked to many cocaine-related heart attacks. There is also an increased chance of overdose. If someone has mixed cocaine with alcohol and is showing signs of a heart attack or overdose, it is critical to seek out immediate medical help.

 

WhiteSands: A Place to Heal from Cocaine and Alcohol Addiction

Some people can occasionally use cocaine and alcohol without falling into addiction, but for many, the story is different. What may begin as a way to escape on the weekends can quickly turn into a compulsive need that disrupts every aspect of your life. Fortunately, with the right treatment, reclaiming your life is possible. If you’ve recognized the risks of combining cocaine and alcohol and feel unable to quit on your own, WhiteSands Treatment is here to help. We offer comprehensive, personalized drug and alcohol addiction treatment with multiple levels of care to meet each person’s unique needs.

Our medical detox program features 24/7 supervision, medication management, therapeutic support, and holistic approaches to help you comfortably and safely overcome drug and alcohol abuse. Patients have the flexibility to select the best path to their recovery, whether through inpatient treatment or outpatient care. The road to recovery is long, but we will be there with you every step of the way, even after your program has concluded through our aftercare services.

WhiteSands is a network of Joint Commission-accredited drug and alcohol treatment facilities with locations throughout Florida. Our modern treatment centers provide a secure and tranquil environment for healing from the effects of addiction and achieving long-term recovery. Programs go beyond traditional evidence-based practices to include complementary and alternative therapies to address the impact of addiction on the body, mind, and spirit.

If you are struggling to stop cocaine and alcohol use, please do not hesitate to reach out to WhiteSands Treatment today at 877-855-3470. Our intake specialists are ready to help you start on the road to recovery.

 

External Sources

• Cureus Journal of Medical Science — Cocaethylene: When Cocaine and Alcohol Are Taken Together 
• Journal of Addictive Diseases — Cocaethylene Toxicity   
• Encyclopedia of Forensic and Legal Medicine — Substance Misuse: Cocaine and Other Stimulants

 

If you or a loved one needs help with abuse and/or treatment, please call the WhiteSands Treatment at (877) 855-3470. Our addiction specialists can assess your recovery needs and help you get the addiction treatment that provides the best chance for your long-term recovery.