Ramón Bataller, hepatologist: ‘The combination of alcohol and cocaine is explosive and many young people are paying for it’

Ramón Batallar, 59, globally renowned hepatologist, has led departments of medical facilities at places like the University of Pittsburgh and currently works at Barcelona’s Hospital Clínic. For three years, he has researched the devastating effects that the abuse of a toxin like alcohol can produce in the liver, and confesses that, at this point in his career, few things can surprise him when it comes to attending patients.

Recently, he ran into an exception. In the course of just a few hours, he saw two individuals in their thirties who were suffering from alcohol-related liver cirrhosis and heart disease compatible with the use of cocaine. Bataller is active on social media, and he didn’t hesitate to share his concern over these cases.

“I’ve seen several young patients with concomitant alcohol-related liver disease and cocaine use. Two devastating consequences: nearly lethal form of alcohol-related hepatitis, co-existence of cardiomyopathy. See the crazy prevalence of COCAINE use in young people. Scary,” Batallar posted on X.

He paired the statement with an infographic that puts Spain in second place — behind the United Kingdom and in front of the United States — on the list of countries with the highest rates of cocaine use among individuals between the age of 15 and 34.

Question. What led you to write that post?

Answer. Alcohol and cocaine are two well-known toxins. But we know less about the combined effect of the two substances on the body. We are seeing patients with serious liver pathologies despite their youth who are, additionally, suffering from cardiomyopathies. It’s uncommon for a person to suffer from both conditions at once and, when we treat a person like this, we have to rule out that they are consuming various toxins at once. My clinical experience is that the combination of alcohol and cocaine is explosive. And that there are many young people who are paying for it.

Q. What makes it so dangerous?

A. In the first place, consumption patterns. One can lead you to consume the other, and do so in greater quantities. Cocaine is highly associated with nighttime activity — although not exclusively — and with a form of recreation in which alcohol is also present. Alcohol reduces inhibitions and among many people who don’t typically consume cocaine, if they’re drinking and at a party where the substance is normalized, they may try it for the first time. Cocaine is a very powerful stimulant, so once you’ve used it, you can party longer, feel more euphoric — and wind up drinking more. And so, by combining the two, people can end up consuming a significant amount of both.

Q. How does that affect the body?

A. Very negatively, although the effects are not yet fully understood. We are quite familiar with the negative effects of alcohol, which causes 15,000 deaths a year in Spain alone. The same goes for cocaine. But we know less about the combined effect of the two toxins. In part, that’s due to methodology. Medicinal research always attempts to isolate the causes of illnesses to determine their effects. So, we have a lot of evidence as to the consequences of consumption of each of the two substances separately, but very little about the two of them together.

Q. What are you seeing in clinical practice?

A. Traditionally in Spain, we’ve seen greater numbers of older liver patients. Some data indicates that global consumption of alcohol is trending down, but some people exhibit elevated consumption patterns that lead them to develop serious pathologies like alcohol-related cirrhosis and hepatitis while still young. Also, it was uncommon for liver patients to also present heart disease; you didn’t expect to see that in a patient. It is exceptional to see a patient with both conditions, and even more so at a young age. And recently, I saw two in one day. This may point to the fact that things are changing.

Q. What does that mean?

A. There have been sudden deaths of young people with no clear explanation. It is not unreasonable to consider the simultaneous consumption of both substances in such cases. There have been some autopsies carried out on people who have died suddenly that support this idea. But in many cases of sudden death, it is not possible to study the involvement of all substances, and it is possible that there has been an underdiagnosis that has prevented us from seeing the real magnitude of the problem.

Q. But what kind of damage can the two substances combined cause to the body?

A. The damage accumulates and multiplies. Cocaine causes ischemia, which means that blood does not reach tissues in the amount that it should. And if blood does not reach cells, they receive less oxygen and suffer from it. You might think that this would be compensated for by the vasodilatory effect of alcohol. But continued consumption of alcohol is harsh on tissues, causing an oxidative effect that damages and weakens them. This is especially dangerous for the heart and cardiovascular system. In Pittsburgh, I visited several young patients who had been admitted to the ICU with sudden cardiac problems. When a urine test is conducted, cocaine is often detected, but that test is not always carried out. And it is not easy for a person who has used illegal drugs to admit it during a medical consultation. That is why I think that many cases go unnoticed.

Q. You have spent many years in high-level positions in the United States and came back to Spain two years ago. Has anything here surprised you?

A. A few things. One of them is cocaine consumption, how normalized it has become. That is something that even I, who doesn’t spend much time in certain environments, have noticed. And I’m coming from the United States, which is also a big consumer of the drug, although to measure it, we always have to turn to indirect sources, like its presence in wastewater. Various studies have placed Barcelona among the cities with the highest rates of cocaine consumption. And I don’t see that being talked about much, it doesn’t appear to have raised much alarm or awareness among young people regarding dangers to their health. To me, that’s shocking. The subject of alcohol consumption is more expected…

Q. What about alcohol consumption?

A. It is so deeply rooted that we do not even attach importance to things like the fact that half of all 15 to 18-year-olds have drunk alcohol in the last month, when they are not allowed to buy it and therefore, that continues to be illegal consumption. In the United States, which does not set a good precedent in many health-related matters, routine checks are carried out to prevent minors from accessing alcohol and adults who provide them with it face harsh penalties. In our country, it is uncommon for a young person to have to show ID to consume alcohol. Still, we have identified worrisome phenomenon that we have to try to prevent from coming here.

Q. Like what?

A. We just published in JAMA, one of the world’s leading medical journals, that the incidence of alcohol-related hepatitis and cirrhosis in young women has multiplied in the English-speaking world. It hasn’t happened here yet, but if we look at consumption data, we see that young girls already drink more than young boys. Fifty-five percent of adolescents between the ages of 15 and 18 have drank during the last month, while among boys, that rate is at 50%. And we know that if the risk factor increases, the illness winds up increasing. We’ve seen it with tobacco and lung cancer. The Spanish Ministry of Health is preparing a law regarding alcohol and minors, and it’s a step in the right direction.

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