Making Crack With Levamisole Hydrochloride

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Two grams of crack cocaine

Crack cocaine, also known simply as crack or rock, is a free base form of cocaine that can be smoked. Crack offers a short but intense high to smokers. The Manual of Adolescent Substance Abuse Treatment calls it the most addictive form of cocaine.[1] Crack first saw widespread use as a recreational drug in primarily impoverishedinner city neighborhoods in New York, Philadelphia, Baltimore, Washington, D.C., Los Angeles, and Miami in late 1984 and 1985; its rapid increase in use and availability is sometimes termed as the 'crack epidemic'.[2]

  • 1Physical and chemical properties
  • 3Adverse effects
    • 3.1Physiological
    • 3.4Reinforcement disorders
  • 5Society and culture
    • 5.4Legal status

Physical and chemical properties

In purer forms, crack rocks appear as off-white nuggets with jagged edges,[3] with a slightly higher density than candle wax. Purer forms of crack resemble a hard brittle plastic, in crystalline form[3] (snaps when broken). A crack rock acts as a local anesthetic (see: cocaine), numbing the tongue or mouth only where directly placed. Purer forms of crack will sink in water or melt at the edges when near a flame (crack vaporizes at 90 °C, 194 °F).[1]

Crack cocaine as sold on the streets may be adulterated or 'cut' with other substances mimicking the appearance of crack cocaine to increase bulk. Use of toxic adulterants such as levamisole[4] has been documented.[5]

Synthesis

In order for cocaine (in plastic bag at bottom) to be converted to crack, several supplies are needed. Pictured here are baking soda, a commonly used base in making crack, a metal spoon, a tealight, and a cigarette lighter. The spoon is held over the heat source in order to 'cook' the cocaine into crack.
A close up of the 'cooking' process that creates crack.

Sodium bicarbonate (NaHCO3, common baking soda) is a base used in preparation of crack, although other weak bases may substitute for it.[6][7] The net reaction when using sodium bicarbonate is

Coc-H+Cl− + NaHCO3 → Coc + H2O + CO2 + NaCl

With Ammonium bicarbonate:

Coc-H+Cl− + NH4HCO3 → Coc + NH4Cl + CO2 + H2O

With Ammonium carbonate:

2(Coc-H+Cl−) + (NH4)2CO3 → 2 Coc + 2 NH4Cl + CO2 + H2O

Crack cocaine is frequently purchased already in rock form,[3] although it is not uncommon for some users to 'wash up' or 'cook' powder cocaine into crack themselves. This process is frequently done with baking soda (sodium bicarbonate), water, and a spoon. Once mixed and heated, the bicarbonate reacts with the hydrochloride of the powder cocaine, forming free base cocaine and carbonic acid (H2CO3) in a reversible acid-base reaction. The heating accelerates the degradation of carbonic acid into carbon dioxide (CO2) and water. Loss of CO2 prevents the reaction from reversing back to cocaine hydrochloride. Free base cocaine separates as an oily layer, floating on the top of the now leftover aqueous phase. It is at this point that the oil is picked up rapidly, usually with a pin or long thin object. This pulls the oil up and spins it, allowing air to set and dry the oil, and allows the maker to roll the oil into the rock-like shape.

Crack vaporizes near temperature 90 °C (194 °F),[1] much lower than the cocaine hydrochloride melting point of 190 °C (374 °F).[1] Whereas cocaine hydrochloride cannot be smoked (burns with no effect),[1]crack cocaine when smoked allows for quick absorption into the blood stream, and reaches the brain in 8 seconds.[1] Crack cocaine can also be injected intravenously with the same effect as powder cocaine. However, whereas powder cocaine dissolves in water, crack must be dissolved in an acidic solution such as lemon juice or white vinegar, a process that effectively reverses the original conversion of powder cocaine to crack.

Recreational use

A woman smoking crack cocaine.

Crack cocaine is commonly used as a recreational drug. Effects of crack cocaine include euphoria,[8] supreme confidence,[9] loss of appetite,[8]insomnia,[8] alertness,[8] increased energy,[8] a craving for more cocaine,[9]and potential paranoia (ending after use).[8][10]Its initial effect is to release a large amount of dopamine,[3] a brain chemical inducing feelings of euphoria.[citation needed] The high usually lasts from 5–10 minutes,[3][8] after which time dopamine levels in the brain plummet, leaving the user feeling depressed and low.[3] When (powder) cocaine is dissolved and injected, the absorption into the bloodstream is at least as rapid as the absorption of the drug which occurs when crack cocaine is smoked,[8] and similar euphoria may be experienced.

