Levamisole Toxicity From Adulterated Cocaine

The increased prevalence appears to be correlated with the escalating abuse of levamisole-adulterated cocaine . This review will summarize the range of clinical and pathologic findings seen in the setting of levamisole-adulterated cocaine exposure with an emphasis on the morphologic features observed in patient biopsies. Previous studies consistently showed strong deficits of CU in attention and working memory, whereas the heterogeneous concept of executive functions was usually less affected15,38,39,40. Here, we also found clear cocaine but no pronounced levamisole effects in the domains of attention and working memory but a significant levamisole effect on executive functions. Thus, one might speculate that at least some of the reported discrepant findings in the newer literature regarding executive function impairments41 might be explained by differences in recent levamisole exposure. A “cutting” agent is an adulterant used to increase the weight or volume of drug product and often thought to modify or increase drug effect.

  • In Holland, the figure is 60 percent, and in the US the DEA puts it at 73 percent.
  • In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.
  • Unless, that is, you’re from northern Finland (which I’ll get to later).
  • Because levamisole shows up in urine for only a few days after exposure, it is important to do any relevant tests as soon as possible.
  • It has been suggested that levamisole might act synergistically with cocaine in producing a longer and intensified ‘high’ .
  • Changes of heart rate during the exposure to the evaluated substances and the following recovery-period are expressed as the deviation from these individual “base lines” and are presented in Figs.1 and 2.

It is critical to identify other treatable causes of vasculitis such as infection or autoimmune disease. It is also important to evaluate and identify any internal organ involvement. The differential diagnosis for cocaine levamisole toxicity includes many of the same diagnoses as for leukocytoclastic vasculitis or drug toxicities. Secondary causes of LCV such as infection, medication reactions, neoplasms, and autoimmune connective tissue disorders should be sought out. Lynch K.L., Dominy S.S., Graf J., Kral A.H. Detection of levamisole exposure in cocaine users by liquid chromatography-tandem mass spectrometry.


Levamisole is also cheaper to obtain than cocaine, making this veterinary pharmaceutical easily accessible, plus it shares similar chemical properties to cocaine. Increased sensorimotor gating in recreational and dependent cocaine users is modulated by craving and attention-deficit/hyperactivity disorder symptoms. The majority of patients have full resolution of symptoms and signs after withdrawal from levamisole–adulterated cocaine.

The serious side effects of cocaine laced with a veterinary drug has prompted a nationwide health alert. Buchanan J.A., Heard K., Burbach C., Wilson M.L., Dart R. Prevalence of levamisole in urine toxicology screens positive for cocaine in an inner-city hospital. Ullrich K., Koval R., Koval E., Bapoje S., Hirsh J.M. Five consecutive cases of a cutaneous vasculopathy in users of levamisole-adulterated cocaine. Olsen N., Halberg P., Halskov O., Bentzon M.W. Scintimetric assessment of synovitis activity during treatment with disease modifying antirheumatic drugs. Levamisole is currently approved as an antihelminthic agent in veterinary medicine, but is also being used illicitly as a cocaine adulterant or bulking agent, given its physical similarity to cocaine. Alteration of cocaine with levamisole can cause serious toxicity-related reactions and result in an increasing number of serious medical complications, emergency department presentations, and hospitalizations.

levamisole coke symptoms

The extend of the increase ranged from 4 to 70 mmHg while the decrease ranged from 51 to 57 mmHg. During the recovery period, several hearts showed further “peaks”, meaning an increase of LVPmax at different points of time ranging from 6 to 65 mmHg while other hearts presented only little changes or a slight but steady alcohol cravings decrease. SAMHSA reports 20 cases of agranulocytosis, including two deaths. Agranulocytosis can show up in users who snort, smoke or inject crack or powder cocaine contaminated by levamisole. Treatment of levamisole toxicity is primarily supportive, and skin lesions typically resolve with cessation of cocaine use.

For over 30 years, Bowling Green Brandywine has provided drug addiction & alcohol abuse rehab treatment for men and women in Kennett Square, Pennsylvania. SAMHSA officials are unclear how and why levamisole is showing up in cocaine. The amount of cocaine laced with levamisole in the United States has been increasing since 2002, according to the U.S. Samples of cocaine that were analyzed in July found that nearly 80 percent contained the veterinary drug, according to SAMHSA. De la Hera I., Sanz V., Cullen D. Necrosis of ears after use of cocaine probably adulterated with levamisole. Bertol E., Mari F., Milia M.G., Politi L., Furlanetto S., Karch S.B. Determination of aminorex in human urine samples by GC-MS after use of levamisole.

What causes levamisole-adulterated cocaine vasculopathy?

However, it was withdrawn from the US market in 2000 due to potential complications, including inducing agranulocytosis. 5 In this case report, we further characterize the renal pathology in levamisole-adulterated cocaine in light of the growing number of cases reported in recent years and to raise awareness about this new public health concern. The mnemonic LINES (Levamisole-Induced NEcrosis Syndrome) was coined to name the syndrome because the name was descriptive, reminds one of a “line” of cocaine, and is easily remembered. Urine levamisole is detected by gas chromatography mass spectrometry and must be performed within 48 hours. It is only detected in 13% of patients with suspected levamisole-adulterated cocaine vasculopathy . In the study group, LVPmax of cocaine hearts (Fig.3a) increased during the exposure period by 4 to 74 mmHg.

