Alcohol is a central nervous system depressant. Some addicts mix the two substances to counteract the unpleasant side effects of either one. Others are convinced that drinking alcohol while using cocaine prolongs the "high," or sense of euphoria and escape, for which they turn to cocaine.
The MOE is defined as ratio between toxicological threshold benchmark dose and estimated human intake. Median lethal dose values from animal experiments were used to derive the benchmark dose.
The human intake was calculated for individual scenarios and population-based scenarios. The toxicological MOE approach validates epidemiological and social science-based drug ranking approaches especially in regard to the positions of alcohol and tobacco high risk and cannabis low risk.
Compared to medicinal products or other consumer products, risk assessment of drugs of abuse has been characterised as deficient, much of this is based on historical attribution and emotive reasoning 1.
The available data are often a matter of educated guesses supplemented by some reasonably reliable survey data from the developed nations 2. Only in the past decade, have there been some approaches to qualitatively and quantitatively classify the risk of drugs of abuse.
These efforts tried to overcome legislative classifications, which were often found to lack a scientific basis 3. UNODC suggested the establishment of a so-called Illicit Drug Index IDIwhich contained a combination of a dose index the ratio between the typical dose and a lethal dose and a toxicology index concentration levels in the blood of people who died from overdose compared with the concentration levels in persons who had been given the drug for therapeutic use 4.
King and Corkery 5 suggested an index of fatal toxicity for drugs of misuse that was calculated as the ratio of the number of deaths associated with a substance to its availability. Availability was determined by three separate proxy measures number of users as determined by household surveys, number of seizures by law enforcement agencies and estimates of the market size.
Gable 6 provided one of the earliest toxicologically founded approaches in a comparative overview of psychoactive substances.
In a follow-up study, Gable 7 refined the approach and now provided a numerical safety ratio, which allowed a rank-ordering of abused substances.
Despite these early efforts for toxicology-based risk assessments, the most common methods are still based on expert panel rankings on harm indicators such as acute and chronic toxicity, addictive potency and social harm, e.
The rankings of the two countries correlated very well 38. Similar studies were conducted by questioning drug users, resulting in a high correlation to the previous expert judgements 1011 The methodology was also criticized because a normalization to either the total number of users or the frequency of drug use was not conducted, which might have biased the result toward the harms of opiate use 14 and may have underrepresented the harms of tobacco The Margin of Exposure MOE is a novel approach to compare the health risk of different compounds and to prioritize risk management actions.
The MOE is defined as the ratio between the point on the dose response curve, which characterizes adverse effects in epidemiological or animal studies the so-called benchmark dose BMDand the estimated human intake of the same compound.
Clearly, the lower the MOE, the larger the risk for humans. In Europe, the MOE was introduced in as the preferred method for risk assessment of carcinogenic and genotoxic compounds In the addiction field, the MOE method was never used, aside from evaluating substances in alcoholic beverages 2021 or tobacco products 22 This study is the first to calculate and compare MOEs for other addiction-related substances.
Results The only toxicological threshold available in the literature for all of the compounds under study was the LD Using the method of Gold et al. As shown in Supplementary Table S1 online, the full range of available LD50 values in different animal species is taken into account as a risk function assuming a normal distribution for BMDL10 rather than that a single value is entered into the calculation except methamphetamine and MDMA for which only one value was available in the literature.
Table 1 Toxicological thresholds selected for calculating the margin of exposure Agent.Many cocaine users never use the drug unless they are drinking alcohol as well, which is very dangerous.
Due to cocaine’s ability to blunt the perception of inebriation, its use can lead to excessive drinking and alcohol poisoning. Regardless of any perceived or real advantages that addicts ascribe to using the two substances together, the effects of mixing cocaine and alcohol are very dangerous.
The two substances combine to form a chemical called cocaethylene, which can cause severe heart damage and liver disease as it builds up in the liver over a long period of time. Jan 30, · For individual exposure the four substances alcohol, nicotine, cocaine and heroin fall into the “high risk” category with MOE.
Cocaethylene is the byproduct of concurrent consumption of alcohol and cocaine as metabolized by the liver.
Normally, metabolism of cocaine produces two primarily biologically inactive metabolites — benzoylecgonine and ecgonine methyl ester. There are many dangers associated with mixing drugs and alcohol. Mixing two or more drugs—whether they’re prescription, over-the-counter, or recreational—can increase the risk of side effects, reduce the effectiveness of medications, and increase the risk of overdose and death.
Drugs people commonly use with cocaine include alcohol, heroin, ecstasy, and ketamine. People often mix the drugs to intensify the high, often at parties. Mixing cocaine with alcohol can lead to chest pain, heart palpitations, irritability, and seizures.