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Is Cocaethylene Really All That Bad?

If the most prominent distinction between cocaine and its metabolite cocaethylene is the metabolite is more cardiotoxic what does that mean to the abuser? First, we need to understand what makes cocaine a cardiotoxin and what that does to your body.

The neurotransmitters that cocaine has the highest affinities for are also the ones that stimulate the sympathetic nervous system. A collective of dopamine, adrenaline and noradrenaline is what is known as a catecholamine. They are responsible for our 'fight-or-flight' mode.

Cocaine inhibits the catecholamine re-uptake and stimulates the sympathetic nervous system. It also behaves like an antiarrhythmic agent (local anesthetic) by blocking sodium and potassium channels.

There are two major pathways for cocaine to affect our cardiovascular system and results in increased heart rate, blood pressure elevation and increases myocardial contractility (the ability of your heart to contract). All of those symptoms have the same effect on our bodies, they increase myocardial oxygen demand. More simply, it makes your heart beat faster and harder. This raises the demand for oxygen to the heart (myocardial oxygen). Myocardial oxygen levels are sapped from coronary vasoconstriction and enhanced thrombosis.

All of these side-effects combine to form a nightmare for you cardiovascular system. The contractility and rhythm of the left ventricular can actually be decreased through heavy abuse.

Cocaine is obviously extremely cardiotoxic, infamously so. How could anything be more cardiotoxic than it already is? In a nutshell cocaethylene amplifies the effects of cocaine on your body as well as remains longer in your blood. It is widely agreed upon that these elevated blood plasma concentrations of cocaine/cocaethylene are the most lethal threat. All of the aforementioned stressors put on your heart alone by cocaine are practically amplified by the presence of cocaethylene. The combination is thought to be responsible for over 90% of "instant-death" cases resulting from cocaine abuse.

With the very real exponential nature of cocaethylene does it seem worth risking potentially lethal and unpredictable side-effects over a few drinks?

As we have stated before, cocaethylene asks for a hefty price.
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NotAJediOrSith
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