Giroud C, Colassis T, Rivier L, Ottinger E
Laboratoire de toxicologie analytique, Université de Lausanne.
Schweiz Rundsch Med Prax. 1993 Apr 13;82(15):441-6.
Cocaine is a powerful reinforcer that has become a popular drug of abuse. Cocaine inhibits the reuptake of dopamine into presynaptic terminals, resulting in an overstimulation of the dopaminergic system. When cocaine and alcohol are taken together, cocaine is partially converted by a liver carboxylesterase to its ethyl homolog called ethylcocaine. In 1991, several studies demonstrated that ethylcocaine is a pharmacologically active metabolite of cocaine. Ethylcocaine was shown to be even more potent than cocaine in mediating lethality. In the USA, prevalent studies have indicated that concurrent and simultaneous abuse of cocaine with alcohol were a very common practice. In Switzerland, as far as we know, epidemiologic studies have not been carried out yet. In our laboratory, radioimmunoassays mainly sensitive to benzoylecgonine (an inert metabolite of cocaine and ethylcocaine) are used to detect cocaine abusers. Positive results are always confirmed by combined gas chromatography (GC) and mass spectrometry (MS). Recently, cocaine, ethylcocaine, methyl ecgonine and ethyl ecgonine were detected by GC/MS in urine from three people arrested after erratic driving. Their blood alcohol concentration was 2.89, 0.98 and 1.26 g/kg. In Switzerland, the influence of alcohol, cocaine and ethylcocaine on the incidence of accidents, overdose and death is not known and requires further studies. Because morbidity and mortality are exacerbated by concurrent use of alcohol and cocaine, physicians should discourage their hooked patients from consuming this deadly mixture.
可卡因是一种强效强化剂，已成为一种流行的滥用药物。可卡因抑制多巴胺再摄取到突触前终末，导致多巴胺能系统过度刺激。当可卡因与酒精同时使用时，可卡因会被肝脏羧酸酯酶部分转化为其乙基同系物，即乙基可卡因。1991年，多项研究表明乙基可卡因是可卡因的一种具有药理活性的代谢产物。研究表明，乙基可卡因在介导致死性方面甚至比可卡因更有效。在美国，普遍的研究表明，同时滥用可卡因和酒精是一种非常常见的行为。据我们所知，在瑞士尚未开展流行病学研究。在我们实验室，主要对苯甲酰爱康宁（可卡因和乙基可卡因的一种惰性代谢产物）敏感的放射免疫分析法用于检测可卡因滥用者。阳性结果总是通过气相色谱（GC）和质谱（MS）联用加以确认。最近，通过GC/MS在三名因驾驶不稳而被捕者的尿液中检测到了可卡因、乙基可卡因、甲基爱康宁和乙基爱康宁。他们的血液酒精浓度分别为2.89、0.98和1.26 g/kg。在瑞士，酒精、可卡因和乙基可卡因对事故、过量用药及死亡发生率的影响尚不清楚，需要进一步研究。由于同时使用酒精和可卡因会加剧发病率和死亡率，医生应劝阻其成瘾患者不要使用这种致命混合物。