Adverse effects

Because crack is an illicit drug, users may consume impure or fake ('bunk') drug,[5] which may pose additional health risks.

Physiological

Main physiological effects of crack cocaine

The short-term physiological effects of cocaine include[8] constricted blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter.[8] Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

Like other forms of cocaine, smoking crack can increase heart rate[11] and blood pressure, leading to long-term cardiovascular problems. Some research suggests that smoking crack or freebase cocaine has additional health risks compared to other methods of taking cocaine. Many of these issues relate specifically to the release of methylecgonidine and its effect on the heart,[11] lungs,[12] and liver.[13]

  • Toxic adulterants: Many substances may have been added in order to expand the weight and volume of a batch, while still appearing to be pure crack. Occasionally, highly toxic substances are used, with a range of corresponding short and long-term health risks. Adulturants used with crack and cocaine include milk powder, sugars such as glucose, starch, caffeine, lidocaine, benzocaine, paracetamol, amphetamine, scopolamine and strychnine.[14]
  • Smoking problems: Any route of administration poses its own set of health risks; in the case of crack cocaine, smoking tends to be more harmful than other routes. Crack users tend to smoke the drug because that has a higher bioavailability than other routes typically used for drugs of abuse such as insufflation.[citation needed] Crack has a melting point of around 90 °C(194 °F),[1] and the smoke does not remain potent for long. Therefore, crack pipes are generally very short, to minimize the time between evaporating and ingestion (thereby minimizing loss of potency).[citation needed] Having a very hot pipe pressed against the lips often causes cracked and blistered lips, colloquially known as 'crack lip'. The use of 'convenience store crack pipes'[15] – glass tubes which originally contained small artificial roses – may contribute to this condition. These 4-inch (10-cm) pipes[15] are not durable and will quickly develop breaks; users may continue to use the pipe even though it has been broken to a shorter length. The hot pipe might burn the lips, tongue, or fingers, especially when passed between people who take hits in rapid succession, causing the short pipe to reach higher temperatures than if used by one person alone.
  • Pure or large doses: Because the quality of crack can vary greatly, some people might smoke larger amounts of diluted crack, unaware that a similar amount of a new batch of purer crack could cause an overdose. This can trigger heart problems or cause unconsciousness.
  • Pathogens on pipes: When pipes are shared, bacteria or viruses can be transferred from person to person.

Crack lung

In crack users, acute respiratory symptoms have been reported, sometimes termed crack lung. Symptoms include fever, coughing up blood and difficulty breathing.[16] In the 48-hour period after use, people with these symptoms have also had associated radiographic findings on chest X-ray of fluid in the lungs (pulmonary edema), interstitial pneumonia, diffuse alveolar hemorrhage, and eosinophil infiltration.[16]

Psychological

Stimulant drug abuse (particularly amphetamine and cocaine) can lead to delusional parasitosis (aka Ekbom's Syndrome: a mistaken belief they are infested with parasites).[17] For example, excessive cocaine use can lead to formication, nicknamed 'cocaine bugs' or 'coke bugs', where the affected people believe they have, or feel, parasites crawling under their skin.[17] (Similar delusions may also be associated with high fever or in connection with alcohol withdrawal, sometimes accompanied by visual hallucinations of insects.)[17]

People experiencing these hallucinations might scratch themselves to the extent of serious skin damage and bleeding, especially when they are delirious.[10][17]

Paranoia and anxiety are among the most common psychological symptoms of crack cocaine use. Psychosis is more closely associated with smoking crack cocaine than intranasal and intravenous use.[18]

Pregnancy and nursing

Main article: Prenatal cocaine exposure

'Crack baby' is a term for a child born to a mother who used crack cocaine during her pregnancy. The threat that cocaine use during pregnancy poses to the fetus is now considered exaggerated.[19] Studies show that prenatal cocaine exposure (independent of other effects such as, for example, alcohol, tobacco, or physical environment) has no appreciable effect on childhood growth and development.[20]However, the official opinion of the National Institute on Drug Abuse of the United States warns about health risks while cautioning against stereotyping:

