La cocaïne s'affirme comme la drogue de M. et Mme Tout-le-Monde

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mikykeupon
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Inscrit le 10 Mar 2009
9631 messages
Une enquête montre que, pour la moitié des utilisateurs, la consommation


Il y a Henri, 32 ans, conducteur de train ; Lucien, 24 ans, au chômage ; Naomi, 18 ans, lycéenne ; Joachim, 25 ans, ouvrier du bâtiment, Rebecca, 22 ans, étudiante en communication... Tous consomment ou ont consommé régulièrement de la cocaïne, une drogue désormais très disponible dans le milieu festif. Avec une cinquantaine d'usagers dits " cachés " car ils échappent à  toute prise en charge sanitaire, ils ont accepté de se confier
à  une équipe dirigée par Catherine Reynaud-Maurupt, sociologue spécialiste des addictions, pour évoquer leurs modes de consommation et leur rapport à  la drogue.
Menée pour le compte de l'Observatoire français des drogues et toxicomanies (OFDT), dans le cadre de leur dispositif " Tendances récentes et nouvelles drogues ", il s'agit de la première enquête qualitative en France sur les
motivations des usagers de cocaïne.
Le temps où la cocaïne n'était réservée qu'à  un cercle étroit de VIP est bien révolu. L'enquête de l'OFDT confirme le statut de drogue de M. et Mme Tout-le-monde qu'a acquise la cocaïne. Plus accessible depuis que le prix du
gramme a chuté (60 euros aujourd'hui), elle n'est pas perçue comme dangereuse. La plupart des usagers interrogés affichent une relation décomplexée à  ce stupéfiant et affirment pouvoir maîtriser leur consommation. L'étude démontre pourtant que plus de la moitié d'entre eux " ont connu au moins un épisode de consommation compulsive de cocaïne, d'un mois à  plusieurs années " qui a entraîné pour eux des dommages sérieux.
Les premières prises de cocaïne ont lieu dans un contexte festif, en soirées privées et se déroulent " selon une logique toujours similaire " : le consommateur, qui a déjà  " pimenté " ses sorties par des prises d'alcool, de
cannabis ou d'ecstasy, " goûte " la cocaïne qui se présente sous forme de rail de poudre à  sniffer. La première prise est souvent due à  l'effet mimétique du groupe de copains, les jeunes voulant alors assouvir leur curiosité.
A ce stade de la consommation, les désagréments induits par la cocaïne sont mineurs, ce qui pousse les jeunes à  réitérer l'essai. L'effet de cette drogue est considéré comme plutôt " doux " par rapport à  d'autres stimulants, comme l'ecstasy. Ses bons côtés (augmentation de la sociabilité, endurance pour la fête, sensation de puissance) renforcent son image positive.
Les jeunes en parlent comme d'une " vitamine ". " Faire la fête " est d'ailleurs la principale motivation pour continuer à  consommer. Lors de cette première phase, qui dure entre six mois et deux ans, les usagers interrogés estiment que le produit n'a " aucun impact sur leur vie sociale, professionnelle ou étudiante ".
Ce n'est plus le cas si la consommation perdure. Sur les 50 personnes interrogées, un tiers s'installe dans un usage strictement festif et une faible minorité consomme occasionnellement en dehors du milieu festif. Pour les autres, soit 28 personnes, la cocaïne prend le pas sur leur vie : les consommations deviennent pluri-hebdomadaires et souvent quotidiennes.
L'émancipation du domicile familial, l'entrée dans la vie active ou étudiante contribuent à  l'augmentation de la  consommation : " La période post-lycéenne est une étape fragile, souligne l'étude, du fait de l'accès à  un premier logement ou de l'expérience de la colocation, surtout si plusieurs consommateurs vivent ensemble. "
Le risque est grand, alors, de s'enfoncer dans la spirale de l'addiction : la polarisation autour du produit, le phénomène du " craving " - qui décrit l'envie constante de reprendre de la drogue -, s'installe progressivement. "
L'appétence pour la cocaïne s'insère dans les actes de la vie quotidienne de façon insidieuse ", note l'étude. Elle n'est plus sniffée par plaisir mais par besoin. Les usagers décrivent des situations où il faut en prendre le matin pour se lever, en prendre pour aller travailler, en prendre pour effectuer telle ou telle tâche...
Les consommateurs deviennent irritables, nerveux. Leurs sommeil et alimentation sont déréglés. Leur vie sociale est affectée, notamment par les dettes accumulées pour se procurer suffisamment de produit.
Après plusieurs mois ou années de dépendance, survient parfois une " prise de conscience " des consommateurs : mesurant la place qu'a prise la drogue dans leur quotidien, ils tentent de s'en éloigner en revenant provisoirement chez leurs parents, en rompant avec leur réseau d'amis consommateurs ou en profitant d'un changement  professionnel... Ceux qui sont le plus ancrés dans l'usage alternent phase de consommation et phase d'abstinence. La plupart s'en détachent en recommençant à  consommer d'autres produits : " Le polyusage, qui gouvernait une grande partie des dynamiques de début de carrière, joue un rôle important lors de la sortie de l'usage intensif de cocaïne ", note l'étude.
Pour Catherine Reynaud-Maurupt, il est urgent d'adapter la prévention. " Il faut informer sur les dangers de la cocaïne là  où sont les jeunes, dans les facultés, les entreprises, explique la sociologue. Les boîtes de nuit sont également des lieux stratégiques, car la drogue y circule de façon clandestine. " La prévention est d'autant plus importante que ce produit surfe sur le malaise ambiant de la société : " Le culte de la performance, la baisse de l'estime de soi, le déclassement des jeunes, tout concourt à  son succès croissant. "

