Comparing the acute toxicities of co-exposure to cocaine and ethanol versus cocaine alone.

Kwun Lok Cheung, Rex Pui Kin Lam, Chi Keung Chan, Man Li Tse, Matthew Sik Hon Tsui, Timothy Hudson Rainer
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Abstract

Introduction: Cocaine is commonly consumed with ethanol, which leads to the formation of cocaethylene through transesterification. Cocaethylene is an active metabolite of cocaine with a longer duration of action. Literature on the combined toxicity of cocaine, ethanol, and cocaethylene is conflicting. We aimed to compare the acute toxicities of co-exposure to cocaine and ethanol versus cocaine alone in Hong Kong.

Methods: This was a retrospective study on acute cocaine toxicities reported to the Hong Kong Poison Control Center from 1 January 2010 to 22 January 2023. Cocaine exposure was confirmed by urine immunoassays/laboratory tests and ethanol co-ingestion was confirmed by blood ethanol concentrations. A serious outcome was defined as a National Poison Data System outcome moderate or above. Univariate analyses and multivariable logistic regression were performed to compare the associations of clinical outcomes with and without ethanol, followed by subgroup analyses of cases with complete data.

Results: We analyzed 109 patients (median age 29 years, 71% men, 68% Chinese), of whom 20 had confirmed ethanol co-ingestion (mean blood ethanol concentration 1350 mg/L). Multivariable analysis showed that co-exposure to cocaine and ethanol was associated with a lower risk of serious outcomes (adjusted odds ratio 0.09, 95% confidence interval 0.01-0.77; p = 0.03) after adjusting for age, sex, ethnicity, route of cocaine administration, and physical health status. Subgroup analyses showed similar findings.

Conclusions: In contrast to previous studies, we did not identify a higher risk of serious outcomes after co-exposure to cocaine and ethanol compared to cocaine alone in a predominantly Chinese cohort.

比较同时暴露于可卡因和乙醇与单独暴露于可卡因的急性毒性。
导言:可卡因通常与乙醇一起服用,乙醇通过酯交换作用形成古柯乙烯。古柯乙烯是可卡因的一种活性代谢物,作用时间较长。有关可卡因、乙醇和古柯乙烯的综合毒性的文献相互矛盾。我们的目的是比较在香港同时接触可卡因和乙醇与单独接触可卡因的急性毒性:这是一项回顾性研究,研究对象是 2010 年 1 月 1 日至 2023 年 1 月 22 日期间向香港中毒控制中心报告的急性可卡因中毒事件。可卡因暴露由尿液免疫测定/实验室检测确认,同时摄入乙醇由血液乙醇浓度确认。严重后果定义为国家毒物数据系统中度或以上的结果。我们进行了单变量分析和多变量逻辑回归,以比较有乙醇和无乙醇的临床结果的相关性,然后对有完整数据的病例进行了亚组分析:我们对 109 名患者(中位年龄 29 岁,71% 为男性,68% 为中国人)进行了分析,其中 20 人已证实同时摄入乙醇(平均血液中乙醇浓度为 1350 毫克/升)。多变量分析表明,在对年龄、性别、种族、可卡因给药途径和身体健康状况进行调整后,同时暴露于可卡因和乙醇与较低的严重后果风险相关(调整后的几率比为0.09,95%置信区间为0.01-0.77;P = 0.03)。分组分析显示了类似的结果:与以往的研究不同,在以中国人为主的队列中,我们没有发现同时暴露于可卡因和乙醇后出现严重后果的风险高于单独暴露于可卡因的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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