{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:16:17Z","timestamp":1786947377311,"version":"build-2736575974"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Karolinska University Laboratory"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>This retrospective study examined the prevalence of combined ethanol and cocaine use, which produces an enhanced psychoactive effect through formation of the active metabolite cocaethylene, compared to combined use of ethanol and two other common recreational drugs, cannabis and amphetamine, based on urine drug test results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study was based on &amp;gt;30,000 consecutive samples from routine urine drug testing in 2020, and 2627 samples from acute poisonings in the STRIDA project (2010\u20132016), in Sweden. Drug testing for ethanol (i.e. ethyl glucuronide and ethyl sulfate), cocaine (benzoylecgonine), cannabis (\u03949-THC-COOH) and amphetamine was done by routine immunoassay screening and LC\u2013MS\/MS confirmatory methods. Seven samples testing positive for cocaine and ethyl glucuronide were also analyzed for cocaethylene by LC\u2013HRMS\/MS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among routine samples for which testing of ethanol and cocaine had been requested, 43% tested positive for both substances, compared with 24% for ethanol and cannabis and 19% for ethanol and amphetamine (P\u2009&amp;lt;\u20090.0001). Among the drug-related intoxications, 60% of cocaine-positive samples were also positive for ethanol, compared to 40% for cannabis and ethanol and 37% for amphetamine and ethanol. Cocaethylene was detected (range 1.3\u2013150\u00a0\u03bcg\/L) in all randomly selected samples testing positive for ethanol and cocaine use.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These results, which were based on objective laboratory measures, indicated that combined ethanol and cocaine exposure was more prevalent than expected from drug use statistics. This may relate both to the common use of these substances in party and nightlife settings, and the amplified and prolonged pharmacological effect by the active metabolite cocaethylene.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/alcalc\/agad009","type":"journal-article","created":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T01:09:18Z","timestamp":1676596158000},"page":"274-279","source":"Crossref","is-referenced-by-count":9,"title":["Urine Drug Tests Indicate Higher Prevalence of Combined Alcohol and Cocaine Use Compared to Alcohol Together with Cannabis or Amphetamine\u2014A Possible Link to Cocaethylene"],"prefix":"10.1093","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7480-8078","authenticated-orcid":false,"given":"Anders","family":"Helander","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Karolinska Institutet , Stockholm , Sweden"},{"name":"Department of Clinical Pharmacology, Karolinska University Laboratory , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Vill\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Karolinska University Laboratory , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Signell","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, Karolinska University Laboratory , Stockholm , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,16]]},"reference":[{"key":"2023050921472915800_ref1","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1300\/J069v16n03_08","article-title":"Cocaethylene toxicity","volume":"16","author":"Andrews","year":"1997","journal-title":"J Addict Dis"},{"key":"2023050921472915800_ref2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s13011-022-00455-5","article-title":"Exploring e-psychonauts perspectives towards cocaine effects and toxicity","volume":"17","author":"Assi","year":"2022","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"2023050921472915800_ref3","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/pds.3592","article-title":"Hospital admissions\/visits associated with drug-drug interactions: a systematic review and meta-analysis","volume":"23","author":"Dechanont","year":"2014","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2023050921472915800_ref4","volume-title":"Polydrug Use: Health and Social Responses","author":"EMCDDA","year":"2021"},{"key":"2023050921472915800_ref5","volume-title":"European Guidelines for Workplace Drug Testing in Urine","author":"EWDTS"},{"key":"2023050921472915800_ref6","doi-asserted-by":"crossref","first-page":"4789","DOI":"10.3390\/ijerph18094789","article-title":"Illicit drug use and associated problems in the nightlife scene: a potential setting for prevention","volume":"18","author":"Feltmann","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2023050921472915800_ref7","doi-asserted-by":"crossref","first-page":"20283","DOI":"10.1038\/s41598-022-24741-1","article-title":"Feasibility of using breath sampling of non-volatiles to estimate the prevalence of illicit drug use among nightlife attendees","volume":"12","author":"Feltmann","year":"2022","journal-title":"Sci Rep"},{"key":"2023050921472915800_ref8","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.vascn.2017.04.003","article-title":"Simultaneous determination of cocaine\/crack and its metabolites in oral fluid, urine and plasma by liquid chromatography-mass spectrometry and its application in drug users","volume":"86","author":"Fiorentin","year":"2017","journal-title":"J Pharmacol Toxicol Methods"},{"key":"2023050921472915800_ref9","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.toxlet.2019.07.001","article-title":"Clinical relevance of ethanol coingestion in patients with GHB\/GBL intoxication","volume":"314","author":"Galicia","year":"2019","journal-title":"Toxicol Lett"},{"key":"2023050921472915800_ref10","author":"Hansson","year":"2015"},{"key":"2023050921472915800_ref11","first-page":"1","article-title":"Drugs most frequently involved in drug overdose deaths: United States, 2011-2016","volume":"67","author":"Hedegaard","year":"2018","journal-title":"Natl Vital Stat Rep"},{"key":"2023050921472915800_ref12","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1093\/jat\/29.5.270","article-title":"Ethyl sulfate: a metabolite of ethanol in humans and a potential biomarker of acute alcohol intake","volume":"29","author":"Helander","year":"2005","journal-title":"J Anal Toxicol"},{"key":"2023050921472915800_ref13","first-page":"21056","article-title":"Drug use and drug trends in Sweden 2010-2020 - 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