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-New Update Added 09/25/2009!! - Widely Used Cocaine Additive Kills 3, Sickens Dozens

Tchort

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By JON GAMBRELL, Associated Press Writer Jon Gambrell, Associated Press Writer – 53 mins ago
LITTLE ROCK, Ark. – Nearly a third of all cocaine seized in the United States is laced with a dangerous veterinary medicine — a livestock de-worming drug that might enhance cocaine's effects but has been blamed in at least three deaths and scores of serious illnesses.

The medication called levamisole has killed at least three people in the U.S. and Canada and sickened more than 100 others. It can be used in humans to treat colorectal cancer, but it severely weakens the body's immune system, leaving patients vulnerable to fatal infections.

Scientific studies suggest levamisole might give cocaine a more intense high, possibly by increasing levels of dopamine, the brain's "feel-good" neurotransmitters.

Drug Enforcement Administration documents reviewed by The Associated Press indicate that 30 percent of all U.S. cocaine seizures are tainted with the drug. And health officials told the AP that most physicians know virtually nothing about its risks.

"I would think it would be fair to say the vast majority of doctors in the United States have no idea this is going on," said Eric Lavonas, assistant director of the Rocky Mountain Poison and Drug Center in Denver, where as much as half of the cocaine is believed to contain levamisole. "You can't diagnose a disease you've never heard of."

Authorities believe cocaine manufacturers are adding the levamisole in Colombia, before the cocaine is smuggled into the U.S. and Canada to be sold as white powder or crack.

Economic pressures may play a role. Decreased supply in the U.S. has raised cocaine prices and lowered street-level purity. Cocaine traffickers may believe levamisole adds an extra boost to an otherwise weakened product.

Levamisole started showing up frequently in cocaine from Colombia in January 2008. By late last year, the DEA concluded that the spiked cocaine was in wide circulation.

At the same time, hospitals around the country began noticing more cocaine users coming in with agranulocytosis, an illness that suppresses white blood cells necessary to fight off infections.

In Spokane, Wash., a woman in her mid-40s who tested positive for cocaine turned up at a hospital suffering from rashes and other maladies. She eventually died, and the doctor who investigated suspected she had used cocaine laced with levamisole. Doctors suspect levamisole in at least three other illnesses in the Spokane area.

"It's hard to know where this contamination (is), in what part of the country it's located, because there's really no systematic testing for it," said Dr. Joel McCullough, health officer for the Spokane area.

"I don't think it's on the radar of a lot of people, so if there are some other symptoms, I don't know if many clinicians would think to consider that."

Other suspected levamisole deaths occurred in New Mexico and in Alberta, Canada.

Many other people have become gravely ill, including about a dozen patients in Denver and 10 more in Seattle. At least one patient in each city required intensive care or extensive surgery.

In a study published in the Annals of Internal Medicine, researchers suggested that the medication might increase dopamine in the brain, as it has in previous animal experiments.

Levamisole "elevates opiate levels in various brain regions, like codeine and morphine," said Don LeGatt, a clinical toxicologist at the University of Alberta who has studied levamisole in cocaine. "Once you get those elevated, people tend to feel fairly comfortable and not too bad."

The tainted cocaine has received only limited attention in the U.S., though federal authorities are monitoring its use, said Paul Knierim, a DEA spokesman in Washington.

"I think the message is the same: Don't use cocaine, it's a dangerous drug," Knierim said.

Doctors and hospitals remain largely unaware of the cocaine additive. A spokesman for the New Mexico health department said his office plans to write a piece for a Centers for Disease Control and Prevention newsletter in September.

LeGatt said doctors should consider levamisole exposure in cases where otherwise healthy adults or newborn babies come down with infections because of low white blood cell counts. But the levamisole only appears in urine for a few days after exposure, meaning tests should be done as soon as possible.

"When they ask their patients, they're probably going to deny that they use cocaine," he said. "But I think it's important for physicians to persevere to try and elucidate whether or not it is the cause."

