Concurrent Use of Cocaine and Alcohol by Patients Treated in the Emergency Department,☆☆,,★★

https://doi.org/10.1016/S0196-0644(96)70114-2Get rights and content

Abstract

Study objective: To compare the demographics, presenting signs and symptoms, morbidity, and mortality of emergency department patients with drug screen results positive for benzoylecgonine ester (BE; a cocaine metabolite) and those positive for BE and alcohol. Methods: We carried out a retrospective cohort study, in a university-affiliated community hospital, of 190 patients positive for BE alone and 125 patients positive for BE and alcohol. Results: Patients positive for BE and alcohol were more often male and single. They were more likely to have been intubated, admitted to an ICU, and involved in violent trauma and to have demonstrated altered mental status than patients who tested positive for BE alone. These patients had higher mean heart rate and blood pressure values than patients positive for BE alone, and the two patients with myocardial infarction were positive for BE and alcohol. The incidence of rhabdomyolysis and the mean blood urea nitrogen value were lower in the patients positive for BE and alcohol. The two deaths in our study were patients in the BE-and-alcohol group, but these were due to trauma and not to the toxic effects of cocaine or alcohol. Conclusion: Cocaine use was associated with a low incidence of morbidity and mortality, but patients who combined it with alcohol had decreased mental status and required a higher intensity of care.

[Vanek VW, Dickey-White HI, Signs SA, Schechter MD, Buss T, Kulics AT: Concurrent use of cocaine and alcohol by patients treated in the emergency department. Ann Emerg Med November 1996;28:508-514.]

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)

There are more references available in the full text version of this article.

Cited by (35)

  • The importance of considering polysubstance use: lessons from cocaine research

    2018, Drug and Alcohol Dependence
    Citation 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, Neuropharmacology
    Citation 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.

  • Differences between adult non-drug users versus alcohol, cocaine and concurrent alcohol and cocaine problem users

    2009, Addictive Behaviors
    Citation 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).

View all citing articles on Scopus

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

View full text