Most issues are caused by concommittant alcohol use, since it makes cocaine metabolize into cocaethylene (ethylcocaine), which is both more addictive and much w

Most issues are caused by concommittant alcohol use, since it makes cocaine metabolize into cocaethylene (ethylcocaine), which is both more addictive and much worse for the heart. Quoth Wikipedia: Some studies suggest that consuming alcohol in combination with cocaine may be more cardiotoxic than cocaine and "it also carries an 18 to 25 fold increase over cocaine alone in risk of immediate death".