In Denver, after word spread about levamisole in cocaine, one man who fell ill asked a doctor if the "animal drug" could have been making him sick. Health officials including Lavonas say the public needs to be warned about the dangers.

"It's not like you can put it on the bottle," he said.

___

Associated Press Writer Frank Bajak in Bogota, Colombia, contributed to this report.
Associated Press

08/31/2009


http://news.yahoo.com/s/ap/20090831/ap_on_re_us/us_drug_war_tainted_cocaine
 
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Tchort

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While we all should take what the DEA says with a grain of salt (maybe the entire salt mine), it can't hurt to gaurd against a potential hazard.

Levamisole has become the subject of recent attention in the medical and public health communities as a new cutting agent that is being used for cocaine. There has been a rising number of hospital cases first in Canada, and now in the United States, of patients with life-threatening, cocaine-associated neutropenia that is attributed to levamisole-adulterated cocaine
Source: Levamisole Found In Patients Cocaine

http://www.mdconsult.com/das/article/body/154945316-2/jorg=journal&source=&sp=21877276&sid=0/N/691072/1.html?issn=01960644



This is a list of side effects of Levamisole (brand name Ergamisol):

Common

-Nausea
-Vomiting
-Loss Of Appetite
-Diarrhea
-Sores in the mouth or lips
-Rash & Itching

Serious

-Allergic Reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives)

-Decreased bone marrow function or blood problems (fever or chills; or signs of infection)

-Nervous system problems (confusion or loss of consciousness, extreme fatigue, memory loss, muscle weakness, numbness or tingling; seizure, speech disturbances)

Based on the cases of Neutropenia caused by Levamisole cut Cocaine, here is a description of the problem:

Neutropenia (adjective neutropenic), from Latin prefix neutro- and Greek suffix -πενία (deficiency) is a hematological disorder characterized by an abnormally low number of a type of white blood cell called a neutrophil. Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defense against infections by destroying bacteria in the blood. Hence, patients with neutropenia are more susceptible to bacterial infections and, without prompt medical attention, the condition may become life-threatening (neutropenic sepsis).
http://en.wikipedia.org/wiki/Neutropenia

Here are some links with more information on the drug Levamisole:

http://en.wikipedia.org/wiki/Levamisole

http://www.drugs.com/mmx/levamisole-hydrochloride.html

http://health.yahoo.com/coloncancer-medications/levamisole/healthwise--d00276a1.html

If you use Cocaine, or know someone who does, this information could be very helpful if someone becomes ill. This information is not widespread among the medical community, so life saving treatment may be delayed due to misdiagnosis. Make sure someone goes to the hospital with whoever is becomes ill to inform the medical personnel of the situation.
 

bit_pattern

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Does anyone with mad chem skills be able to say whether this stuff would separate from the coke when you turn it to freebase?
 

DeadheadChemistry

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That is actually some really helpful information. Like it says almost nobody in the medical community knows about this (or many other common drug trends for that matter) and it would be vital knowledge if yourself or someone you used cocaine with became sick to the point they needed to be hospitalized. I know I'll be writing down the name of this drug so I don't forget it. I don't use cocaine very often, but it's always good to be informed.
 

bit_pattern

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To answer my own question , no it is not.

Levamisole Contaminated Cocaine: A New Epidemic?

Eric Lavonas, MD, FACEP
Chair

In January, 2009, the New Mexico Department of Health reported 11 cases of unexplained neutropenia occurring in patients who used cocaine.1 Testing of samples from some of these patients revealed the presence of levamisole, a veterinary medication that can cause agranulocytosis. Several of the New Mexico patients developed severe opportunistic infections; one died. We've found one confirmed case in Denver; a look back through our hospital's medical records system produced nine more suspected cases in the last year. Clinicians in Alberta, Canada reported a 5-patient case series in February.2 Levamisole has also been found in autopsy urine samples in Great Britain.3

What is levamisole, and what is it doing in our patient's cocaine?