Cécile Prieur
Etude à  lire sur le site www.ofdt.fr


Le " free-base ", la cocaïne aux dangers méconnus Le " free-base " est une préparation artisanale qui permet  d'obtenir un caillou de crack à  partir de poudre de cocaïne. Les deux tiers des personnes rencontrées dans l'étude en avaient consommé. Il entraîne des effets violents sous forme de flash - certains parlent d'un effet " coup de fusil " -
et conduit rapidement à  une consommation compulsive.
Les jeunes le fument souvent sans en connaître les risques - ils ignorent que le crack et le free-base sont des produits identiques. La perte de contrôle du produit et le renfermement sur soi constituent les effets les plus couramment constatés.

Source : Le Monde, daté 27 mars 2011

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Mammon Tobin
Modéranimateur à  la retraite
Inscrit le 07 Sep 2007
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Il entraîne des effets violents sous forme de flash - certains parlent d'un effet " coup de fusil " -

Vous croyez qu'ils ont voulu faire un "shoot" à  la française? fume_une_joint

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bighorsse
Banni
Inscrit le 19 Mar 2007
8506 messages
quelle absurdité!!

l angoisse est le vertige de la liberté

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prescripteur
Modérateur
Inscrit le 22 Feb 2008
11142 messages
Il faut savoir que la cocaine entraine des effets vasculaires (jusqu'à  accident vasculaire cerebral et infarctus du myocarde) même chez les jeunes consommateurs. J'ai discuté avec des urgentistes qui, à  la suite d'une reprise des dossiers, ont decouvert que certains de ces accidents n'avaient pas été attribués à  la cocaine au moment du passage aux urgences, probablement parce que le resultat des tests d'urines avait été reçu par la suite.
Il y a donc probablement actuellement  une sous evaluation de ce  risque.

Rappelons aussi que la cocaine et l'alcool (et bien sûr l'association des deux) sont les produits les plus toxiques pour le foetus chez la femme enceinte.
Amicalement

S'il n'y a pas de solution, il n'y a pas de problème. Devise Shadok (et stoicienne)

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bighorsse
Banni
Inscrit le 19 Mar 2007
8506 messages
je ne voulais pas dire que la CC n'est pas toxique pour le corps! non, c'est juste le terme "coup de fusil" qui me parait absurde

l angoisse est le vertige de la liberté

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prescripteur
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Inscrit le 22 Feb 2008
11142 messages
A Bighorsse,
Ce n'etait pas une critique de ta reponse mais un complement au premier message, qui n'en parle pas.
Amicalement

S'il n'y a pas de solution, il n'y a pas de problème. Devise Shadok (et stoicienne)

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empathy
Psycho junior
Inscrit le 18 Oct 2010
253 messages
Prescripteur, j'ai appris que lors du mélange cocaïne + alcool, il se créé une substance psycho-active très dangereuse pour l'organisme : le coca-éthylène. Celle-ci est responsable de décès brutaux dus à  des accidents neurologiques ou des atteintes hépatiques graves.
Est-ce-vrai, connais-tu ce phénomène ?

Si la société ne peut t'intégrer et t'en tient rigueur, réjouis-toi d'être un homme et non un rouage. R. Guilleaumes.

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prescripteur
Modérateur
Inscrit le 22 Feb 2008
11142 messages
Tout à  fait. Je joins une courte phrase en français (trouvée sur Internet) et des details mais malheureusement je n'ai pas trouvé en français, donc c'est en anglais.
Amicalement

Cocaéthylène
Substance psychoactive obtenue par mélange de cocaïne et d'alcool. Elle présente une activité et une toxicité proches de celles de la cocaïne, avec une demi-vie prolongée. Sa rémanence dans l'organisme augmente le risque d'accidents neurologiques, d'atteintes hépatiques et de perturbation du système immunitaire. Les risques de décès brutal sont également sensiblement majorés.

