Cocaine and Levamisole: Waiting for the Cycle to Repeat

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It first came to the medical profession’s attention in 2008, in Canada. Then, the syndrome appeared in San Francisco in 2009. This summer, the condition appeared in New York and Los Angeles. Patients appear with dark spots on the skin, a low white blood cell count and an immune reaction that attacks the small blood vessels of the skin. In one report, it was referred to as “flesh eating.”

A letter to the Annals of Internal Medicine describes the five Canadian patients and the common theme – a veterinary worming drug used to dilute cocaine. The common element was cocaine use within the last two weeks. The adulterant, levamisole was withdrawn for human use because of these side effects. What was it doing in cocaine?

The reason cocaine is diluted is obvious. The powder is sold by weight, adding something to a purer form adds profits. But why levamisole? The reason is because it looks like cocaine (a crystalline white powder) and passes the street level tests for adulterants. It causes a slight stimulant effect as well.

How prevalent is it? The DEA found that 69% of seized cocaine powder had levamisole in it in 2008 and 2009. Since then, the percentage with levamisole has gone up to 80%. Since users or dealers may switch suppliers, most cocaine users (90%) will show positive for levamisole in their urine. Only a small percentage of those people will come down with the most severe, flesh eating symptoms.

The question now is when the next cycle of patients will hit the hospitals. Most will get better if they do not continue to take levamisole laced cocaine. A few will develop a more serious reaction and lose parts of their noses, ears or toes. Since patients may get a serious lowering of their white cell count, secondary infections may occur, some serious – and many won’t be detected as a result of levamisole poisoning.

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