Published: Journal of Analytical Toxicology, Volume 20, Number 2, March/April 1996, pp. 143.

LetÕs Not Overlook Nicotine
J.M. Roll and S.T. Higgins

To the Editor:
We would like to comment on the recent report by Bailey (1) concerning the detection of cocaethylene during toxicological screening. Although we were impressed by the thoroughness of the screening for other drug use in this report, we would like to suggest that, in addition, there should be a screening procedure for nicotine use via a cotinine assay. Interesting and clinically important relationships exist between cigarette smoking and both cocaine and ethanol use. Regarding cocaine use, the prevalence of cigarette smoking in cocaine-dependent individuals is more than three times that found in the general population (2). Virtually all cocaine abusers who are cigarette smokers report smoking cigarettes while using cocaine, and the majority report that they smoke more when under the influence of cocaine than when sober (3,4). This is substantiated by several experimental reports indicating that cocaine ingestion increases cigarette smoking (4,5). Cocaine-dependent individuals who are cigarette smokers also report more frequent cocaine use than their nonsmoking peers (3). Finally, combined cocaine and cigarette use has been demonstrated experimentally to produce greater cardiovascular risk than either drug used alone (6,7).

With regard to ethanol use, consumption increases as the number of cigarettes smoked increases (8). Ethanol consumption also increases the rate of cigarette smoking (9). Additionally, alcoholics who are smokers drink more frequently and larger amounts of ethanol than do alcoholics who are nonsmokers (10).

Stated another way, cigarette smoking is related in several ways to the use of both precursors of cocaethylene (cocaine and ethanol). We believe that incorporating a cotinine screen into the type of assay reported by Bailey (1) would be beneficial from both a clinical and scientific point of view. From a clinical perspective, the presence or absence of cotinine may be related to the severity of any underlying substance abuse problems, as cigarette smokers are generally a more substance-impaired population (3). From a scientific perspective, providing data on the simultaneous occurrence of cotinine and other substances, especially cocaine and ethanol, might further our understanding of the unique relationships between cigarette smoking and the use of these substances.

John M. Roll1 and Stephen T. Higgins1,2
Departments of 1Psychiatry and 2Psychology
University of Vermont

References

1. D.N. Bailey. Cocaethylene (ethylcocaine) detection during toxicological screening of a university medical center patient population. J. Anal. Toxicol. 19: 247–50 (1995).
2. A.J. Budney, S.T. Higgins, J.R. Hughes, and W.K. Bickel. Nicotine and caffeine use in cocaine-dependent individuals. J. Subst. Abuse 5: 117–30 (1993).
3. J.M. Roll, S.T. Higgins, A.J. Budney, W.K. Bickel, and G.J. Badger. A comparison of cocaine-dependent cigarette smokers and non-smokers on demographic, drug use and other characteristics. Drug Alcohol Depend., in press.
4. S.T. Higgins, A.J. Budney, J.R. Hughes, W.K. Bickel, M. Lynn, and A. Mortensen. Influence of cocaine use on cigarette smoking. J. Am. Med. Assoc. 272: 1724 (1994).
5. R. Nemeth–Coslet, J. Henningfield, J. Katz, and S. Goldberg. Effects of cocaine on rate of cigarette smoking. Pharmacol., Biochem. Behav. 25: 300 (1986).
6. R.L. Minor, B.D. Scott, D.D. Brown, and M.D. Winniford. Cocaine-induced myocardial infarction in patients with normal coronary arteries. Ann. Intern. Med. 115: 797–806 (1991).
7. D.J. Moliterno, J.E. Willard, R.A. Lange, B.H. Negus, J.D. Boehrer, D.B. Glamann, C. Landau, J.D. Rossen, M.D. Winniford, and L.D. Hillis. Coronary artery vasoconstriction induced by cocaine, cigarette smoking, or both. N. Engl. J. Med. 330: 454–59 (1994).
8. J. Kaprio, N. Hammar, M. Koskenvuo, B. Floderus–Myrhed, H. Lamginvainio, and S. Sarna. Cigarette smoking and alcohol use in Finland and Sweden: a cross national twin study. Int. J. Epidemiol. 11: 378–86 (1982).
9. R.R. Griffiths, G. Bigelow, and I. Liebson. Facilitation of human tobacco self-administration by ethanol: a behavioral analysis. J. Exp. Anal. Behav. 25: 279–92 (1976).
10. J.L. York and J.A. Hirsch. Drinking patterns and health status in smoking and nonsmoking alcoholics. Alcohol Clin. Exp. Res. 19: 666–73 (1995).
    

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