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Contaminated Cocaine

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Addiction Medicine FYI

Contaminated Cocaine

It has been reported by the Departments of Health in New Mexico, Canada and Delaware that there have been several cases of agranulocytosis (uh-gran-yuh-loh-sahy-toh-sis) following the use of cocaine. This condition leaves patients unable to fight off infections.

The unusual condition can be fatal because it compromises the immune system. It appears that the condition could be related to using cocaine that is contaminated with levamisole. The U.S. Department of Justice reported that between January and April 2008, levamisole found in tested cocaine had increased from 9 percent to 19 percent.

Levamisole is a cancer (antineoplastic) medication used in cancer treatment. It is also widely used in veterinary medicine in the de-worming of many animals. Serious side effects have been reported with the use of levamisole including: 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); and others.

People who use cocaine and experience one or more of the following should see a doctor and inform them of their cocaine use:

  • persistent or recurrent fever and chills
  • worsening swollen glands
  • painful sores in the mouth or around the anus
  • frequent, persistent or worsening skin infections
  • pneumonia
  • worsening or persistent sore throat
  • thrush - a white coating of the mouth, tongue, or throat
  • other unusual infection


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 2009.  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); and
  • 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) and/or pneumonia (fever, cough, shortness of breath).

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.