Quelques details en anglais

Cocaethylene:

Responding to combined

alcohol and cocaine use

Summary

Cocaethylene is a unique compound formed when alcohol and cocaine are combined.

Cocaethylene has been associated with increased health and social risks, although

understanding and awareness of the risks appears low. Scope to improve knowledge and

responses within drug and alcohol strategy approaches appear important given

indications of increasing popularity of combined alcohol and powder cocaine use.

Key findings:

ï‚·

ï‚·

ï‚·

ï‚·

ï‚·

Qualitative data based on survey findings, reports from professionals and users

suggests combined alcohol and cocaine use is a significant and increasing trend,

particularly amongst young recreational  „binge”Ÿ drinkers

There is a broad consensus that cocaethylene significantly increases risk of heart

attack and other possible health effects. It is also linked to other social harms such

as an increased propensity to violence amongst users

Further understanding about the increased health and social risks resulting from

combined alcohol and cocaine use is lacking; however some figures are commonly

recited such as significantly increased risks of sudden death or heart attack

There is limited quantitative data about the actual prevalence, use or

understanding of cocaethylene specifically, although extensive separate data on

alcohol and cocaine use can be corroborated to some extent

Available statistical data indicates high combined levels of alcohol and cocaine

use: the NTA report that around 75% of those in treatment for powder cocaine

reported alcohol use at start of treatment. 61% of those reporting powder cocaine

use in the Mixmag survey said they  „always drank alcohol when snorting cocaine”Ÿ

Key recommendations:

ï‚·

ï‚·

ï‚·

Brief interventions and psychosocial treatment can be effective for both alcohol

and cocaine users - optimum approaches should be explored for combined users

Practitioners should be offered training and guidance to better understand and

respond to the needs of combined alcohol and cocaine users

The impact of combined alcohol and drug use needs further research and

increased recognition within drug and alcohol strategy approaches

1

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

1. Background

Cocaethylene is reported to produce heightened euphoria amongst users, with a more

prolonged effect than taking cocaine on its own. However concerns over greater health

risks have been increasingly discussed following further research into the subject.

However there has been debate over the actual impact and risks of combined use, and

the consensus appears to remain that further research is needed.

The most commonly recited effect of cocaethylene, as given in a 1990 New Scientist

article1, asserts that “When cocaine and alcohol are taken together, the combination is 21

times more likely to kill people with severe heart problems than cocaine on its own.”

Whilst this statistic has been disputed, there is consensus that the effect of cocaethylene

increases the risk of cardiac problems and other possible effects such as seizures and

liver damage. It has also been linked to an increased risk of violent and impulsive

behaviour.

Anecdotal reports from practitioners and those in the drug and alcohol field suggest that

increasingly drinkers in the UK are intentionally poly-using cocaine. This is largely

corroborated by significant increases in powder cocaine use as explored in recent

cocaine reports by the House of Commons Home Affairs Committee and National

Treatment Agency. Yet reports also suggest combined users are largely unaware of the

increased health and social risks presented by their combined use.

Currently there appears to be limited recognition of the potential health or social impacts

of combined alcohol and cocaine use amongst users or policy makers. Although the

deliberate use of alcohol and cocaine is not a new phenomenon, current drug and alcohol

policies are not geared to address the future impact of potentially significant increases in

use.2 This paper therefore aims to explore current understanding, gaps in learning and

opportunities for local and national drug and alcohol leads to respond.

„Vin Mariani”Ÿ, a  „tonic”Ÿ wine which contained

cocaine was popular in the 19th century. It

claimed to  „fortify and refresh body and brain”Ÿ,

and was also promoted as a treatment for a

range of conditions. Fans reportedly included

Queen Victoria and Pope Leo XIII awarded the

wine a Vatican gold medal, also endorsing it on

a poster.

2

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

2. What is ‘Cocaethylene´?

When alcohol and cocaine are exposed in the liver, they form a unique metabolite

ethylbenzoylecgonine (cocaethylene). Whilst the effect is similar to the metabolite formed

by cocaine (benzoylecgonine), several differences are observed affecting the

psychoactive and biological impacts on the body.

Most significantly, cocaethylene (like cocaine) blocks the re-uptake of dopamine3 in the
Cocaethylene:

Responding to combined

alcohol and cocaine use

Summary

Cocaethylene is a unique compound formed when alcohol and cocaine are combined.

Cocaethylene has been associated with increased health and social risks, although

understanding and awareness of the risks appears low. Scope to improve knowledge and

responses within drug and alcohol strategy approaches appear important given

indications of increasing popularity of combined alcohol and powder cocaine use.

