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de Souza Schwarz P, Dos Santos BP, Birk L, Eller S, de Oliveira TF. Development of an innovative analytical method for forensic detection of cocaine, antidepressants, and metabolites in postmortem blood using magnetic nanoparticles. Anal Bioanal Chem 2024; 416:3239-3250. [PMID: 38573343 DOI: 10.1007/s00216-024-05273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
Cocaine and antidepressants rank high globally in substance consumption, emphasizing their impact on public health. The determination of these compounds and related substances in biological samples is crucial for forensic toxicology. This study focused on developing an innovative analytical method for the determination of cocaine, antidepressants, and their related metabolites in postmortem blood samples, using unmodified commercial Fe3O4 nanoparticles as a sorbent for dispersive magnetic solid-phase extraction (m-d-SPE), coupled with liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) analysis. An aliquot of 100 µL of whole blood and 5 µL of the internal standard pool were added to 30 mg of nanoparticles. The nanoparticles were separated from the sample using a neodymium magnet inserted into a 3D-printed microtube rack. The liquid was then discarded, followed by desorption with 300 µL of 1/1/1 acetonitrile/methanol/ethyl acetate. The sample was vortexed and separated, and 1.5 µL of the organic supernatant was injected into the LC-MS/MS. The method was acceptably validated and successfully applied to 263 postmortem blood samples. All samples evaluated in this study were positive for at least one substance. The most frequent analyte was benzoylecgonine, followed by cocaine and cocaethylene. The most common antidepressants encountered in the analyzed samples were citalopram and fluoxetine, followed by fluoxetine's metabolite norfluoxetine. This study describes the first report of this sorbent in postmortem blood analysis, demonstrating satisfactory results for linearity, precision, accuracy, and selectivity for all compounds. The method's applicability was confirmed, establishing it as an efficient and sustainable alternative to traditional techniques for forensic casework.
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Affiliation(s)
- Patricia de Souza Schwarz
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, 90050-170, Brazil.
| | - Bruno Pereira Dos Santos
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, 90050-170, Brazil
| | - Letícia Birk
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, 90050-170, Brazil
| | - Sarah Eller
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, 90050-170, Brazil
| | - Tiago Franco de Oliveira
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, 90050-170, Brazil
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Pragst F, Niebel A, Thurmann D, Dullin M, Eichberg S, Mörlein F, Hartwig S. Is there a relationship between abuse of alcohol and illicit drugs seen in hair results? Drug Test Anal 2024. [PMID: 38686500 DOI: 10.1002/dta.3702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Combined use of alcohol and illicit drugs is a serious health and social problem. In this study, it was examined, whether a relationship between alcohol and drug abuse can be ascertained by comparison of alcohol marker and drug concentrations in hair. In the frame of a social support system for families with parental abuse of illicit drugs, hair samples were analyzed between 2011 and 2022 for methadone, heroin (6-acetylmorphine), cocaine, amphetamine, ecstasy (MDMA), cannabinoids (THC), and the alcohol markers ethyl glucuronide (EtG) and ethyl palmitate (EtPa). For 1314 hair samples from adolescent and adult family members, the hair results show a prevalence of combined occasional or regular drug use and social or abusive alcohol use of 41%-60% except heroin (35%). The drug concentrations were statistically compared in the three categories of abstinence or moderate drinking, social drinking, and alcohol abuse. For the most frequently detected drug cocaine (n = 703), a significant increase of the concentrations with rising alcohol consumption was found. The frequent detection of cocaethylene proved the preferred simultaneous intake of both substances. For THC (n = 489), no significant difference between the alcohol consumer groups was seen. Concerning the less frequently detected methadone (n = 89), 6-acetylmorphine (n = 92), amphetamine (n = 123), and MDMA (n = 105), no clear trend between drug and alcohol marker results was determined. It is concluded that the evaluation of hair results is an appropriate way to study the extent of combined drug-alcohol consumption and complements other studies based on acquisition of consumption data by interview or questionnaire.
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Affiliation(s)
- Fritz Pragst
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - André Niebel
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Denise Thurmann
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Monique Dullin
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Susann Eichberg
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Frederike Mörlein
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Sven Hartwig
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
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van Amsterdam J, Gresnigt F, van den Brink W. Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine-A Systematic Review. J Clin Med 2024; 13:1475. [PMID: 38592322 PMCID: PMC10935323 DOI: 10.3390/jcm13051475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/19/2024] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The simultaneous use of cocaine and alcohol is highly prevalent and is associated with high numbers of emergency department admissions, primarily due to cardiovascular complications. Aims: To answer the question of whether the co-use of cocaine and alcohol increases the cardiovascular risk compared to the use of cocaine alone. Method: A systematic review of human studies comparing the cardiovascular risk of co-used cocaine and alcohol with the use of cocaine alone. Results: Despite a higher myocardial workload induced by the co-use of cocaine and alcohol and the potentiation of cocaine's cardiovascular effects by alcohol, the findings on the risk and severity of cardiovascular symptoms due to combined use are inconsistent. However, the co-use of cocaine and alcohol clearly leads to higher mortality. Interestingly, the presence of cocaethylene, a unique metabolite generated only via a pharmacokinetic interaction between alcohol and cocaine, carries an 18- to 25-fold increase over the absence of cocaethylene (cocaine-alone users) in the risk of sudden death and is associated with myocardial injury and cardiac arrest, probably due to the inhibition of cardiac ion channels by cocaethylene. Conclusion: Despite the inconsistency in some of the results, it is concluded that the co-use of cocaine and alcohol poses an additional risk of cardiovascular fatalities compared to the use of cocaine alone.
