Concurrent Use of Cocaine and Alcohol by Patients Treated in the Emergency Department☆,☆☆,★,★★
Section snippets
INTRODUCTION
Alcohol and cocaine are two of the most commonly used drugs in the United States.1 The 1993 National Household Survey on Drug Abuse revealed that 23.5 million people had used cocaine and 173 million had used alcohol.2 Other studies have shown that the frequency of combined alcoholism and cocaine addiction, or the heavy concurrent use of alcohol and cocaine, is substantially greater than would be expected by chance alone.1, 3
Cocaine and alcohol have opposite pharmacologic effects. Cocaine is a
MATERIALS AND METHODS
This retrospective study was conducted at St Elizabeth Health Center in Youngstown, Ohio, a 660-bed, university-affiliated hospital located in a lower-income area of a medium-sized city (metropolitan population of 250,000).
We reviewed medical records from all patients admitted to the ED and found to be positive for BE between April 1991 and September 1992 and in November and December 1992 (October 1992 data not available). All ED drug screens and other tests were ordered at the emergency
RESULTS
During the study period, 1,287 drug screens were performed on ED patients; 498 patients (39% of total) were positive for BE. The study group comprised the 190 patients (38% of BE-positive patients) who were positive for BE alone and the 125 (25% of BE-positive pateints) who were positive for BE and alcohol. We excluded 47 patients (9%) who were positive for cocaine, alcohol, and other drugs; 100 (20%) who were positive for cocaine and other drugs but not alcohol, and 36 (7%) from whom blood was
DISCUSSION
The frequency of trauma was markedly different between our cocaine and cocaine/alcohol groups and it was the only significant independent variable in both of the logistic-regression models. A greater proportion of the patients in the cocaine/alcohol group were involved in violent trauma, such as gunshot or knife wounds and assaults, than were patients in the cocaine group (37% versus 17%). Other studies have revealed a strong association between cocaine use and the incidence of trauma and
Acknowledgements
The authors acknowledge John Hazy, MA, director of the computer laboratory, Division of Clinical Research, St Elizabeth Health Center; and Claire Bourguet, PhD, epidemiologist, Northeastern Ohio Universities College of Medicine, for their assistance with statistical analysis.
References (21)
- et al.
Concurrent and simultaneous use of alcohol and cocaine: Results of national survey
Drug Alcohol Depend
(1990) - et al.
The lethal effects of ethanol and cocaine and their combination in mice: Implications for cocaethylene formation
Pharmacol Biochem Behav
(1995) - et al.
Cocaine-related medical problems: Consecutive series of 233 patients
Am J Med
(1990) - et al.
Incidence of cocaine-associated rhabdomyolysis
Ann Emerg Med
(1991) - et al.
Emergency department presentation of cocaine intoxication
Ann Emerg Med
(1989) Alcohol and cocaine: Clinical and pharmacological interactions
National Household Survey on Drug Abuse: Population Estimates 1993
(1993)- et al.
Recent advances in pharmacological research on alcohol
- et al.
Molecular mechanisms associated with cocaine effects
- et al.
Cocaethylene: A unique cocaine metabolite displays high affinity for the dopamine transporter
J Neurochem
(1991)
Cited by (35)
The importance of considering polysubstance use: lessons from cocaine research
2018, Drug and Alcohol DependenceCitation Excerpt :Seven studies used community samples in different locations. Only four studies using clinically sampled data were included because they either had relatively large samples (n>1000) (Kedia et al., 2007; Lindsay et al., 2009), included patients from multiple inpatient and outpatient clinics (Guindalini et al., 2006), or used an emergency department-based sampling scheme which allowed us to estimate the PSU prevalence in the general population (Vanek et al., 1996). Four studies reported only simultaneous use and 6 studies reported only concurrent use; one study reported both simultaneous and concurrent use.
Cocaine reverses the naltrexone-induced reduction in operant ethanol self-administration: The effects on immediate-early gene expression in the rat prefrontal cortex
2012, NeuropharmacologyCitation Excerpt :These data support the idea that cocaine use could increase the vulnerability to the development of ethanol dependence (Rubio et al., 2008) and vice versa. A careful examination of the clinical data indicates that the concurrent use of ethanol and cocaine is associated with increased mortality and morbidity resulting from cerebro- and cardiovascular complications (Cami et al., 1998; O'Connor et al., 2005; Randall, 1992; Vroegop et al., 2009) as well as hepatotoxicity and compromised mental status (Odeleye et al., 1993; Vanek et al., 1996). Taken together, these facts underscore the urgency and necessity to develop pharmacotherapeutic interventions for alcoholism and the comorbidity of alcoholism with cocaine use.
Cocaine use trajectories of club drug-using young adults recruited using time-space sampling
2011, Addictive BehaviorsPatients with detectable cocaethylene are more likely to require intensive care unit admission after trauma
2010, American Journal of Emergency MedicineDifferences between adult non-drug users versus alcohol, cocaine and concurrent alcohol and cocaine problem users
2009, Addictive BehaviorsCitation Excerpt :The prevalence of concurrent abuse and dependence of cocaine and alcohol is a serious public health problem associated with significant morbidity and mortality as well as high cost of health care (Coffin et al., 2003; Grant & Harford, 1990; McCance-Katz, Kosten, & Jatlow, 1998; Vanek et al., 1996).
- ☆
From the Departments of Surgery*, Emergency Medicine‡, and Clinical Research§, St Elizabeth Health Center, Youngstown, Ohio; and the Departments of Pharmacology∥, Neurobiology¶, and Surgery#, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio
- ☆☆
Supported by the St Elizabeth Health Center Research Fund
- ★
Address for reprints: Vincent W Vanek, MD, Department of Surgical Education, St Elizabeth Health Center, 1044 Belmont Avenue, PO Box 1790, Youngstown, Ohio 44501, 330-480-3287, Fax 330-480-2070
- ★★
Reprint no. 47/1/76893