Key findings:

ï‚·

ï‚·

ï‚·

ï‚·

ï‚·

Qualitative data based on survey findings, reports from professionals and users

suggests combined alcohol and cocaine use is a significant and increasing trend,

particularly amongst young recreational  „binge”Ÿ drinkers

There is a broad consensus that cocaethylene significantly increases risk of heart

attack and other possible health effects. It is also linked to other social harms such

as an increased propensity to violence amongst users

Further understanding about the increased health and social risks resulting from

combined alcohol and cocaine use is lacking; however some figures are commonly

recited such as significantly increased risks of sudden death or heart attack

There is limited quantitative data about the actual prevalence, use or

understanding of cocaethylene specifically, although extensive separate data on

alcohol and cocaine use can be corroborated to some extent

Available statistical data indicates high combined levels of alcohol and cocaine

use: the NTA report that around 75% of those in treatment for powder cocaine

reported alcohol use at start of treatment. 61% of those reporting powder cocaine

use in the Mixmag survey said they  „always drank alcohol when snorting cocaine”Ÿ

Key recommendations:

ï‚·

ï‚·

ï‚·

Brief interventions and psychosocial treatment can be effective for both alcohol

and cocaine users - optimum approaches should be explored for combined users

Practitioners should be offered training and guidance to better understand and

respond to the needs of combined alcohol and cocaine users

The impact of combined alcohol and drug use needs further research and

increased recognition within drug and alcohol strategy approaches

1

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

1. Background

Cocaethylene is reported to produce heightened euphoria amongst users, with a more

prolonged effect than taking cocaine on its own. However concerns over greater health

risks have been increasingly discussed following further research into the subject.

However there has been debate over the actual impact and risks of combined use, and

the consensus appears to remain that further research is needed.

The most commonly recited effect of cocaethylene, as given in a 1990 New Scientist

article1, asserts that “When cocaine and alcohol are taken together, the combination is 21

times more likely to kill people with severe heart problems than cocaine on its own.”

Whilst this statistic has been disputed, there is consensus that the effect of cocaethylene

increases the risk of cardiac problems and other possible effects such as seizures and

liver damage. It has also been linked to an increased risk of violent and impulsive

behaviour.

Anecdotal reports from practitioners and those in the drug and alcohol field suggest that

increasingly drinkers in the UK are intentionally poly-using cocaine. This is largely

corroborated by significant increases in powder cocaine use as explored in recent

cocaine reports by the House of Commons Home Affairs Committee and National

Treatment Agency. Yet reports also suggest combined users are largely unaware of the

increased health and social risks presented by their combined use.

Currently there appears to be limited recognition of the potential health or social impacts

of combined alcohol and cocaine use amongst users or policy makers. Although the

deliberate use of alcohol and cocaine is not a new phenomenon, current drug and alcohol

policies are not geared to address the future impact of potentially significant increases in

use.2 This paper therefore aims to explore current understanding, gaps in learning and

opportunities for local and national drug and alcohol leads to respond.

„Vin Mariani”Ÿ, a  „tonic”Ÿ wine which contained

cocaine was popular in the 19th century. It

claimed to  „fortify and refresh body and brain”Ÿ,

and was also promoted as a treatment for a

range of conditions. Fans reportedly included

Queen Victoria and Pope Leo XIII awarded the

wine a Vatican gold medal, also endorsing it on

a poster.

2

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

2. What is ‘Cocaethylene´?

When alcohol and cocaine are exposed in the liver, they form a unique metabolite

ethylbenzoylecgonine (cocaethylene). Whilst the effect is similar to the metabolite formed

by cocaine (benzoylecgonine), several differences are observed affecting the

psychoactive and biological impacts on the body.

Most significantly, cocaethylene (like cocaine) blocks the re-uptake of dopamine3 in the

brain, producing euphoric but habit forming reward effects. Because cocaethylene has a

longer half-life than cocaine on its own, the euphoric effects are prolonged. Cocaethylene

increases the levels of cocaine in the blood, which is cleared more slowly (the half-life).

Additionally, cocaethylene has a less significant effect in regulating serotonin than

cocaine, also thought to increase euphoric effects.

The affect of cocaine on

the brain

Cocaine interrupts the

natural re-absorption of

dopamine in the brain.

Dopamine results in

signals that create a

feeling of euphoria.

Cocaethylene further

blocks the re-uptake

causing a greater build up

of dopamine and longer

sense of euphoria.

Source: National Institute on

Drug Abuse (NIDA)

Evidence suggests that the ingestion of alcohol before cocaine is required to create

cocaethylene (McGowan 20084).

3. Increased health and social risks?

The extent of the increased risk of cocaethylene appears hard to quantify in non-medical

terms, although there has been a significant degree of academic research into its nature

as a compound and various interactions5. There is therefore varied reporting about the

actual risks in terms of death or serious health conditions as explored below.

