Concurrent use of cocaine and alcohol by patients treated in the emergency department

To compare the demographics, presenting signs and symptoms, morbidity, and mortality of emergency department patients with drug screen results positive for benzoylecgonine ester (BE; a cocaine metabolite) and those positive for BE and alcohol.

We carried out a retrospective cohort study, in a university-affiliated community hospital, of 190 patients positive for BE alone and 125 patients positive for BE and alcohol.

Patients positive for BE and alcohol were more often male and single. They were more likely to have been intubated, admitted to an ICU, and involved in violent trauma and to have demonstrated altered mental status than patients who tested positive for BE alone. These patients had higher mean heart rate and blood pressure values than patients positive for BE alone, and the two patients with myocardial infarction were positive for BE and alcohol. The incidence of rhabdomyolysis and the mean blood urea nitrogen value were lower in the patients positive for BE and alcohol. The two deaths in our study were patients in the BE-and-alcohol group, but these were due to trauma and not to the toxic effects of cocaine or alcohol.

Cocaine use was associated with a low incidence of morbidity and mortality, but patients who combined it with alcohol had decreased mental status and required a higher intensity of care.