COCAETHYLENE

Effects & toxicity explained

Learn about cocaethylene: what it is, how it forms when alcohol & cocaine are used together, the risks to your heart and liver, and simple steps to reduce harm.

What is Cocaethylene?

Cocaine and alcohol are increasingly being used together as a ‘straightener’ to keep the night going, allowing people to drink more alcohol and lessen the ‘comedown’ from cocaine.

But when alcohol and cocaine are used together your body produces a third substance called cocaethylene.

The information in this booklet will help you minimise the risks caused by cocaethylene.

Cocaethylene effects

For some people, cocaethylene can increase the duration and the intensity of the ‘high’ caused by cocaine, but the downside, (yes, there always is one!) is that cocaethylene is also a toxic substance which can cause short-and long-term, physical and mental health problems for some people.

Cocaethylene risks

Health:

Cocaethylene can force your heart rate and blood pressure to higher levels than cocaine alone would. Even for perfectly healthy people, this can increase the chance of seizures, heart attacks and strokes. For anyone with an underlying heart condition, this is extremely risky.

Cocaethylene increases the toxicity of cocaine in your body and slows down the rate at which your liver processes both cocaine and alcohol. This puts a greater strain on the liver and, over time, can cause serious damage.

Violence

The combination of the disinhibiting effect of alcohol and confidence inducing cocaine with the addition of cocaethylene leads to a heightened possibility of impulsive or reckless behaviour and even violence.

Sex

The combined effect of cocaine and alcohol can ruin sexual performance. It can make you feel horny but makes it more difficult for men to get hard and women to get lubricated. Both men and women will find it difficult to orgasm. As trying to climax can take longer, this can damage the penis, vagina and anus, leading to increased risk of sexually transmitted infections (STIs).

Always use a condom and plenty of water-based lubricant like KY Jelly. Using a sexual stimulant like Viagra alongside cocaine and alcohol can put a massive strain on the heart. Not recommended!

Warning signs

There is nothing to suggest cocaethylene poses an increased risk of dependence that using either of the two substances on their own would. But you can become so used to using both together, that using one can start a craving for the other. As a result, a dependency for both can develop.

Some of the warning signs are:

Using larger amounts of alcohol and cocaine to get the same effect, or to cancel out the negative parts of either substance.
Spending time thinking about when you are going to use next.
Having problems at home, work or uni because of your behaviour or not doing what you should have.
Getting involved in violence or injuring yourself or others after a session.

Taking control

If you want to cut down or stop using alcohol and cocaine, the following advice may help.

Use less alcohol and cocaine at each session and give yourself more time to recover between sessions.
Think about the negatives. These could be things like being skint and feeling crap all the time. Remind yourself of these when you feel the urge to use.
Avoid things that remind you of alcohol and cocaine. These could be a place or people you would normally use with. Take a break from your friends for a few weeks, avoid certain pubs and clubs. Do other things when you would normally be indulging.
Tell someone what you are doing or get a mate to join you. Having someone to talk to during your moments of weakness can make all the difference.
Don’t give up. It is possible to break the habit. If you don’t manage it the first time, don’t beat yourself up about it, you have taken the first step. Try again!

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Additional cocaethylene information

The information above is from our cocaethylene harm-reduction leaflet. It includes everything people need to reduce the risks of using cocaine and alcohol together.

The additional information below comes from questions we receive from clients and searches made on our website and takes a deeper dive into the science of cocaethylene.

How is cocaethylene made in the body?

Cocaethylene is a drug that forms automatically in your liver when you use cocaine and alcohol together. It stays in your body 3-5 times longer than cocaine alone.

How cocaethylene forms:

Normal cocaine breakdown

When you use cocaine by itself, your liver breaks it down into two inactive waste products: benzoylecgonine and ecgonine methyl ester. These don't produce drug effects and get filtered out by your kidneys and eliminated from your body through urine.

What changes when alcohol is present

When someone drinks alcohol and uses cocaine at the same time, something different happens in the liver. Instead of just breaking down the cocaine normally, some of the cocaine combines with the alcohol inside the liver to create a completely new drug called cocaethylene.

How toxic is cocaethylene compared to cocaine?

Cocaethylene is significantly more toxic than cocaine alone and carries a much higher risk of overdose. Research studies consistently show that combining cocaine and alcohol dramatically increases the risk of fatal complications compared to using cocaine by itself.

What "more toxic" means:

Stays active longer: It remains in your body 3-5 times longer than cocaine, prolonging harmful effects
Affects the heart more severely: It causes more dangerous changes to blood pressure and heart rhythm than cocaine alone
Impacts multiple organ systems: It's more damaging to the liver, lungs, and immune system compared to cocaine by itself
Creates stronger effects: It produces a more intense "high" than cocaine, which can lead to using larger amounts

Research findings: Multiple studies have found that people who use cocaine and alcohol together face substantially higher risks of serious medical complications and fatal outcomes compared to those who use cocaine alone, though the exact level of increased risk varies between studies.

How much stronger is cocaethylene than cocaine?

Cocaethylene produces more intense and longer-lasting effects than cocaine alone. While it's not necessarily "stronger" in terms of how much you need to feel effects, it creates a more powerful high and stays active in your body 3-5 times longer than cocaine.

Why the effects feel more intense:

More intense high: Cocaethylene creates stronger feelings of pleasure than cocaine by itself.
Longer duration: Because it stays in your system much longer, the effects last much longer compared to cocaine alone.
Different brain activity: It affects brain chemistry differently than cocaine, which can create a more rewarding sensation.
Building up effect: Since it doesn't break down as quickly, it can build up in your system if you keep using both substances.

Important distinction: Rather than being "stronger," cocaethylene is better described as more intense and longer-lasting, which is why people often find the combination of cocaine and alcohol more appealing.