3

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

3.1 Affect on the body

Cocaine use is linked to cardiovascular problems especially increased heart rate and

blood pressure. These risks have been demonstrated to be further increased by

cocaethylene. A study in 1997 (Farre et al) found that whilst cocaine increased heart

rates by 12 beats per minute (BPM), cocaethylene increased heart rates by 33 BPM.

Increased heart risks are thought to be concomitant with up to 30% increased blood

cocaine levels when cocaethylene is formed6.

Cocaethylene”Ÿs increased health risks, especially for those with heart conditions has

been linked to cocaine”Ÿs ability to block sodium channels of cardiac cells - this blocking

effect is thought to be greater from cocaethylene than cocaine (Xu et al, 19947).

Additionally cocaethylene is a myocardial depressant, which means the drug impairs the

strength and force of the heart”Ÿs contractile function. This can lead to heart failure in

some individuals, which may persist despite abstaining from the drug in the future. A

recent paper  „Neurotoxic and Cardiotoxic Effects of Cocaine and Ethanol”Ÿ8 concluded

that:

“The combination of ethanol and cocaine has been associated with a significant increase

in the incidence of neurological and cardiac emergencies including cerebral infarction,

intracranial haemorrhage, myocardial infarction, cardiomyopathy, and cardiac

arrhythmias.”

The New Scientist article  „Science: Cocaine and alcohol make a heart-stopping cocktail”Ÿ9

published in 1990 stated:

“In tests with mice, scientists have found that cocaethylene is between 50 and 100 per

cent more lethal than cocaine. However, Mash says that the jury is still out on why it kills

people. Cocaine and cocaethylene may disrupt the function of the limbic parts of the brain

which control the heart, she says. They also bind to other molecules in the brain, known

as muscinaric and sigma receptors. These have been linked with abnormal heart

function, mental disorders, and also with delirium.”

The US National Institute on Drug Abuse (NIDA) report in a Research Report Series

paper10 on cocaine states:

“While more research needs to be done, it is noteworthy that the mixture of cocaine and

alcohol is the most common two-drug combination that results in drug-related death.”

4

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

However cocaine-related health risks have a better recognition as a lone drug,

particularly in terms of the impact on the heart. Recent national  „Frank”Ÿ campaigns have

highlighted the risk to the heart in particular:

“Cocaine is highly risky for anybody with high blood pressure or a heart condition.

Perfectly healthy, young people can have a fit or heart attack after taking too much coke

and you may not know you”Ÿve got a pre-existing heart condition.” www.talktofrank.com

However the role of alcohol in the research behind cocaine harms is commonly

overlooked. A 2008 article in The Times called  „The New Cocaine Crisis”Ÿ11 reported that

A&E presentations of young revellers with heart problems had become so common they

had been labelled  „coke strokes”Ÿ by A&E staff. The article explores in particular the

frequency of cocaine-related Saturday night emergency admissions:

“The problem, though, is that getting high at weekends can put huge strain on the heart:

cocaine, in particular, constricts the blood vessels, raising blood pressure and making the

heart work harder. Throw in alcohol and amphetamines, and you have what some

doctors believe is a  „ticking time bomb of acute cardiac problems”Ÿ.”

3.2 Increased risk of violence?

The consequences of combined alcohol and cocaine use may not only be health related;

professionals point out that cocaine”Ÿs stimulant effect reduces a drinker”Ÿs feeling of

intoxication and allows greater quantities of alcohol to be consumed. Furthermore, with

the disinhibiting effect of alcohol combined with a heightened sense of self confidence

associated with cocaine, the links between increased violent or impulsive behaviour seem

logical.

Both alcohol and cocaine elevate extraneuronal dopamine and serotonin levels which in

turn may lead to deficits in impulse control and, thus, violent behaviour12. It is therefore

possible to hypothesise that the combination of alcohol and cocaine increases the risk of

violence than either drug taken alone. There is some research from the US that suggests

that combined alcohol and cocaine use increases the risk of violence (Chermack & Blow

200113; McDonald et al, 200814). In a separate review of the research evidence on

cocaethylene and violence, Penning et al. (2002) noted that:

“Retrospective research on violence suggests a major role for alcohol alone and additive

increases in violent behaviour or crime from the combination [with cocaine]. For ethical

reasons, high repeated doses of cocaine have not been studied experimentally. The

behavioural toxicity of highdose binge use of cocaine with alcohol may thus be

5

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

underestimated. One study shows a potentiation effect of the cocaine-alcohol

combination on the number of thoughts and threats of violence” 15

Volume 24 (March/April 2009) of Druglink magazine featured an article entitled  „The

hidden mixer”Ÿ16 exploring the possible link between combined alcohol and cocaine use

and violence. It reported that drug tests by Greater Manchester police had found that

„between a quarter and a third of people arrested for violence snorted powder cocaine

before fighting.”Ÿ However the article concluded that alcohol was still the most likely drug

affecting the risk of violent behaviour, and that personality is still the key determining

factor.

