China
Africa
Explore chapters and articles related to this topic
Stimulants: cocaine, amphetamines and party drugs
Published in Berry Beaumont, David Haslam, Care of Drug Users in General Practice, 2021
Taking alcohol with cocaine is dangerous, because they react together to form cocaethylene. This is more harmful to the liver and heart than cocaine and is more likely to produce convulsions. Using alcohol and cocaine together hugely increases the risk of sudden death.3 Sudden death is unusual among cocaine users who do not smoke tobacco.
Critical Review of Evidence for Neonatal Cocaine Intoxication and Withdrawal
Published in Richard J. Konkol, George D. Olsen, Prenatal Cocaine Exposure, 2020
Delia A. Dempsey, Donna M. Ferriero, Sarah N. Jacobson
Cocaine is lipid soluble; it readily crosses the blood brain barrier and the placenta; and it has a volume of distribution of 2 to 3 1/kg.24 Its major route of elimination is metabolic with less than 5% excreted unchanged in the urine.24 The elimination half-life ranges from 30 to 90 minutes, although half-lives up to 3.3 hours have been reported in patients presenting with seizures and strokes temporally related to cocaine use.70,73. The important metabolic elimination pathways of cocaine are illustrated in Figure 7.2. There are at least 11 metabolites of cocaine, but most of them account for only a fraction of cocaine’s metabolism.40 See Chapter 2 on cocaine metabolism for elaboration. Quantitatively, the 2 most important metabolites of cocaine are benzoylecgonine and ecgonine methyl ester.76,77 Norcocaine is a nonprominent, pharmacologically active metabolite.78 Cocaethylene is a pharmacologically active metabolite formed in the liver in the presence of ethanol.39,79
Stimulants and mental health
Published in David B Cooper, Practice in Mental Health—Substance Use, 2018
Richard Orr McLeod, Philip D Cooper
A major problem with stimulants, and the above risks, relates to purity of the drug. Adulteration prevents the individual from competent knowledge related to the concentration of pure ingredients, i.e. strength, which can lead to an increased risk of potential harms when purity is greater than usual. Moreover, it is unclear what other substances have been mixed with the pure substance; some of these can be, in themselves, dangerous. In addition, poly-substance use (the use of two or more substances on one occasion) can increase the risk of harm to the individual. Cocaine and alcohol are frequently used together but can produce a unique compound known as cocaethylene when they are simultaneously exposed in the liver. Cocaethylene appears to produce a heightened euphoria for the individual and prolongs the effects of the cocaine. However, it can increase an individual’s heart rate and blood pressure to a greater extent than when using cocaine alone, and consequently increases the risk of cardiovascular problems.2
The interpretation of hair analysis for drugs and drug metabolites
Published in Clinical Toxicology, 2018
Eva Cuypers, Robert J. Flanagan
A recent study [89] has highlighted the complexities of testing minor cocaine metabolites for definitive proof of deliberate cocaine consumption. Following analysis of 90 hair samples from cocaine users for cocaine, benzoylecgonine, norcocaine, cocaethylene, and tropococaine by GC-MS, cocaine usage was stratified as: light (0.5–3 ng/mg hair), moderate (3.1–10 ng/mg) and heavy (10.1–40 ng/mg). Cocaine concentrations ranged from 1.63–39.29 (mean 9.49) and benzoylecgonine ranged from 0.19–5.77 (mean 1.40). The benzoylecgonine:cocaine ratio was ≥5% (6.4–26.1%) in all samples. Norcocaine was present in 60% of samples (range: 0.22–3.14 ng/mg) and was strongly predictive only of heavy cocaine use (sensitivity 100% for cocaine concentrations >9.6 ng/mg). Cocaethylene was detected in 20 samples from moderate/heavy users (range 0.22–1.98, mean 0.73 ng/mg). However, both norcocaine and cocaethylene may occur in “street” cocaine if processing has involved the use of ethanol and potassium permanganate, hence hydroxycocaine and/or hydroxybenzoylecgonine are assumed to be more specific markers of cocaine exposure [90].