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What if someone knows how cocaine affects them, and they know how alcohol affects them, but not how they can affect them when taken together? The use of both cocaine and alcohol together results in a unique metabolite called cocaethylene. This metabolite stays in the system longer and prevents the reuptake of dopamine resulting in a longer lasting and more intense symptomology for both drugs.

In criminal cases this is relevant in multiple ways:

  • The user may not be aware of how the drug combination will affect them, including increased anxiety, impulsivity, and aggression.
  • Cocaethylene stays in the system 3-5 times longer, which may result in a positive toxicology finding beyond the expected window.
  • Users are at higher risk of stroke and heart attack; cocaethylene carries an sudden death risk of 18 to 25 times higher than using cocaine alone.
  • Cocaethylene has been associated with seizures.

It is important to note, however, that most cocaine abusers often abuse alcohol, so a defense attorney would have to be able to show that they haven’t been using cocaine for long.


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Works Cited

Andrews, P. (1997). Cocaethylene toxicity. Journal of Addictive Diseases, 16(3), 75-84. Retrieved from

Hearn, W., Flynn, D., Hime, G., Rose, S., Cofino, J., Manteor-Atienza, E., . . . Mash, D. (1991, Feb). Cocaethylene: a unique cocaine metabolite displays high affinity for the dopamine transporter. Journal of Neurochemistry, 56(2), 698-701. Retrieved from

Jatlow, P. (1993, Dec). Cocaethylene: pharmacologic activity and clinical significance. Therapeutic Drug Monitoring, 15(6), 533-6. Retrieved from

Macdonald, S., Erickson, P., Wells, S., Hathaway, A., & Pakula, B. (2008, Jul 13). Predicting violence among cocaine, cannabis, and alcohol treatment clients. Addictive Behaviors, 33(1), 201-5. Retrieved from

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