It has yet to be established exactly how and under what circumstances the combination

of alcohol and cocaine may give rise to increased risk of aggression and violence. There

is currently a shortage of in depth research which includes the role of important social

and contextual factors such as the night-time economy or domestic settings17. Further

exploration of combined use in violent offences could provide additional insight. Models of

data collection such as the Cardiff A&E data sharing model and initiatives such as alcohol

arrest referral schemes could be important opportunities to further explore risk factors

and prevalence relating to combined alcohol and cocaine use.

3.3 Addiction risks?

There appears to be insufficient research to assess whether combined cocaine and

alcohol use is likely to increase levels of addiction to either drug, or whether there is the

possibility of a particular habit-forming reaction to cocaethylene. A medical review of the

literature available on the psychological and somatic consequences of combined use

found no evidence that cocaethylene produced an enhanced addictive effect (McGowan,

2008). However one early study18 on cocaethylene concluded that  „The formation of

cocaethylene may play an important role in the systemic toxicity and abuse liability

associated with dual addiction to cocaine and alcohol.”Ÿ

Nonetheless, the already strong tendency of each drug to form a variety of physical and

psychological disorders without a combined synergy should not be overlooked. It has also

been suggested that  „some combined use can be explained by classical conditioning

theory. A combined user has their alcohol and cocaine use conditioned together so that

using one brings on the craving or desire to use the other.”Ÿ (McGowan, 2008). Anecdotal

reports also suggest that the  „crash”Ÿ or  „comedown”Ÿ effects of cocaine are reduced if

combined with alcohol, which may also be likely to lead to increased conditioning of poly-

use.

6

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

4. Use and prevalence of cocaethylene

Whilst medium to longer term trends of both cocaine and alcohol consumption have been

rising, there is little specific data available directly identifying cocaethylene prevalence.

However anecdotal reports suggest that many drinkers in the UK now see cocaine as an

integral part of their recreational alcohol use. A qualitative study19 of 34 young cocaine

users in London found that:

„Virtually everyone interviewed reported that they regularly drank alcohol when using

cocaine. Reports of drinking more heavily than usual while under the influence of cocaine

were widely described, with several reporting that they often drank at least twice their

usual alcohol intake. For a significant number of respondents, cocaine use was always

accompanied by alcohol. Some used cocaine to moderate the undesirable effects of

alcohol (such as feeling less in control and unsteady on their feet), so that they could

continue to drink. In contrast, others used alcohol in a functional way to moderate the

effects of cocaine: to help them take the edge off feelings of anxiety or paranoia and to

help them to sleep at the end of the evening. As Kate, an unemployed 22-year-old,

explained:

„I won”Ÿt have cocaine without alcohol. Because when you have cocaine on its own it”Ÿs a

completely different buzz. You can get on a paranoid buzz if you have it on its own. The

alcohol brings you on a level.”Ÿ (Kate, aged 22)

Overall, respondents reportedly recognised very few risks associated with using cocaine

and alcohol together.”Ÿ

brain, producing euphoric but habit forming reward effects. Because cocaethylene has a

longer half-life than cocaine on its own, the euphoric effects are prolonged. Cocaethylene

increases the levels of cocaine in the blood, which is cleared more slowly (the half-life).

Additionally, cocaethylene has a less significant effect in regulating serotonin than

cocaine, also thought to increase euphoric effects.

The affect of cocaine on

the brain

Cocaine interrupts the

natural re-absorption of

dopamine in the brain.

Dopamine results in

signals that create a

feeling of euphoria.

Cocaethylene further

blocks the re-uptake

causing a greater build up

of dopamine and longer

sense of euphoria.

Source: National Institute on

Drug Abuse (NIDA)

Evidence suggests that the ingestion of alcohol before cocaine is required to create

cocaethylene (McGowan 20084).

3. Increased health and social risks?

The extent of the increased risk of cocaethylene appears hard to quantify in non-medical

terms, although there has been a significant degree of academic research into its nature

as a compound and various interactions5. There is therefore varied reporting about the

actual risks in terms of death or serious health conditions as explored below.

3

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

3.1 Affect on the body

Cocaine use is linked to cardiovascular problems especially increased heart rate and

blood pressure. These risks have been demonstrated to be further increased by

cocaethylene. A study in 1997 (Farre et al) found that whilst cocaine increased heart

rates by 12 beats per minute (BPM), cocaethylene increased heart rates by 33 BPM.

Increased heart risks are thought to be concomitant with up to 30% increased blood

cocaine levels when cocaethylene is formed6.

Cocaethylene”Ÿs increased health risks, especially for those with heart conditions has

been linked to cocaine”Ÿs ability to block sodium channels of cardiac cells - this blocking

effect is thought to be greater from cocaethylene than cocaine (Xu et al, 19947).