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Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1012 WP Amsterdam, The Netherlands;
- Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Femke Gresnigt
- Emergency Department, OLVG Hospital, Oosterpark 9, 1091 AC Amsterdam, The Netherlands;
- Dutch Poison Information Center, UMC Utrecht, University Utrecht, 3508 GA Utrecht, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1012 WP Amsterdam, The Netherlands;
- Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Arbouche N, de Lestrange A, Raul JS, Kintz P. Mariani wine: What's really in it? Analysis of the most popular tonic drink of the 19th century after 100 years of storage. J Pharm Biomed Anal 2024; 238:115804. [PMID: 37866081 DOI: 10.1016/j.jpba.2023.115804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
During the Belle Epoque, the use of cocaine, well known to the South American populations, spread among the European elite in the form of a tonic drink created from coca leaves macerated in Bordeaux wine, the Mariani wine. Nowadays, bottles in circulation are extremely rare but the investigations of a Parisian historian led him to the discovery of a bottle of wine that belonged to Angelo Mariani's estate at the end of the 19th century. Our laboratory was asked to analyse the contents of the bottle in order to search for the main active compounds and to estimate the state of preservation. The analysis of the centenarian product collected was aimed at identifying the alcohols and solvents by HS-GC/FID and HS-GC/MS after dilution in water, and the main alkaloids contained in all the samples by LC-HRMS screening and LC-MS/MS quantification. The Mariani wine presented an alcohol content of 15.7°. The screening and the subsequent dosage revealed the following substances: cocaine (86 ng/mL), benzoylecgonine (383 ng/mL), cocaethylene (17 ng/mL), ecgonine methyl ester (130 ng/mL), caffeine, cuscohygrine, cinnamoylcocaine and synephrine. The alkaloids found in the Mariani wine confirm the real presence of coca leaves in this drink. Their low concentrations may indicate drug instability. The presence of cocaethylene demonstrates that it can be formed without passing through the liver, which was supposed to be the site of production when cocaine and ethanol are present in the body at the same time. These appear to be the first report in the literature presenting the analysis of Mariani wine with the dosage of cocaine derivatives.
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Affiliation(s)
| | | | | | - Pascal Kintz
- Institut de Médecine Légale, Strasbourg, France; X-Pertise Consulting, Mittelhausbergen, France
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Cheung KL, Lam RPK, Chan CK, Tse ML, Tsui MSH, Rainer TH. Comparing the acute toxicities of co-exposure to cocaine and ethanol versus cocaine alone. Hum Exp Toxicol 2024; 43:9603271241269024. [PMID: 39075331 DOI: 10.1177/09603271241269024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
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.
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Affiliation(s)
- Kwun Lok Cheung
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Rex Pui Kin Lam
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chi Keung Chan
- Hong Kong Poison Control Centre, Hospital Authority, Kowloon, China
| | - Man Li Tse
- Hong Kong Poison Control Centre, Hospital Authority, Kowloon, China
| | - Matthew Sik Hon Tsui
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Timothy Hudson Rainer
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Riley ED, Kazi DS, Coffin PO, Vittinghoff E, Wade AN, Bulfone TC, Lynch KL, Atai Z, Wu AH. Impact of multiple substance use on circulating ST2, a biomarker of adverse cardiac remodelling, in women. Biomarkers 2022; 27:802-808. [PMID: 36168954 PMCID: PMC9744090 DOI: 10.1080/1354750x.2022.2129451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/22/2022] [Indexed: 01/28/2023]
Abstract
CONTEXT Cardiovascular disease (CVD) and heart failure (HF) are major causes of mortality in low-income populations and differ by sex. Risk assessment that incorporates cardiac biomarkers is common. However, research evaluating the utility of biomarkers rarely includes controlled substances, which may influence biomarker levels and thus influence CVD risk assessment. MATERIALS AND METHODS We identified the effects of multiple substances on soluble "suppression of tumorigenicity 2" (sST2), a biomarker of adverse cardiac remodelling, in 245 low-income women. Adjusting for CVD risk factors, we examined associations between substance use and sST2 over six monthly visits. RESULTS Median age was 53 years and 74% of participants were ethnic minority women. An sST2 level > 35 ng/mL (suggesting cardiac remodelling) during ≥1 study visit was observed in 44% of participants. In adjusted analysis, higher sST2 levels were significantly and positively associated with the presence of cocaine (Adjusted Linear Effect [ALE]:1.10; 95% CI:1.03-1.19), alcohol (ALE:1.10; 95% CI:1.04-1.17), heroin (ALE:1.25; 95% CI:1.10-1.43), and the interaction between heroin and fentanyl use. CONCLUSION Results suggest that the use of multiple substances influences the level of sST2, a biomarker often used to evaluate cardiovascular risk. Incorporating substance use alongside cardiac biomarkers may improve CVD risk assessment in vulnerable women.