Chronic consumption also causes changes in structure and function of heart and blood vessels like arterial stiffness and increase of left ventricular mass . Cardiovascular complications like cardiac hypertrophy, obstructive small vessel disease and premature coronary sclerosis are the main reasons for cocaine-related sudden deaths . People who use coke cut with levamisole may experience certain adverse side effects. The most common side effect of levamisole cocaine is agranulocytosis, a rare condition in which your bone marrow doesn’t make a sufficient amount of a certain kind of white cell, most often ones called neutrophils. These are the type of white blood cells that the body needs to fight off infections. They also make up the largest portion of white blood cells in the human body.

A second possible reason why levamisole is used to cut cocaine is that it can enhance the effects of cocaine or modify its pharmacological properties. Levamisole’s nicotinic acetylcholinergic effects are thought to play a role in this. It’s believed to prolong the euphoric side effects of cocaine by acting as nicotine would on the central nervous system .

levamisole coke symptoms

Victims of tainted cocaine developed purple-colored patches of necrotic skin on their ears, nose, cheeks and other parts and suffered permanent scarring after they had used the contaminated cocaine. Last evening on NBC news, reports of this similar strain of Levamisole tainted cocaine were reported to have been found all throughout the southl and Los Angeles. News media outlets reported that 70% of cocaine was tainted with for this anti worming enzyme. Discuss the emerging public health issue related to cocaine cut with levamisole. 3 With such a widening base for potential exposure, levamisole appears to be the compound responsible for a number of newly emerging cases of toxicity reported in recent years.

What is Levamisole?

After the experiments all hearts were fixed in formalin, tissue sections were prepared and stained with hemtaoxylin and eosin (H&E). Polyarteritis nodosa – medium vessel vasculitis with subcutaneous nodules, livedo reticularis, ulcers, and gangrene as cutaneous manifestations. Wegener’s granulomatosis is ANCA positive and has necrotizing granulomatous inflammation of the upper and lower respiratory tracts, glomerulonephritis.

Levamisole is thought to increase T-cell activation and proliferation, neutrophil mobility, adherence, and chemotaxis. It is also thought to increase the formation of antibodies to various antigens. Unfortunately, it also acts as a hapten and triggers an immune reaction causing the opsonization and destruction of white blood cells. Cocaine-related deaths occur regularly in forensic routine work. In cases in which the detected concentration of cocaine is rather low and other causes of death apart from intoxication can be ruled out, the question arises if adulterants of cocaine might have played a crucial role.

How is levamisole-adulterated cocaine vasculopathy diagnosed?

The DEA says levamisole takes up nine percent of the average American bag of cocaine. An analysis last year of 103 random cocaine samples from around the world, conducted by the Energy Control drug testing service, found that the average concentration was 11 percent. Levamisole, a common cutting agent in cocaine, made the news recently for its apparent skin-destroying properties—but there’s a lot more to the substance than that. LVPmax of the hearts of the control group was rather stable, increasing only sligthly from 68 to 74 mmHg during the addition of buffer. During the administration of ACN, the LVPmax increased slightly by 3 to 24 mmHg in the first minute and then decreased during and after the addition until the end of the experiment by 56 to 106 mmHg (Fig. 1b). Use of this site constitutes acceptance of Skinsight’s terms of service and privacy policy.

Most of the hearts also showed a second peak between minute 1 and 20 of the recovery period with an increase of 14 to 56 mmHg. Only the hearts that were exposed to 0.5 μg and 5 μg of cocaine did not show this second peak. Furthermore, the hearts exposed to 5 μg cocaine presented a continuous decrease of LVPmax during the recovery-period. Stock solutions of each cocaine and levamisole chronic heavy drinking leads to serious risk of dementia, study warns in acetonitrile with concentrations of 100 μg/mL and 1 mg/mL were prepared. Cocaine was dissolved in acetonitrile to prevent its spontaneous hydrolysis to benzoylecgonine . Different quantities of these stock solutions were added to 5 mL of Krebs-Hensleit buffer in a 50-mL perfusor syringe in order to expose the study hearts to different amounts of the substances.

The diagnosis of levamisole-adulterated cocaine vasculopathy should be considered in individuals with current cocaine use, painful joints, and retiform purpura. «So yes, to an extent, the low concentration is somewhat protective in that the total daily dose will be low.» So does snorting cocaine that contains five, 10 or even 20 percent levamisole warrant the media hype? After all, there are up to an estimated 21 million cocaine users on the planet—you’d expect the hospitals to be rammed with people losing all their skin. Levamisole has, over the last decade, become a major cutting agent in the world’s cocaine supplies.

Improved reporting of cases to state public health departments and the Centers for Disease Control and Prevention will help us to understand the true incidence and prevalence of this condition among cocaine users. Additionally, it is still unclear https://en.forexpamm.info/ why only some cocaine users develop levamisole toxicity. Of those who develop this condition, some present in more severe forms with widespread vasculitis and necrosis, while others present with only mild cutaneous symptoms and arthralgias.

His crack pipe was acquired at a later time by the Drug Enforcement Agency and the remnant cocaine also tested positive for levamisole. Cocaine levamisole toxicity is a diagnosis of exclusion and depends heavily on the history. Although very suggestive, the use of cocaine before a characteristic purpuric eruption does not necessarily implicate this drug or contamination with levamisole.

The rats were anaesthetised by intraperitoneal injection of 29 ng pentobarbital and 1000 IE heparin. Rats were decapitated and the hearts were excised immediately and mounted on the Langendorff system. The hearts were perfused at constant pressure with a modified Krebs-Hensleit buffer solution. Oxygenation was realized with a carbogen mixture consisting of 95% O2 and 5% CO2.

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