Concomitant cocaine and ethanol use produce the compound cocaethylene. A 1995 study estimated that 60 to 80 percent of cocaine users consume ethanol simultaneously. Some users of cocaine mix it with ethanol together as they extend the euphoric sensation and lessen the dysphoria associated with a cessation of cocaine. Cocaethylene, a compound synthesized in vivo, was only identified in 1979. It also has been named in literature as ethylcocaine, ethylbenzoylecgonine, and benzoylecgonine ethyl ester. In 1990, an NIAAA Survey reported that 5.3 million Americans had used cocaine concurrently (during the same period of time) with alcohol, and 4.6 million simultaneously (on the same occasion) with ethanol.

Although the mechanism by which the combination of cocaine and ethanol may be particularly deleterious to the cardiovascular system is unknown, two hypotheses have been proposed:

1. It may markedly increase the determinants of myocardial oxygen demand and simultaneously diminish...