Additionally cocaethylene is a myocardial depressant, which means the drug impairs the

strength and force of the heart”Ÿs contractile function. This can lead to heart failure in

some individuals, which may persist despite abstaining from the drug in the future. A

recent paper  „Neurotoxic and Cardiotoxic Effects of Cocaine and Ethanol”Ÿ8 concluded

that:

“The combination of ethanol and cocaine has been associated with a significant increase

in the incidence of neurological and cardiac emergencies including cerebral infarction,

intracranial haemorrhage, myocardial infarction, cardiomyopathy, and cardiac

arrhythmias.”

The New Scientist article  „Science: Cocaine and alcohol make a heart-stopping cocktail”Ÿ9

published in 1990 stated:

“In tests with mice, scientists have found that cocaethylene is between 50 and 100 per

cent more lethal than cocaine. However, Mash says that the jury is still out on why it kills

people. Cocaine and cocaethylene may disrupt the function of the limbic parts of the brain

which control the heart, she says. They also bind to other molecules in the brain, known

as muscinaric and sigma receptors. These have been linked with abnormal heart

function, mental disorders, and also with delirium.”

The US National Institute on Drug Abuse (NIDA) report in a Research Report Series

paper10 on cocaine states:

“While more research needs to be done, it is noteworthy that the mixture of cocaine and

alcohol is the most common two-drug combination that results in drug-related death.”

4

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

However cocaine-related health risks have a better recognition as a lone drug,

particularly in terms of the impact on the heart. Recent national  „Frank”Ÿ campaigns have

highlighted the risk to the heart in particular:

“Cocaine is highly risky for anybody with high blood pressure or a heart condition.

Perfectly healthy, young people can have a fit or heart attack after taking too much coke

and you may not know you”Ÿve got a pre-existing heart condition.” www.talktofrank.com

However the role of alcohol in the research behind cocaine harms is commonly

overlooked. A 2008 article in The Times called  „The New Cocaine Crisis”Ÿ11 reported that

A&E presentations of young revellers with heart problems had become so common they

had been labelled  „coke strokes”Ÿ by A&E staff. The article explores in particular the

frequency of cocaine-related Saturday night emergency admissions:

“The problem, though, is that getting high at weekends can put huge strain on the heart:

cocaine, in particular, constricts the blood vessels, raising blood pressure and making the

heart work harder. Throw in alcohol and amphetamines, and you have what some

doctors believe is a  „ticking time bomb of acute cardiac problems”Ÿ.”

3.2 Increased risk of violence?

The consequences of combined alcohol and cocaine use may not only be health related;

professionals point out that cocaine”Ÿs stimulant effect reduces a drinker”Ÿs feeling of

intoxication and allows greater quantities of alcohol to be consumed. Furthermore, with

the disinhibiting effect of alcohol combined with a heightened sense of self confidence

associated with cocaine, the links between increased violent or impulsive behaviour seem

logical.

Both alcohol and cocaine elevate extraneuronal dopamine and serotonin levels which in

turn may lead to deficits in impulse control and, thus, violent behaviour12. It is therefore

possible to hypothesise that the combination of alcohol and cocaine increases the risk of

violence than either drug taken alone. There is some research from the US that suggests

that combined alcohol and cocaine use increases the risk of violence (Chermack & Blow

200113; McDonald et al, 200814). In a separate review of the research evidence on

cocaethylene and violence, Penning et al. (2002) noted that:

“Retrospective research on violence suggests a major role for alcohol alone and additive

increases in violent behaviour or crime from the combination [with cocaine]. For ethical

reasons, high repeated doses of cocaine have not been studied experimentally. The

behavioural toxicity of highdose binge use of cocaine with alcohol may thus be

5

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

underestimated. One study shows a potentiation effect of the cocaine-alcohol

combination on the number of thoughts and threats of violence” 15

Volume 24 (March/April 2009) of Druglink magazine featured an article entitled  „The

hidden mixer”Ÿ16 exploring the possible link between combined alcohol and cocaine use

and violence. It reported that drug tests by Greater Manchester police had found that

„between a quarter and a third of people arrested for violence snorted powder cocaine

before fighting.”Ÿ However the article concluded that alcohol was still the most likely drug

affecting the risk of violent behaviour, and that personality is still the key determining

factor.

It has yet to be established exactly how and under what circumstances the combination

of alcohol and cocaine may give rise to increased risk of aggression and violence. There

is currently a shortage of in depth research which includes the role of important social

and contextual factors such as the night-time economy or domestic settings17. Further

exploration of combined use in violent offences could provide additional insight. Models of

data collection such as the Cardiff A&E data sharing model and initiatives such as alcohol

arrest referral schemes could be important opportunities to further explore risk factors

and prevalence relating to combined alcohol and cocaine use.