The DEA has detected levamisole in cocaine seized in New York, Illinois, Florida, Kansas, Missouri.4 The drug cartels seem to be adding levamisole to cocaine shipments in the source countries; it has been detected in cocaine kilogram bricks seized in South America.5 Estimates of the prevalence of levamisole in street cocaine samples vary; here in Denver, it's 19%. Both crack and powder cocaine are involved.

Levamisole the levo isomer of tetramisole, a synthetic imidazothiazole derivative used as an antihelminthic in pigs, sheep, and cattle.6 It's actually a fascinating drug. Levamisole is an immunostimulant that enhances replication of T-lymphocytes, and, to a lesser extent, B-lymphocytes. Unfortunately, some patients (the range is 0.4% to 20%) develop agranulocytosis. This appears to be due to an autoimmune mechanism. Once patients are neutropenic, they are at risk for fulminate and opportunistic infections.

Levamisole can be detected in urine using GC, capillary electrophoresis, FTIR spectroscopy, mass spectrometry, or NMR. Analytic profiles for these methods can be found in reference 5. Currently, only a few reference labs, and the New Mexico Department of Health lab, offer levamisole testing.

Nobody outside the drug cartels knows why levamisole is being used to "cut" cocaine. It's clear that levamisole does not ruin the appearance of cocaine. It is not removed by the free base extraction process used to make crack cocaine, survives pyrolysis, and is absorbed by inhalation. It's not clear why some cocaine users, but not others, develop agranulocytosis.

What do we do about it?

This problem doesn't seem to be going away; with increased awareness, I expect diagnosed cases to increase.

From the standpoint of prevention, the message remains the same as it has since 1880: Don't use cocaine – it's bad for you! How many of the nation's 2.4 million active cocaine users will heed this advice with new information remains to be seen.

From the standpoint of therapy, I believe that every patient who uses cocaine and develops signs of infection should have a CBC with differential to evaluate for neutropenia. Patients with agranulocytosis from levamisole-contaminated cocaine should be treated like other neutropenic patient.

Keep your eye on this one, folks. I suspect this will be a frequent clinical issue in our hospitals, ED's, and clinics!

Structure of levamisole



Structure of levamisole, from reference 5.

References:

1. Anonymous. Department of Health investigates unusual contamination that harms immune system: Potential cocaine contamination could be cause [Press release]. Santa Fe, NM: New Mexico Department of Health, 2009 (Jan 16). Available at: http://www.nmhealth.org/documents/agranulocytosis1-16-09.pdf, accessed March 10, 2009.
2. Zhu NY, LeGatt DF, Turner AR. Agranulocytosis after consumption of cocaine adulterated with levamisole. Ann Int Med 2009: 150(4):287-9. Available at: http://www.annals.org/cgi/content/full/150/4/287, accessed March 10, 2009.
3. Morley SR, Forrest ARW, Galloway JH. Levamisole as a contaminant of illicit cocaine. Proceedings of the International Association of Forensic Toxicologists (TIAFT) 44th International Meeting, Ljubljana, Slovenia, 2006. Available at: http://www.tiaft2006.org/proceedings/pdf/PT-p-06.pdf, accessed March 10, 2009.
4. United States Drug Enforcement Agency, various reports, 2003-2008. Available at www.dea.gov, accessed March 10, 2009.
5. Valentino AMM, Fuentecilla K. Levamisole: An analytical profile. Microgram J. 2005: 3(3-4).