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Affiliation(s)
- Elise D. Riley
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, USA
| | - Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA and Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Phillip O. Coffin
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, USA
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Eric Vittinghoff
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, California, USA
| | - Amanda N. Wade
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, USA
| | - Tommaso C. Bulfone
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, USA
| | - Kara L. Lynch
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, California, USA
| | - Zahra Atai
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, California, USA
| | - Alan H.B. Wu
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, California, USA
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Tamargo JA, Sherman KE, Sékaly RP, Bordi R, Schlatzer D, Lai S, Khalsa JH, Mandler RN, Ehman RL, Baum MK. Cocaethylene, simultaneous alcohol and cocaine use, and liver fibrosis in people living with and without HIV. Drug Alcohol Depend 2022; 232:109273. [PMID: 35033954 PMCID: PMC8885871 DOI: 10.1016/j.drugalcdep.2022.109273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/29/2021] [Accepted: 12/18/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The simultaneous consumption of cocaine and alcohol results in the production of cocaethylene (CE) in the liver, a highly toxic metabolite. Prior research suggests that cocaine use contributes to liver disease and its concomitant use with alcohol may increase its hepatotoxicity, but studies in humans are lacking. We evaluated the role of cocaine, its simultaneous use with alcohol, and CE on liver fibrosis. METHODS We performed a cross-sectional analysis of the Miami Adult Studies on HIV (MASH) cohort. Cocaine use was determined via self-report, urine screen, and blood metabolites, using liquid chromatography with tandem mass spectrometry. Hazardous drinking was determined with the AUDIT-C and liver fibrosis with the Fibrosis-4 Index (FIB-4). RESULTS Out of 649 participants included in this analysis, 281 (43.3%) used cocaine; of those, 78 (27.8%) had CE in blood. Cocaine users with CE had higher concentrations of cocaine metabolites in blood and were more likely to drink hazardously than cocaine users without CE and cocaine non-users. Overall, cocaine use was associated with liver fibrosis. CE in blood was associated with 3.17 (95% CI: 1.61, 6.23; p = 0.0008) times the odds of liver fibrosis compared to cocaine non-users, adjusting for covariates including HIV and HCV infection. The effect of CE on liver fibrosis was significantly greater than that of cocaine or alcohol alone. CONCLUSIONS CE is a reliable marker of simultaneous use of cocaine and alcohol that may help identify individuals at risk of liver disease and aid in the prevention of its development or progression.
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Affiliation(s)
| | | | - Rafick-Pierre Sékaly
- Emory University, Atlanta, GA, USA; Case Western Reserve University, Cleveland, OH, USA.
| | - Rebeka Bordi
- Emory University, Atlanta, GA, USA; Case Western Reserve University, Cleveland, OH, USA.
| | | | | | - Jag H Khalsa
- George Washington University, Washington, DC, USA.
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Pergolizzi J, Breve F, Magnusson P, LeQuang JAK, Varrassi G. Cocaethylene: When Cocaine and Alcohol Are Taken Together. Cureus 2022; 14:e22498. [PMID: 35345678 PMCID: PMC8956485 DOI: 10.7759/cureus.22498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Cocaine is taken frequently together with ethanol and this combination produces a psychoactive metabolite called cocaethylene which has similar properties to the parent drug and may be more cardiotoxic. Cocaethylene has a longer half-life than cocaine, so that people who combine cocaine and ethanol may experience a longer-lasting, as well as more intense, psychoactive effect. Cocaethylene is the only known instance where a new psychoactive substance is formed entirely within the body. Although known to science for decades, cocaethylene has not been extensively studied and even its metabolic pathways are not entirely elucidated. Like its parent drug, cocaethylene blocks the reuptake of dopamine and increases post-synaptic neuronal activity; the parent drug may also block reuptake of serotonin as well. Cocaethylene has been studied in animal models in terms of its pharmacology and its potential neurological effects. Since the combination of cocaine and alcohol is commonly used, it is important for clinicians to be aware of cocaethylene, its role in prolonging or intensifying cocaine intoxication, and how it may exacerbate cocaine-induced cardiovascular disorders. Most cardiac-related risk assessment tools do not ask about cocaine use, which can prevent clinicians from making optimal therapeutic choices. Greater awareness of cocaethylene is needed for clinicians, and those who use cocaine should also be aware of the potential for polysubstance use of cocaine and ethanol to produce a potentially potent and long-lasting psychoactive metabolite.
