Dispelling myth of  cocaethylene in urine test from alcohol and cocaine use

Seems folks who have been learning from Hair Razor Detox that cocaine use during alcohol consumption use crests a metabolite called cocaethylene that is screened for in Hair test. 

  They then get confused and spread it all over the internet wrongfully  that this is a general case and is tested for in urine. IT IS NOT .

  

First what is Cocaethylene  ?

Metabolic production from cocaine

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. The hepatic enzyme carboxylesterase is an important part of cocaine's metabolism because it acts as a catalyst for the hydrolysis of cocaine in the liver, which produces these inactive metabolites. If ethanol is present during the metabolism of cocaine, a portion of the cocaine undergoes transesterification with ethanol, rather than undergoing hydrolysis with water, which results in the production of cocaethylene.^[1]

cocaine + H₂O → benzoylecgonine + methanol (with liver carboxylesterase 1)^[4]

benzoylecgonine + ethanol → cocaethylene + H₂O

cocaine + ethanol → cocaethylene + methanol (with liver carboxylesterase 1)^[5]

 

        NOW the ISSUE AT HAND IS  WHAT IS TESTED FOR IN URINE VS  HAIR !

 

A hair screen presents more metabolites for cocaine than any drug . 

 The cocaine part of Hair Test are 

Cocaine 

Major metabolites

benzoylecgonine (BE) 

 Eecgonine methylester(EME) 

Minor metabolites

Cocaethylene (CE) ( created by presence of alcohol) 

Norcocaine  ( NCoc )  ( minor metabolite )

3 isomers of hydroxycocaine (p-OHCoc, m-OHCoc, and o-OHCoc) found higher in body hair vs head

p-hydroxybenzoylecgonine (pOHBE), and m-hydroxybenzoylecgonine

Hydroxycocaines as percent of cocaine did not appear to be affected by cocaine concentrations, but were shown to increase with cocaethylene concentrations  (1)

not all Hair test screened for these   the most common are 

 Cocaine 300 pg/mg

 Benzoylecgonine 300 pg/mg

 Cocaethylene 300 pg/mg 

 Norcocaine 300 pg/mg

• Detection Period: The detection period for cocaethylene is similar to that of cocaine, which is relatively short, usually up to a few days. 

URINE SCREENS

 

Quest urine alcohol test 

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are the alcohol (ie, ethyl alcohol, ethanol) metabolites measured in this test.  (  AS YOU SEE NO COCAETHYLENE )

 

  https://www.questdiagnostics.com/healthcare-professionals/clinical-education-center/faq/faq158#accordion-c9280a9c2c-item-af9f1f7cc3

 

 no separate test for Cocaethylene

Cocaine is a common drug of abuse. To detect its use, a screening detection concentration for the cocaine metabolite benzoylecgonine is commonly set at 150 ng/mL and its confirmatory cut‐off is set at 100 ng/mL. (2)(3)

 their are other metabolites used such as

enzoylecgonine (BE)   ( up to %40 of the metabolites) 

 

 ecgonine methyl ester and six minor metabolites (norcocaine, benzoylnorecgonine, m-hydroxycocaine, p-hydroxycocaine, m-hydroxybenzoylecgonine, and p-hydroxybenzoylecgonine) accounted for approximately 18%,

 

 Anhydroecgonine methyl ester was present in trace amounts (0.02% dose) in specimens collected after smoked cocaine

anhydroecgonine methyl ester tho not common in urine test show when cocaine was smoked such as crack 

 

 However the only one used in a standard urine screen is BE

HOW IS ALCOHOL FOUND IN URINE ?

Urine analysis can test for alcohol use by detecting the presence of  Ethyl Glucuronide (EtG), a metabolite found in alcoholic beverages. The test can show ethanol ingestion within the previous 3-4 days

Ethyl glucuronide (EtG) is a metabolite of ethanol which is formed in the body by glucuronidation following exposure to ethanol, usually from drinking alcoholic beverages. It is used as a biomarker to test for ethanol use and to monitor alcohol abstinence in situations where drinking is prohibited, such as by the military, in alcohol treatment programs, in professional monitoring programs (health professionals, attorneys, airline pilots in recovery from addictions), in schools, liver transplant clinics, or in recovering alcoholic patients.^[1][2] In addition to its use to monitor abstinence and detect drinking, EtG also has potential for monitoring the amount of alcohol use over time because it can be detected in hair and nails, though the effectiveness of this has not yet been proven.^[3][4]

• Detection Period: ETG can be detected in various biological samples such as urine, blood, and hair for an extended period, sometimes up to 80 hours or more after alcohol consumption.

  
  

• ONLY the main metabolite benzoylecgonine (BE) is screened in a urine test.  If they want to test for alcohol it is standard practice to look at ETG.

 ETG and Cocaethylene COULD be found in all types of testing However   

Alcohol metabolites  ETG is tested for in urine and Cocaethylene  is tested for in hair test. 

 ETG is used in Urine vs. cocaethylene because it is  found longer in urine .

 

1. https://pubmed.ncbi.nlm.nih.gov/33010562/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573903/

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371026/

https://pubmed.ncbi.nlm.nih.gov/9780135/

https://www.sciencedirect.com/science/article/abs/pii/S0379073820303789