Available at: http://www.usdoj.gov/dea/programs/forensicsci/microgram/journal_v3_num34/journal_v3_num34_pg3.html, accessed March 10, 2009.
 

hanselrabbit

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according to the wikipedia entry, levamisole's melting point is considerably lower than cocaine, so why would it survive pyrolysis?
 

ttfunk

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i am wondering if there is a simple way to test cocaine for presence of this....anyone?
 

bit_pattern

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Identification of Levamisole Impurities Found in Illicit Cocaine Exhibits

John F. Casale,* Elizabeth M. Corbeil, and Patrick A. Hays
U.S. Department of Justice
Drug Enforcement Administration
Special Testing and Research Laboratory
22624 Dulles Summit Court
Dulles, VA 20166
[email address withheld at corresponding author’s request]

ABSTRACT: 6-Phenyl-2,3-dihydroimidazo[2,1b]thiazole and 3-(2-mercaptoethyl)-5-phenylimidazolidine-2-one, known levamisole degradation products, were identified in a “crack” cocaine exhibit. Spectroscopic and chromatographic data are provided for both compounds, and their presence in the sample is discussed.

KEYWORDS: Levamisole, Degradation, Cocaine Base, “Crack” Cocaine, Impurities, 6-phenyl-2,3-dihydroimidazo[2,1b]thiazole, 3-(2- mercaptoethyl)-5-phenylimidazolidine-2-one, Forensic Chemistry

Introduction

This laboratory recently received a 1 gram portion of a “crack” cocaine (cocaine base) exhibit from another laboratory for the purpose of identifying an unknown component. The exhibit contained 79% cocaine base, 6% levamisole, and 3% of an unknown compound. The unknown had an apparent molecular weight of 202 Daltons based on the mass spectrum generated by the original laboratory, and was suspected to be a levamisole-related impurity. Upon screening, the exhibit was found to also contain trace amounts of a second unknown compound, suspected to be another levamisole-related impurity. Levamisole (Figure 1), an antineoplactic (cancer chemotherapy drug), has been a cocaine adulterant for nearly 5 years [1], but this is the first report of suspected levamisole impurities in illicit cocaine. The prevalence of levamisole in cocaine hydrochloride bricks has increased dramatically over the past year, and is currently found in 30% of all seizures (Figure 2). Herein, we report the preparative isolation, gas and liquid chromatographic mass spectrometry, and nuclear magnetic resonance spectroscopy of both impurities. The major unknown compound (6-phenyl-2,3-dihydroimidazo[2,1b]thiazole) was confirmed via comparison to an authentic standard, while the trace unknown compound (3-(2-mercaptoethyl)-5-phenyl-imidazolidine-2-one) was synthesized to verify its identity.



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Tchort

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i am wondering if there is a simple way to test cocaine for presence of this....anyone?
I was just thinking the same thing.

I wonder if Levamisole is capable of causing a false positive on a NIDA-5 or extended UA for a screened substance? If so, a very crude way that may or may not be reliable would be to mix a small amount of street blow with 300-500ml of water and put it in an OTC drug test, and see if the false positive result comes up.

A better idea would be to find out how Cocaine and Levamisole react to the various reagant test kits (like those available through BL, the EZ Tests), Marquis,etc.
 

fastandbulbous

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Levamisole has cholinesterase inhibitor properties if I remember correctly. That makes it akin to nerve gas poisoning

Not nice

Scientific studies suggest levamisole might give cocaine a more intense high, possibly by increasing levels of dopamine, the brain's "feel-good" neurotransmitters.
First I've heard of an anticholinesterase increasing dopaminergic activity
 

qwe

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^(@mentor)yeah... society is basically a vast unstoppable killing machine

when will a reasonable social system emerge???
 

Vivid

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30% is a large amount and not odds i would want to take when talking about using something that could take your life, or at least make you really sick.
 

hanselrabbit

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according to the wikipedia entry, levamisole's melting point is considerably lower than cocaine, so why would it survive pyrolysis?
...just answered my own question, the HCL version's melting point is very high.

according to its data Levamisole HCL is light sensitive, so that might be something for people worried about their safety.

but who's to say it doesn't photodegrade into something nastier?
 

jimjones

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I can breath but the feeling sucks now. It was bad and dangerously euphoric at that dose. Now for the down time. No more. Probably good binge over.
 
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