Levamisole: A Dangerous New Cocaine Adulterant

Abstract

Levamisole has increasingly been discovered in street cocaine as an adulterant. Recent reports have linked levamisole in street cocaine to agranulocytosis in cocaine users. It is well known that agranulocytosis is associated with therapeutic use of levamisole, and this may have led to the withdrawal of the drug from the US market. Levamisole was a US Food and Drug Administration-approved drug that has been used as an immunomodulator, a chemotherapy adjuvant, and anthelmintic medication. The purpose of adulterating street cocaine with levamisole is not known, but it has been speculated that it is added intentionally in order to potentiate the effects of cocaine. This may be supported by the recent report of metabolism of levamisole to aminorex in racehorses. Aminorex and related compounds, specifically 4-methylaminorex, or "ice," have high abuse potential because of their amphetamine-like pharmacological activity. This metabolism has not been reported in humans, and therefore the intended role of levamisole in street cocaine remains an enigma.

Nephrotoxic Effects of Common and Emerging Drugs of Abuse

“…An increased incidence of agranulocytosis was first noticed among cocaine abusers in 2008, and toxicologic analysis of urine revealed the presence of cocaine and levamisole (89). By 2009, levamisole was detected in 69% of cocaine entering the United States that was seized by law enforcement officials (86,90). A mini-epidemic of complications related to levamisoleadulterated cocaine use ensued (83,84,91).…”

“…It was also used as an immunomodulator for minimalchange glomerulopathy and rheumatoid arthritis and was even approved by the Food and Drug Administration in 1991 as adjuvant therapy for colorectal cancer. In 1999, however, it was withdrawn from the market in the United States because of adverse effects, most notably agranulocytosis (86,87). Of note, it is still under investigation as a possible therapy for aplastic anemia (88).…”

Levamisole-Contaminated Cocaine Use in HIV-Infected and Uninfected Unstably Housed Women

“…[1][2][3][4] Used as an immunomodulator for specific conditions in humans, and a veterinary antihelminthic, it has been speculated that one reason for contaminating cocaine with levamisole is to potentiate the effects of cocaine through increased peripheral sympathetic activity and increased central neurotransmission. 5,6 Case reports and laboratory studies have established that levamisole produces a number of potential harmful effects in humans. Harmful effects include agranulocytosis, necrotizing vasculitis, fixed drug eruptions and pruritic rashes, [7][8][9][10][11][12][13] and levamisole-toxicity cases are disproportionately described among women.…”

Desenvolvimento de sensores eletroquímicos e colorimétricos para aplicações em amostras de interesse forense

“…Nos seres humanos, além do uso para o tratamento de parasitoses, tem sido estudado em combinação com outras formas de quimioterapia para câncer do cólon, melanoma e outros [111]. A droga foi banida dos EUA e Canadá em 2000 e 2003, respectivamente, devido ao risco de efeitos secundários graves [112]. O principal efeito tóxico da droga é a agranulocitose, uma depleção grave das células brancas do sangue que deixa os pacientes mais vulneráveis à infecção.…”

“…Diversos trabalhos demonstram a identificação de levamisol como adulterante de amostras de cocaína ao redor do mundo, principalmente nos EUA, e suas graves consequências à saúde dos usuários dessa droga de abuso são reportadas [112,113]. …”