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Colvin KJ, Killen HS, Kanter MJ, Halperin MC, Engel L, Dickinson MB, Fimmel AI, Holland JG, Currie PJ. Differential effects of intra-ventral tegmental area ghrelin and glucagon-like peptide-1 on the stimulatory action of D-amphetamine and cocaine-induced ethanol intake in male Sprague Dawley rats. Behav Brain Res 2021; 421:113726. [PMID: 34954300 DOI: 10.1016/j.bbr.2021.113726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/24/2022]
Abstract
In order to further elucidate the role of mesolimbic peptides in the expression of ethanol reward, the present study investigated the effects of ghrelin and glucagon-like peptide-1 (GLP-1) on ethanol intake, in addition to ethanol intake stimulated by systemic d-amphetamine or cocaine treatment. While a number of studies suggest that ghrelin plays an important role in mesolimbic reward, emerging data now indicate that GLP-1 receptor mechanisms inhibit reward signaling, possibly by directly or indirectly inhibiting ghrelinergic activity within the mesolimbic system. In the present study all rats were initially habituated to a 6% ethanol solution. We then demonstrated that intraperitoneal injections of d-amphetamine and cocaine increased ethanol intake compared to the vehicle condition. In subsequent testing we examined the effects of ventral tegmental area (VTA) ghrelin or vehicle paired with a fixed dose of d-amphetamine or vehicle. In separate rats we then investigated the impact of the GLP-1 agonist exendin-4 (Ex-4), injected into the VTA, on ethanol intake alone, or when Ex-4 was co-administered with d-amphetamine or cocaine. Our results indicated that VTA ghrelin significantly increased ethanol intake, and most importantly, potentiated the effect of d-amphetamine and cocaine on ethanol consumption. Conversely, VTA Ex-4 inhibited ethanol intake and antagonized the stimulatory effect of d-amphetamine and cocaine on ethanol consumption. In a final study we further demonstrated that VTA Ex-4 treatment significantly inhibited the combined stimulatory effects of ghrelin paired with d-amphetamine or ghrelin paired with cocaine. Overall our findings are consistent with a critical role for both ghrelin and GLP-1 receptor mechanisms in mesolimbic ethanol reward circuitry. Moreover, our results further suggest that ghrelin and GLP-1 modulate the stimulatory effect of psychostimulants on ethanol intake.
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Affiliation(s)
- Kayla J Colvin
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Henry S Killen
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Maxwell J Kanter
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Maximilian C Halperin
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Liv Engel
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Matthew B Dickinson
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Anna I Fimmel
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - James G Holland
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA
| | - Paul J Currie
- Department of Psychology, Reed College, 3203 SE Woodstock Blvd., Portland, OR 97202, USA.
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Relationship between cocaine and cocaethylene blood concentration with the severity of clinical manifestations. Am J Emerg Med 2021; 50:404-408. [PMID: 34481259 DOI: 10.1016/j.ajem.2021.08.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Poisonings resulting from the abuse of drugs currently represent a serious problem for public health. Among the main agents involved, cocaine stands out. It became one of the most abused drugs around the world, and one of the main reasons for visits to the emergency department due to the use of illicit substances. The use of cocaine is primarily in combination with alcoholic beverages. There are few studies that correlate cocaine blood concentration and the severity of clinical manifestations in patients evaluated at Emergency Department. The aim of the present study was to verify the possible relationship between the blood concentration of cocaine and cocaethylene (product of the interaction of cocaine with ethanol) with the severity of the clinical manifestations presented by patients with cocaine intoxication. METHODS Blood levels were measured by high-performance liquid chromatography (HPLC) and the severity of clinical manifestations was assessed using the Stimulant Intoxication Score (SIS). To establish this relationship, Pearson's chi-square statistical test (x2) was used for categorical variables and Student's t for continuous variables, with statistical significance of 5% (p < 0.05). RESULTS Of the 81 patients included in the study, 77.8% were men with a mean age of 32.5 years ± 8.5 and mean of SIS 3.4 ± 2.5. Considering the toxicological analysis results, 24.7% of the blood samples were positive. The mean of cocaine and cocaethylene concentrations were 0.34 μg/mL ± 0.45 and 0.38 μg/mL ± 0.34, respectively. The blood concentration of cocaine and cocaethylene has not been shown to be useful information for the treatment and prognosis of patients, but blood levels of these substances at the time of treatment, regardless of their concentration, may be an indicator of severity, showing that any concentrations of these substances should be considered as potentially toxic. CONCLUSION The application of the SIS score proved to be an important alternative capable of predicting the severity of the patients due to cocaine intoxication in a fast and simplified way.
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Supervía A, Ibrahim-Achi D, Miró Ò, Galicia M, Ferrando JP, Leciñena MA, de L'Hotellerie MJV, Bajo ÁB, Martín-Pérez B, Burillo-Putze G. Impact of co-ingestion of ethanol on the clinical symptomatology and severity of patients attended in the emergency department for recreational drug toxicity. Am J Emerg Med 2021; 50:422-427. [PMID: 34482128 DOI: 10.1016/j.ajem.2021.08.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Investigate whether there are differences in the drugs involved, symptomatology and severity of drug intoxication in patients with co-ingestion of alcohol attended in hospital emergency departments (ED). METHOD Patients attended in 11 Spanish EDs due to drug intoxication were included. Sociodemographic and clinical characteristics were collected. A combined adverse event of cardiorespiratory arrest, need for intubation, and admission to intensive care or death was considered as the primary indicator of severity. The symptomatology and severity were compared adjusted for age, sex and type of drug based on whether or not ethanol had been co-ingested. RESULTS 3925 patients (alcohol co-ingestion: 2290, 58.3%) with a mean age of 33 (±11) years were included, and 25% were women. Co-ingestion of alcohol was observed in younger patients, in EDs in areas with high leisure tourism, on holidays and during the early morning hours. It was also more frequent in individuals intoxicated by amphetamine derivatives (66.2%) and cocaine (65.7%), and was more frequently associated with a reduction in consciousness (odds ratio [OR] = 2.13, 95% confidence interval [CI] 1.69-2.67) and agitation/aggressiveness (OR = 1.22, 95% = 1.04-1.43). A combined adverse event was observed in 114 patients (2.9%) with no differences between individuals co-ingesting or not ethanol (3.1% vs. 2.7%; OR = 1.11, 95% CI = 0.74-1.65). CONCLUSION Co-ingestion of alcohol is more frequent in individuals intoxicated by cocaine and amphetamines and predisposes a greater reduction in the level of consciousness or agitation, although there are no differences in the severity of the episodes of drug intoxication.