3.3 Addiction risks?

There appears to be insufficient research to assess whether combined cocaine and

alcohol use is likely to increase levels of addiction to either drug, or whether there is the

possibility of a particular habit-forming reaction to cocaethylene. A medical review of the

literature available on the psychological and somatic consequences of combined use

found no evidence that cocaethylene produced an enhanced addictive effect (McGowan,

2008). However one early study18 on cocaethylene concluded that  „The formation of

cocaethylene may play an important role in the systemic toxicity and abuse liability

associated with dual addiction to cocaine and alcohol.”Ÿ

Nonetheless, the already strong tendency of each drug to form a variety of physical and

psychological disorders without a combined synergy should not be overlooked. It has also

been suggested that  „some combined use can be explained by classical conditioning

theory. A combined user has their alcohol and cocaine use conditioned together so that

using one brings on the craving or desire to use the other.”Ÿ (McGowan, 2008). Anecdotal

reports also suggest that the  „crash”Ÿ or  „comedown”Ÿ effects of cocaine are reduced if

combined with alcohol, which may also be likely to lead to increased conditioning of poly-

use.

6

www.alcoholpolicy.net ...news and analysis for the UK alcohol harm reduction field

AERC Alcohol Academy briefing paper 004

April 2010

Promoting excellence in

local alcohol harm reduction

www.alcoholacademy.net

4. Use and prevalence of cocaethylene

Whilst medium to longer term trends of both cocaine and alcohol consumption have been

rising, there is little specific data available directly identifying cocaethylene prevalence.

However anecdotal reports suggest that many drinkers in the UK now see cocaine as an

integral part of their recreational alcohol use. A qualitative study19 of 34 young cocaine

users in London found that:

„Virtually everyone interviewed reported that they regularly drank alcohol when using

cocaine. Reports of drinking more heavily than usual while under the influence of cocaine

were widely described, with several reporting that they often drank at least twice their

usual alcohol intake. For a significant number of respondents, cocaine use was always

accompanied by alcohol. Some used cocaine to moderate the undesirable effects of

alcohol (such as feeling less in control and unsteady on their feet), so that they could

continue to drink. In contrast, others used alcohol in a functional way to moderate the

effects of cocaine: to help them take the edge off feelings of anxiety or paranoia and to

help them to sleep at the end of the evening. As Kate, an unemployed 22-year-old,

explained:

„I won”Ÿt have cocaine without alcohol. Because when you have cocaine on its own it”Ÿs a

completely different buzz. You can get on a paranoid buzz if you have it on its own. The

alcohol brings you on a level.”Ÿ (Kate, aged 22)

Overall, respondents reportedly recognised very few risks associated with using cocaine

and alcohol together.”Ÿ

S'il n'y a pas de solution, il n'y a pas de problème. Devise Shadok (et stoicienne)

Hors ligne

 

Mammon Tobin
Modéranimateur à  la retraite
Inscrit le 07 Sep 2007
5574 messages

empathy a écrit

Prescripteur, j'ai appris que lors du mélange cocaïne + alcool, il se créé une substance psycho-active très dangereuse pour l'organisme : le coca-éthylène. Celle-ci est responsable de décès brutaux dus à  des accidents neurologiques ou des atteintes hépatiques graves.
Est-ce-vrai, connais-tu ce phénomène ?

Oui (ui, je suis pas prescripteur fume_une_joint), j'avais même fait un thread à  ce sujet il y a un bout de temps (au moins 3 ans, je vais retrouver ça). Trop peu de gens sont au courant, et c'est souvent dans des soirées alcoolisées qu'on se voit proposer son premier rail par des potes (enfin moi c'était ça, heureusement je buvais pas ce soir là ).

Hors ligne

 

empathy
Psycho junior
Inscrit le 18 Oct 2010
253 messages
@Prescripteur, j'ai pris le temps de traduire le texte en anglais et il y a des choses vraiment intéressantes.
Ils parlent bien de toutes les conséquences néfastes que cette substance peut avoir sur l'organisme, aussi bien au niveau des organes que au niveau du comportement.
A un moment donné ils disent que l'effet désinhibant de l'alcool conjugué à  un excès de confiance en soi dû à  la cocaïne, peut engendrer des comportements violents.......bah tu m'étonnes ! Il y a une majoration de l'impulsivité !
Les populations les plus à  risque de décéder sont celles qui ont une pression artérielle importante ou celles qui ont déjà  une fragilité/maladie du coeur.
Le seul point positif et non des moindres, c'est que le cocaéthylène augmente et prolonge les effets euphorisants.

@Mammon, si tu peux retrouver le thread, c'est cool, thanks.

Dernière modification par empathy (04 avril 2011 à  20:54)


Si la société ne peut t'intégrer et t'en tient rigueur, réjouis-toi d'être un homme et non un rouage. R. Guilleaumes.

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