Cocaine & Levamisole

The serious side effects of cocaine laced with a veterinary drug has prompted a nationwide health alert.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) issued a warning to substance abuse treatment centers, medical professionals and other public health authorities about the dangers of cocaine laced with levamisole, a drug used to prevent parasites in cattle, sheep and swine.

Levamisole was once used in human medicine to treat autoimmune disease and cancer, but is no longer approved for use in humans. Mixing the veterinary drug with cocaine causes agranulocytosis, a serious and often fatal blood disorder that reduces a person’s white blood cells, suppressing immune function and the body’s ability to fight infections.

The symptoms of agranulocytosis appear rapidly, and include the following:

  • High fever, chills or weakness
  • Swollen glands
  • Painful sores in the mouth and anus
  • An infection that won’t go away or that quickly gets worse
  • Thrush (a white coating of the mouth, tongue or throat)
  • Pneumonia
  • Skin infections or abscesses

An Increasing Problem

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. Drug Enforcement Administration (DEA). Samples of cocaine that were analyzed in July found that nearly 80 percent contained the veterinary drug, according to SAMHSA.

An Aug. 31 Associated Press article reported that levamisole began showing up frequently in cocaine from Columbia beginning in January 2008, and that, by late 2008, the DEA found the laced cocaine being widely circulated. Nearly 30 percent of all U.S. cocaine seizures are laced with the drug, according to an AP review of DEA documents.

Don LeGatt, a clinical toxicologist at the University of Alberta who has studied levamisole in cocaine, told the AP that the drug elevates opiate levels in the brain, much like morphine and codeine. “Once you get those elevated, people tend to feel fairly comfortable and not too bad,” he said.

It may also increase dopamine levels in the brain, providing users of laced cocaine with a more intense high than they would get through cocaine that has not been tainted, reported the AP.

Immediate Treatment Necessary

SAMHSA is informing substance abuse treatment providers, clinicians, outreach workers and users of cocaine that agranulocytosis is a very serious illness that needs to be treated at a hospital. 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.

The AP reported that most physicians know almost nothing about the risks of cocaine laced with levamisole, and cited LeGatt as saying that doctors should consider exposure to levamisole when otherwise healthy adults or newborns come down with infections due to low white blood cell counts.

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.