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Affiliation(s)
- August Supervía
- Emergency Department and Functional Toxicology Unit, Hospital del Mar, Barcelona, Spain
| | - Dima Ibrahim-Achi
- Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Òscar Miró
- Area of Emergencies, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Galicia
- Area of Emergencies, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Ángel Bajo Bajo
- Emergency Department, Hospital Clínico de Salamanca, Salamanca, Spain
| | | | - Guillermo Burillo-Putze
- Department of Physical Medicine and Pharmacology, Universidad de La Laguna, Tenerife, Spain.
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Pélissier-Alicot AL, Deveaux M, Sastre C, Baillif-Couniou V, Christia MA, Champeaux-Fesquet C, Leonetti G. Planned complex suicide involving combined drug intoxication and femoral catheterization. J Forensic Sci 2021; 66:2527-2531. [PMID: 34291457 DOI: 10.1111/1556-4029.14809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Abstract
Complex planned suicide is characterized by the simultaneous use of two or more methods to ensure that death occurs even if one method fails. The authors present an original combination of two self-killing methods. A 42-year-old cardiologist, with a major depressive syndrome and several suicide attempts, as well as cocaine addiction, was found dead at his home with a femoral catheter inserted in the right femoral artery. The autopsy concluded that death was due to major hemorrhagic process in a context of suicide. Toxicological analyses, performed in peripheral blood by gas chromatography coupled to mass spectrometry and by liquid chromatography-diode array detection, revealed the presence of ethanol (0.13 g/L), cocaine, and metabolites (cocaine: 432 µg/L, benzoylecgonine: 3286 µg/L, ecgonine methyl ester: 1195 µg/L, cocaethylene: 41 µg/L), a potentially lethal concentration of citalopram (1.03 mg/L), toxic concentrations of hydroxyzine (0.11 mg/L), bromazepam (2.06 mg/L), and lidocaine (7.30 mg/L). At the end of these analyses, the death was reclassified as planned complex suicide combining drug intoxication and catheterization of the femoral artery. The authors discuss the main aspects of this case and stress the importance of meticulous analysis of all available evidence: witness reports, victim's medical history and occupation, findings of at-the-scene examination, autopsy, and toxicological analyses, in order to exclude homicide and to understand the sequence of events that led to death.
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Affiliation(s)
| | | | - Caroline Sastre
- Service de Médecine Légale, CHU Timone, APHM, Aix Marseille Univ., Marseille, France
| | | | | | | | - Georges Leonetti
- Service de Médecine Légale, CHU Timone, APHM, Aix Marseille Univ., Marseille, France
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13
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Sanvisens A, Hernández-Rubio A, Zuluaga P, Fuster D, Papaseit E, Galan S, Farré M, Muga R. Long-Term Outcomes of Patients With Cocaine Use Disorder: A 18-years Addiction Cohort Study. Front Pharmacol 2021; 12:625610. [PMID: 33679404 PMCID: PMC7930813 DOI: 10.3389/fphar.2021.625610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Cocaine Use Disorder (CUD) has been associated with multiple complications and premature death. The purpose of the present study was to analyze the relationship between baseline medical comorbidity and long-term medical outcomes (i.e., hospitalization, death) in a cohort of patients primarily admitted for detoxification. In addition, we aimed to analyze cause-specific mortality. Methods: longitudinal study in CUD patients admitted for detoxification between 2001 and 2018. Substance use characteristics, laboratory parameters and medical comorbidity by VACS Index were assessed at admission. Follow-up and health-related outcomes were ascertained through visits and e-health records. Kaplan-Meier and Cox regression models were used to analyze survival and predictors of hospitalization and death. Results: 175 patients (77.7% men) were included. Age at admission was 35 years [IQR: 30–41 years], 59.4% of the patients being intranasal users, 33.5% injectors, and 7.1% smokers. Almost 23% of patients had concomitant alcohol use disorder, 39% were cannabis users and 9% opiate users. The median VACS Index score on admission was 10 points [IQR: 0–22]. After 12 years [IQR: 8.6–15 years] of follow-up there were 1,292 (80.7%) ED admissions and 308 (19.3%) hospitalizations. The incidence rate of ED admission and hospitalization was 18.6 × 100 p-y (95% CI: 15.8–21.8 × 100 p-y). Mortality rate was 1.4 × 100 p-y (95% CI: 0.9–2.0 × 100 p-y) and, baseline comorbidity predicted hospitalization and mortality: those with VACS Index >40 were 3.5 times (HR:3.52, 95% CI: 1.19–10.4) more likely to dye with respect to patients with VACS < 20. Conclusion: addiction care warrants optimal stratification of medical comorbidity to improve health outcomes and survival of CUD patients seeking treatment of the disorder.
