Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Pharmacology, Karolinska University Laboratory, Stockholm, Sweden.
Alcohol Alcohol. 2023 May 9;58(3):274-279. doi: 10.1093/alcalc/agad009.
This retrospective study examined the prevalence of combined ethanol and cocaine use, which produces an enhanced psychoactive effect through formation of the active metabolite cocaethylene, compared to combined use of ethanol and two other common recreational drugs, cannabis and amphetamine, based on urine drug test results.
The study was based on >30,000 consecutive samples from routine urine drug testing in 2020, and 2627 samples from acute poisonings in the STRIDA project (2010-2016), in Sweden. Drug testing for ethanol (i.e. ethyl glucuronide and ethyl sulfate), cocaine (benzoylecgonine), cannabis (Δ9-THC-COOH) and amphetamine was done by routine immunoassay screening and LC-MS/MS confirmatory methods. Seven samples testing positive for cocaine and ethyl glucuronide were also analyzed for cocaethylene by LC-HRMS/MS.
Among routine samples for which testing of ethanol and cocaine had been requested, 43% tested positive for both substances, compared with 24% for ethanol and cannabis and 19% for ethanol and amphetamine (P < 0.0001). Among the drug-related intoxications, 60% of cocaine-positive samples were also positive for ethanol, compared to 40% for cannabis and ethanol and 37% for amphetamine and ethanol. Cocaethylene was detected (range 1.3-150 μg/L) in all randomly selected samples testing positive for ethanol and cocaine use.
These results, which were based on objective laboratory measures, indicated that combined ethanol and cocaine exposure was more prevalent than expected from drug use statistics. This may relate both to the common use of these substances in party and nightlife settings, and the amplified and prolonged pharmacological effect by the active metabolite cocaethylene.
本回顾性研究通过尿液药物检测结果，检查了乙醇和可卡因联合使用的流行率，这种联合使用会通过形成活性代谢物古柯乙酯产生增强的精神活性效应，而与乙醇和两种常见的娱乐性药物大麻和苯丙胺联合使用相比。
该研究基于 2020 年超过 30000 例连续常规尿液药物检测样本，以及 STRIDA 项目（2010-2016 年）中 2627 例急性中毒样本。乙醇（即乙基葡萄糖醛酸苷和乙基硫酸盐）、可卡因（苯甲酰爱康宁）、大麻（Δ9-四氢大麻酸-COOH）和苯丙胺的药物检测采用常规免疫分析筛选和 LC-MS/MS 确认方法。对 7 例可卡因和乙基葡萄糖醛酸苷检测阳性的样本，还采用 LC-HRMS/MS 分析古柯乙酯。
在要求检测乙醇和可卡因的常规样本中，有 43%同时检测出这两种物质，而乙醇和大麻的阳性率为 24%，乙醇和苯丙胺的阳性率为 19%（P<0.0001）。在与药物相关的中毒中，60%可卡因阳性样本也同时检测出乙醇，而与大麻和乙醇的阳性率为 40%，与苯丙胺和乙醇的阳性率为 37%。在所有随机选择的乙醇和可卡因检测阳性样本中都检测到了古柯乙酯（范围 1.3-150μg/L）。
这些基于客观实验室测量的结果表明，乙醇和可卡因联合暴露的流行率高于药物使用统计数据所预期的水平。这可能与这些物质在派对和夜生活场所的常见使用有关，以及活性代谢物古柯乙酯增强和延长的药理学效应。
