The illicit cocaine supply is widely contaminated with levamisole, a veterinary drug not intended for human consumption. This adulterant poses significant health concerns, transforming cocaine into a more dangerous substance with serious medical complications.
Levamisole’s Role as a Cocaine Adulterant
Levamisole hydrochloride is an anthelmintic, used to treat parasitic worm infections in livestock. Though it had limited human use, it was withdrawn from the U.S. market in 2000 due to adverse effects.
This veterinary drug is now a common cutting agent in illicit cocaine due to several factors. Levamisole is a white, crystalline powder, visually indistinguishable from cocaine. It can also interfere with some field drug tests, leading to false positives for cocaine purity, which benefits distributors. Additionally, some in the illicit drug trade believe it enhances or prolongs cocaine’s euphoric effects or adds bulk, as it metabolizes into aminorex, a stimulant.
Severe Health Consequences
Exposure to levamisole through contaminated cocaine can lead to a range of health problems. The most significant side effect is agranulocytosis, a drastic reduction in neutrophils, a type of white blood cell that fights infection. This condition severely compromises the immune system, leaving individuals highly vulnerable to bacterial and fungal infections. Another serious complication is vasculitis, which involves the inflammation of blood vessels. This often manifests as painful, purplish skin lesions, particularly on the ears, nose, and other extremities, and can progress to skin necrosis, or tissue death. Vasculitis can also affect internal organs, leading to kidney problems like glomerulonephritis or pulmonary hemorrhage in the lungs. Other potential health issues include joint pain (arthralgia), neurological problems such as encephalopathy, and psychiatric symptoms. Chronic exposure can also contribute to kidney damage, liver toxicity, and cardiovascular issues. The combined effects of immune suppression and tissue damage highlight the risks associated with levamisole-adulterated cocaine.
Widespread Presence and Detection
Levamisole has become a pervasive adulterant in the global cocaine supply. Reports indicate that a significant percentage of seized cocaine samples contain levamisole. For instance, the U.S. Drug Enforcement Agency reported that up to 87% of seized cocaine bricks contained levamisole. Users cannot visually identify levamisole in cocaine due to its similar appearance. Accurate detection requires specialized laboratory testing, such as gas chromatography-mass spectrometry (GC-MS). This method identifies chemical components, confirming levamisole’s presence.
Medical Management and Prognosis
Diagnosing levamisole toxicity involves a patient’s history of cocaine use, physical examination for characteristic symptoms like skin lesions, and laboratory tests. A complete blood count (CBC) checks neutrophil levels, as agranulocytosis is a hallmark of levamisole exposure. Tests for specific antibodies, such as antineutrophil cytoplasmic antibodies (ANCA), may also be conducted.
The primary treatment for levamisole toxicity is the immediate cessation of cocaine use. Medical care then focuses on supportive measures, which include treating any opportunistic infections that arise due to a compromised immune system. Corticosteroids may be used to manage vasculitis, and in severe cases of agranulocytosis, granulocyte colony-stimulating factors (G-CSF) can be administered to stimulate white blood cell production.
While many individuals recover with prompt treatment and discontinuation of cocaine use, the prognosis can vary. Severe cases of levamisole toxicity can lead to prolonged illness, permanent tissue damage, or be fatal, particularly if overwhelming infections occur as a result of agranulocytosis. Recovery of neutrophil counts generally occurs within 10 days after discontinuing cocaine use.