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Affiliation(s)
- Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Anna Hernández-Rubio
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Paola Zuluaga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Daniel Fuster
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Esther Papaseit
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Galan
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Magí Farré
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Robert Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
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14
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Laitano HV, Ely A, Sordi AO, Schuch FB, Pechansky F, Hartmann T, Hilgert JB, Wendland EM, Von Dimen L, Scherer JN, Calixto AM, Narvaez JCM, Ornell F, Kessler FHP. Anger and substance abuse: a systematic review and meta-analysis. BRAZILIAN JOURNAL OF PSYCHIATRY 2021; 44:103-110. [PMID: 33605366 PMCID: PMC8827371 DOI: 10.1590/1516-4446-2020-1133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/19/2020] [Indexed: 01/20/2023]
Abstract
Objective: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). Methods: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. Results: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. Conclusion: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.
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Affiliation(s)
- Helen V Laitano
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psicologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Amanda Ely
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.,Serviço de Psicologia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Anne O Sordi
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Felipe B Schuch
- Departamento de Métodos e Técnicas Desportivas, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Flavio Pechansky
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Thiago Hartmann
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliana B Hilgert
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Eliana M Wendland
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Lisia Von Dimen
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Juliana N Scherer
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Alessandra Mendes Calixto
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Joana C M Narvaez
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Felipe Ornell
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Félix H P Kessler
- Centro de Pesquisa em Álcool e Drogas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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15
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Edland-Gryt M. Cocaine Rituals in Club Culture: Intensifying and Controlling Alcohol Intoxication. JOURNAL OF DRUG ISSUES 2021. [DOI: 10.1177/0022042620986514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Clubbing is an important part of the nighttime economy, and cocaine use is, for some young people, an essential part of this clubbing culture. However, the interaction rituals around the use of powder cocaine in this context remain understudied. This study is based on qualitative interviews with young adult recreational cocaine users ( n = 28) and explores how they use cocaine in club settings, in relation to rituals and drinking culture. The analysis identified three main explanations for using cocaine: (a) unity with friends because of shared transgression, (b) the high as a “collective effervescence,” and (c) the possibility to control, extend, and intensify drinking to intoxication. These three explanations illustrate how cocaine rituals were deeply integrated in drinking-to-intoxication rituals, and how the illegality of cocaine use reinforced feelings of unity with friends. In the nighttime economy, cocaine use and its related rituals are used to intensify and control alcohol-fuelled partying.
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Affiliation(s)
- Marit Edland-Gryt
- Department of Alcohol, Tobacco, and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Department of Sociology and Human Geography, University of Oslo, Norway
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Roizenblatt M, Fidalgo TM, Polizelli M, Cruz NFSD, Roizenblatt A, Jiramongkolchai K, Gehlbach PL, Farah ME, Belfort R, Maia M. Effect of chronic cocaine use on fine motor coordination tested during ophthalmic vitreoretinal simulated performance. J Psychiatr Res 2021; 132:7-12. [PMID: 33035762 DOI: 10.1016/j.jpsychires.2020.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/06/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
We conducted a case-control study using the Eyesi simulator to assess the surgical performance of 24 chronic cocaine users (CCUs) and 24 sex-/age-matched controls to numerically quantify ophthalmic microsurgical simulator performance and fine motor deficiencies. The inclusion criteria were no exposure to illicit drugs other than cocaine, marijuana, or alcohol within the previous month and no health conditions that could impact manual task performance. The outcomes included surgical scores (0-100, worst-best) and task completion time (minutes). Fisher's exact test, analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test followed by Dunn-Bonferroni post-hoc were conducted for statistical analysis. The Eyesi scores were lower among CCUs compared to controls for bimanual tasks (4.50 ± 14.30 vs. 18.46 ± 26.64, p = 0.012), for exercises demanding upper and lower limb coordination (both hands and two foot pedals, respectively) (74.13 ± 35.01 vs. 85.21 ± 24.1, p = 0.045), and in the overall score for all three tasks (27.38 ± 15.06 vs. 39.5 ± 18.66, p = 0.021). CCUs took longer to complete tasks when performing exercises demanding upper and lower limb coordination compared to controls (1.26 ± 0.38 vs. 1.02 ± 0.44 min, p = 0.006). Individuals who used cocaine during the previous month had an independent lower bimanual score compared to controls (1.42 ± 4.91 vs. 18.46 ± 26.64, p = 0.018). No differences in performance among the CCUs were attributable to sporadic cannabis or alcohol use. Chronic use of cocaine negatively impacted fine dexterity as measured by bimanual tasks or maneuvers that required simultaneous coordination of the upper and lower limbs. This was most notable among individuals who used cocaine during the 1-month period before the simulation.
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Affiliation(s)
- Marina Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil; Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Thiago Marques Fidalgo
- Department of Psychiatry, Universidade Federal de São Paulo, 570, Borges Lagoa Street, 04038-000, Administrative Office, São Paulo, Brazil.
| | - Murilo Polizelli
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Natasha Ferreira Santos da Cruz
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Arnaldo Roizenblatt
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil.
| | - Kim Jiramongkolchai
- Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Peter Louis Gehlbach
- Wilmer Eye Institute, Johns Hopkins University, 600 N. Broadway, Maumenee 724, 21287, Baltimore, MD, USA.
| | - Michel Eid Farah
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
| | - Rubens Belfort
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
| | - Mauricio Maia
- Department of Ophthalmology, Universidade Federal de São Paulo, 821, Botucatu Street, 1st floor, 04023-062, Administrative Office, São Paulo, Brazil; Vision Institute, IPEPO, Paulista Medical School, 1083, 11 floor, Borges Lagoa Street, 04038-032, Administrative Office, São Paulo, Brazil.
