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Doctors Should be Alert for Levamisole Exposure in Patients

mixin

Well-known member
Snips

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."

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.

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."

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.

http://www3.signonsandiego.com/stor...ug-war-tainted-cocaine-083109/?&zIndex=158219
 
Re: Doctors Should be Alert for Levamisole Exposure in Patients

They have known about this since January 2008. We finally have a grand total of 8 states participating in surveillance?!

Based on the numbers below, how many million Americans age 12 and over are using tainted cocaine?

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Dec. 18, 2009, CDC MMWR

Agranulocytosis Associated with Cocaine Use --- Four States, March 2008--November 2009

DEA has reported that, as of July 2009, 69% of the cocaine seized at U.S. borders contained levamisole, although the reason why levamisole is added to cocaine remains unclear.

Agranulocytosis has been recognized as an idiosyncratic reaction to levamisole in 2.5%--13% of persons using levamisole for treatment of rheumatoid arthritis and in combined therapy for breast cancer (1). However, the proportion of cocaine users exposed to levamisole who might develop levamisole-induced agranulocytosis, is unknown.

CDC has begun national surveillance for agranulocytosis in association with suspected cocaine or heroin use, collecting information via medical abstraction form and patient interview. As of December 15, eight states had agreed to participate. The goals of surveillance are to characterize the extent of the problem, identify risk factors for exposure, and describe clinical presentation of patients with agranulocytosis associated with cocaine or heroin use.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a3.htm?s_cid=mm5849a3_x

--------------------------------------------

Agranulocytosis, also known as agranulosis, is an acute condition involving a severe and dangerous leukopenia, most commonly of neutrophils, causing a neutropenia in the circulating blood. It represents a severe lack of one major class of infection-fighting white blood cells. People with this condition are at very high risk of serious infections due to their suppressed immune system.

Agranulocytosis may be asymptomatic, but may clinically present with sudden fever, rigors and sore throat. Infection of any organ may be rapidly progressive (e.g., pneumonia, urinary tract infection). Septicemia may also progress rapidly.

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

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In 2008, 5.3 million Americans age 12 and older had abused cocaine in any form and 1.1 million had abused crack at least once in the year prior to being surveyed. Source: National Survey on Drug Use and Health (Substance Abuse and Mental Health Administration Web Site). The NIDA-funded 2008 Monitoring the Future Study showed that 1.8% of 8th graders, 3.0% of 10th graders, and 4.4% of 12th graders had abused cocaine in any form and 1.1% of 8th graders, 1.3% of 10th graders, and 1.6% of 12th graders had abused crack at least once in the year prior to being surveyed. Source: Monitoring the Future (University of Michigan Web Site).

http://www.drugabuse.gov/DrugPages/Cocaine.html
 
Re: Doctors Should be Alert for Levamisole Exposure in Patients

"Toxic cocaine in Alberta

Health agencies are warning Albertan street-drug users about cocaine laced with a toxic substance being sold in the province. Seven people from Red Deer to northern Alberta have developed suppressed immune systems after taking the cocaine. The resulting condition, agranulocytosis, leaves people unable to fight off infections. The condition can be fatal. Alberta Health believes that the cocaine may have been mixed with a chemical called levamisole, which is designed to treat intestinal worms in humans and animals.

By The Gazette (Montreal)November 29, 2008"
http://www.canada.com/montrealgazette/news/story.html?id=d7e7f50b-fc27-40dc-920e-ed6b2eea5544

"Forty-two cases of NATC were identified in Alberta and British Columbia from January 1, 2008 to March 31, 2009. In this time period, 16 confirmed, and 26 probable, NATC cases were identified. Eighteen (43%) NATC cases had recurrent episodes of neutropenia associated with cocaine use (range: 2 to 8 episodes).

Literature suggests that levamisole remains stable when heated [17], but may potentiate the nicotinic acetylcholine receptors of the human central nervous system and act as a ganglion nicotinic acetylcholine receptor agonist [18,19]. Levamisole has also been found to increase dopamine and endogenous opiate (morphine, codeine) levels in the brains of rats [20]. However, it remains unknown where levamisole is added to the cocaine and for what purpose."
http://www.harmreductionjournal.com/content/6/1/30

Levamisole, OxyContin, Coke Cocktail Kills DJ AM
http://www.cbsnews.com/blogs/2009/09/29/crimesider/entry5351261.shtml
 
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