Nationwide Public Health Alert Issued Concerning Life-Threatening Risk Posed by Cocaine Laced with Veterinary Drug

The Substance Abuse and Mental Health Services Administration (SAMHSA) issued an alert to medical professionals, substance abuse treatment centers and other public health authorities this week about the risk that substantial levels of cocaine may be adulterated with levamisole – a veterinary anti-parasitic drug. There have been approximately 20 confirmed or probable cases of agranulocytosis (a serious, sometimes fatal blood disorder), including two deaths, associated with cocaine adulterated with levamisole. The number of reported cases is expected to increase this information spreads.

“SAMHSA and other public health authorities are working together to inform everyone of this serious potential public health risk and what measures are being taken to address it,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., MPH.

Levamisole is used in veterinary medicine and is currently approved for use in cattle, sheep and swine as an anti-parasitic agent. Although it was once used in human medicine in the past for treating autoimmune diseases and cancer, it is no longer an approved drug for human use.

Ingesting cocaine mixed with levamisole can seriously reduce a person's white blood cells, suppressing immune function and the body's ability to fight off even minor infections. People who snort, smoke, or inject crack or powder cocaine contaminated by levamisole can experience overwhelming, rapidly-developing, life threatening infections. Other serious side effects can also occur.

According to the Drug Enforcement Administration and State testing laboratories, the percentage of cocaine specimens containing levamisole has increased steadily since 2002, with levamisole now found in over 70 percent of the illicit cocaine analyzed in July. In addition, a recent analysis in Seattle, Washington found that almost 80 percent of the individuals who test positive for cocaine also test positive for levamisole.

According to the SAMHSA alert substance abuse treatment providers, clinicians, outreach workers, and individuals who abuse cocaine need to be aware of the following:

A dangerous substance, levamisole, is showing up with increasing frequency in illicit cocaine powder and crack cocaine. Levamisole can severely reduce the number of white blood cells, a problem called agranulocytosis. THIS IS A VERY SERIOUS ILLNESS THAT NEEDS TO BE TREATED AT A HOSPITAL.

If you use cocaine, watch out for:

• high fever, chills, or weakness
• swollen glands
• painful sores (mouth, anal)
• any infection that won’t go away or gets worse very fast, including sore throat or mouth sores -skin infections, abscesses -thrush (white coating of the mouth, tongue, or throat) -pneumonia (fever, cough, shortness of breath).”

SAMHSA is working with the U.S. Centers for Disease Control and Prevention (CDC), the Drug Enforcement Administration, the Food and Drug Administration, the Office of National Drug Control Policy, and other federal and international organizations, as well as state agencies to monitor the levamisole issue. CDC will be publishing a case report analysis in the Morbidity and Mortality Weekly Report (MMWR) and will be working with state health departments to systematically collect information on cocaine-associated agranulocytosis cases. Information from this effort will be used to guide treatment and prevention initiatives to address this public health concern.

Individuals are encouraged to report suspected and confirmed cases of agranulocytosis that are associated with cocaine abuse to their respective state health departments. Cases can also be reported to local Poison Control Centers (1-800-222-1222), these centers may also provide assistance in clinical management and additional reporting.

For further medical/technical information, contact Nicholas Reuter, SAMHSA.