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17
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Riley ED, Vittinghoff E, Wu AHB, Coffin PO, Hsue PY, Kazi DS, Wade A, Braun C, Lynch KL. Impact of polysubstance use on high-sensitivity cardiac troponin I over time in homeless and unstably housed women. Drug Alcohol Depend 2020; 217:108252. [PMID: 32919207 PMCID: PMC7873814 DOI: 10.1016/j.drugalcdep.2020.108252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The use of controlled substances like cocaine increases the risk of cardiovascular disease (CVD) and myocardial infarction (MI). However, outside of alcohol and tobacco, substance use is not included in CVD risk assessment tools. We identified the effects of using multiple substances (nicotine/cotinine, cannabis, alcohol, cocaine, methamphetamine, heroin and other opioids) on cardiac injury measured by high-sensitivity troponin (hsTnI) in homeless and unstably housed women. METHODS We recruited 245 homeless and unstably housed women from shelters, free meal programs and street encampments. Participants completed six monthly study visits. Adjusting for traditional CVD risk factors, we examined longitudinal associations between substance use and hsTnI. RESULTS Median participant age was 53 years and 74 % were ethnic minority women. At baseline, 76 % of participants had hypertension, 31 % were HIV-positive, 8% had a history of a prior MI and 12 % of prior stroke. The most commonly used substances were cotinine/nicotine (80 %), cannabis (68 %) and cocaine (66 %). HsTnI exceeding the 99th percentile (14.7 ng/L) - a level high enough to signal possible MI - was observed in 14 participants during >1 study visit (6%). In adjusted analysis, cocaethylene and fentanyl were significantly associated with higher hsTnI levels. CONCLUSIONS Fentanyl use and the co-use of cocaine and alcohol are associated with myocardial injury, suggesting that the use of these substances may act as long-term cardiac insults. Whether risk counseling on these specific substances and/or including their use in CVD risk stratification would improve CVD outcomes in populations where substance use is high merits further investigation.
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Affiliation(s)
- Elise D Riley
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA.
| | - Eric Vittinghoff
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Alan H B Wu
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, CA, USA
| | - Phillip O Coffin
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Priscilla Y Hsue
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of Cardiology, San Francisco, CA, USA
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Amanda Wade
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Carl Braun
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Kara L Lynch
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, CA, USA
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Hill VA, Schaffer MI, Paulsen RB, Stowe GN. Hydroxycocaines as Metabolic Indicators of Cocaine Ingestion. Forensic Sci Int 2020; 317:110516. [PMID: 33010562 DOI: 10.1016/j.forsciint.2020.110516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
Hydroxycocaines in hair were investigated with many hundreds of head and body hair samples. All samples were washed by a published extensive aqueous method prior to confirmation by LC-MS/MS. Concentrations, percent of cocaine, and ratios of para- and meta-hydroxycocaines to ortho-hydroxycocaine are presented. Hydroxycocaines as percent of cocaine did not appear to be affected by cocaine concentrations, but were shown to increase with cocaethylene concentrations. Stability of hydroxycocaines over a year of ambient storage was demonstrated. Ortho-hydroxycocaine was shown to be formed by exposure of cocaine-positive hair to peroxide, while para- and meta-hydroxycocaines were not. Presence of para- or meta-hydroxycocaine at > 0.05% of cocaine is proposed as indicating ingestion of cocaine. This indicator prevents black hair from being more likely interpreted as positive for ingestion than lighter colored hair.
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Affiliation(s)
- Virginia A Hill
- Psychemedics Corporation, 5832 Uplander Way, Culver City, CA 90230, United States.
| | - Michael I Schaffer
- Psychemedics Corporation, 5832 Uplander Way, Culver City, CA 90230, United States.
| | - Ryan B Paulsen
- Psychemedics Corporation, 5832 Uplander Way, Culver City, CA 90230, United States.
| | - G Neil Stowe
- Psychemedics Corporation, 5832 Uplander Way, Culver City, CA 90230, United States.
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Eiden C, Vincent M, Serrand C, Serre A, Richard N, Picot MC, Frauger E, Fouilhé N, Daveluy A, Peyrière H. Health consequences of cocaine use in France: data from the French Addictovigilance Network. Fundam Clin Pharmacol 2020; 35:455-465. [PMID: 32854152 DOI: 10.1111/fcp.12603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022]
Abstract
As the number and severity of complications related to cocaine use reported to the French Addictovigilance Network have increased, the French health authorities requested a national epidemiologic study of the data collected by this network from 2010 to 2016. For this purpose, the spontaneous reports (SRs) linked to cocaine notified by health professionals were analyzed as well as the data from the pharmacoepidemiological surveys OPPIDUM (observation of illegal drugs and misuse of psychotropic medications) and DRAMES (deaths related to the abuse of licit and illicit psychoactive substances). In total, 1 265 SRs were analyzed (510% increase from 2010 to 2016). Users were mainly men (952/1 261; 75%), with a median age of 35.0 years [IQ25-75 : 28-42]. Cocaine was consumed through the intranasal route by 52% of users (416/797), followed by intravenous administration (32%, 253/797) and inhalation (24%, 190/797). The use of cocaine powder and crack cocaine was reported in 70% (475/674) and 23% (154/674) of SRs, respectively. Cocaine was consumed with other psychoactive substances and alcohol in 47% (603/1265) and 60% (387/649) of cases, respectively. The main cocaine-related complications were psychiatric complications (29%), neurologic complications (24%) and cardiovascular complications (23%). Analysis of the OPPIDUM survey data showed that in 2016, 15.9 and 2.4% of the included subjects consumed cocaine or crack cocaine the week preceding the survey, the highest rate for the 2006-2016 period. The DRAMES survey indicated that cocaine-related deaths increased by threefold from 2014 to 2016. These data confirm that cocaine use in France is worrying with an increase in the number of severe complications and deaths.
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Affiliation(s)
- Céline Eiden
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Marc Vincent
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Chris Serrand
- Unité de Recherche Clinique et d'Epidémiologie, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Anais Serre
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Nathalie Richard
- ANSM Agence Nationale de Sécurité du Médicament et des Produits de Santé, Saint-Denis, 93285, France
| | - Marie-Christine Picot
- Unité de Recherche Clinique et d'Epidémiologie, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
| | - Elisabeth Frauger
- Service de Pharmacologie Clinique et Pharmacovigilance, Centre d'Evaluation et d'Information sur la Pharmacodependance Paca Corse, Hôpital de la Timone, Marseille, 13005, France
| | - Nathalie Fouilhé
- Centre d'Addictovigilance, CHU de Grenoble, Grenoble cedex 9, 38043, France
| | - Amélie Daveluy
- Centre d'Addictovigilance, Service de Pharmacologie Médicale, CHU de Bordeaux, INSERM U657, Place Amélie Raba-Léon, Bordeaux, 33000, France
| | - Hélène Peyrière
- Département de Pharmacologie Médicale et Toxicologie, Centre d'Addictovigilance, CHU Montpellier, Univ Montpellier, Avenue du Doyen Gaston Giraud, Montpellier, 34295, France
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20
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Dai Z, Abate MA, Long DL, Smith GS, Halki TM, Kraner JC, Mock AR. Quantifying enhanced risk from alcohol and other factors in polysubstance-related deaths. Forensic Sci Int 2020; 313:110352. [PMID: 32590196 DOI: 10.1016/j.forsciint.2020.110352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To quantify how alcohol, polysubstance use and other factors influence opioid concentrations in drug-related deaths in West Virginia (WV), United States. METHODS Multiple linear regression models were employed to identify relationships among alcohol, other factors, and the concentrations of four commonly identified opioids (fentanyl, hydrocodone, oxycodone, methadone), accounting for demographic, toxicological and comorbid characteristics in WV drug-related deaths from 2005 to 2018. RESULTS Alcohol concentrations of 0.08% or above were associated with significant reductions in blood concentrations of fentanyl (27.5%), hydrocodone (30.5%) and methadone (32.4%). Significantly lower predicted concentrations of all opioids studied were associated with multiple opioid vs. single opioid presence, with predicted concentration reductions ranging from 13.7% for fentanyl to 65-66% for hydrocodone and oxycodone. Benzodiazepine presence was associated with small, non-statistically significant changes in opioid concentrations, while stimulant presence was associated with statistically significant reductions in hydrocodone and oxycodone concentrations. CONCLUSIONS Co-ingestion of alcohol, multiple opioids or stimulants were associated with significantly decreased predicted concentrations of commonly identified opioids in drug deaths. Further evidence is provided for enhanced risks from polysubstance use with opioids, which has important public health implications.
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Affiliation(s)
- Zheng Dai
- School of Public Health, West Virginia University, One Medical Center Drive, Morgantown, WV 26506, United States.
| | - Marie A Abate
- School of Pharmacy, West Virginia University, 1124 Health Sciences North, Morgantown, WV 26506, United States
| | - D Leann Long
- School of Public Health, University of Alabama at Birmingham, 327F Ryals Public Health Building, Birmingham, AL 35294, United States
| | - Gordon S Smith
- School of Public Health, West Virginia University, One Medical Center Drive, Morgantown, WV 26506, United States
| | - Theresa M Halki
- School of Pharmacy, West Virginia University, 1124 Health Sciences North, Morgantown, WV 26506, United States
| | - James C Kraner
- West Virginia Office of the Chief Medical Examiner, West Virginia Department of Health and Human Resources, 619 Virginia Street West, Charleston, WV 25302, United States
| | - Allen R Mock
- West Virginia Office of the Chief Medical Examiner, West Virginia Department of Health and Human Resources, 619 Virginia Street West, Charleston, WV 25302, United States
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Becam J, Sastre C, Baillif-Couniou V, Gaulier JM, Tuchtan-Torrents L, Champeaux-Fesquet C, Léonetti G, Pélissier-Alicot AL. Décès par rupture d’un sachet de cocaïne situé au niveau gastrique. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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