Many recall that 'crack babies', or babies born to mothers who used crack cocaine while pregnant, were at one time written off by many as a lost generation. They were predicted to suffer from severe, irreversible damage, including reduced intelligence and social skills. It was later found that this was a gross exaggeration. However, the fact that most of these children appear normal should not be over-interpreted as indicating that there is no cause for concern. Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, yet significant, later deficits in some children, including deficits in some aspects of cognitive performance, information-processing, and attention to tasks—abilities that are important for success in school.[21]

There are also warnings about the threat of breastfeeding: 'It is likely that cocaine will reach the baby through breast milk.'The March of Dimes advises the following regarding cocaine use during pregnancy:

Cocaine use during pregnancy can affect a pregnant woman and her unborn baby in many ways. During the early months of pregnancy, it may increase the risk of miscarriage. Later in pregnancy, it can trigger preterm labor (labor that occurs before 37 weeks of pregnancy) or cause the baby to grow poorly. As a result, cocaine-exposed babies are more likely than unexposed babies to be born with low birthweight (less than 5.5 lb or 2.5 kg). Low-birthweight babies are 20 times more likely to die in their first month of life than normal-weight babies, and face an increased risk of lifelong disabilities such as mental retardation and cerebral palsy. Cocaine-exposed babies also tend to have smaller heads, which generally reflect smaller brains. Some studies suggest that cocaine-exposed babies are at increased risk of birth defects, including urinary-tract defects and, possibly, heart defects. Cocaine also may cause an unborn baby to have a stroke, irreversible brain damage, or a heart attack.[22]

Reinforcement disorders

Tolerance

An appreciable tolerance to cocaine's high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience.[8] Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users might also become more sensitive (drug sensitization) to cocaine's local anesthetic (pain killing) and convulsant (seizure inducing) effects, without increasing the dose taken; this increased sensitivity may explain some deaths occurring after apparent low doses of cocaine.[8]

Addiction

Crack cocaine is popularly thought to be the most addictive form of cocaine.[1] However, this claim has been contested: Morgan and Zimmer wrote that available data indicated that '..smoking cocaine by itself does not increase markedly the likelihood of dependence.. The claim that cocaine is much more addictive when smoked must be reexamined.'[23] They argued that cocaine users who are already prone to abuse are most likely to 'move toward a more efficient mode of ingestion' (that is, smoking).

The intense desire to recapture the initial high is what is so addictive for many users.[3] On the other hand, Reinarman et al. wrote that the nature of crack addiction depends on the social context in which it is used and the psychological characteristics of users, pointing out that many heavy crack users can go for days or weeks without using the drugs.[24]

Overdose

A typical response among users is to have another hit of the drug; however, the levels of dopamine in the brain take a long time to replenish themselves, and each hit taken in rapid succession leads to progressively less intense highs.[3] However, a person might binge for 3 or more days without sleep, while inhaling hits from the pipe.[10]

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia.[8] This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.[8]

Large amounts of crack cocaine (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior.[8] Large amounts can induce tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning.[8]

Society and culture

Synonyms

atari; base; bazooka; beamers; beemers; bebe; bee-bee; berry; bing; bolo; bomb; boulder; boulders; butter; caine; cane; Casper; Casper the ghost; cavvy; chemical; chewies; cloud; cloud nine; crills; crunch and munch; dip; famous dimes; fan; fish scale; fries; fry; glo; golfball; gravel; grit; hail; hamburger; helper; hubba; ice cube; kangaroo; kibbles and bits; kibbles; krills; lightem; paste; patico; pebbles; pee wee; pony; raw; ready; ready rocks; redi rocks; roca; rock; rooster; rox; Roxanne; scud; Scotty; scramble; scruples; seven-up; sherm; sherms; sleet; snowballs; stones; teeth; tension; top gun; tweak; ultimate; wash; white cloud; work; yahoo; yale; yay; yayoo; yeah-O; yeyo; yeo; yuck.[25]

Drug combinations

Crack cocaine may be combined with amphetamine ('croack'); tobacco ('coolie'); marijuana ('buddha'; 'caviar'; 'chronic'; 'cocoa puffs'; 'fry daddy'; 'gimmie'; 'gremmie'; 'juice'; 'primo'; 'torpedo'; 'turbo'; 'woolie'; 'woola'); heroin ('moon rock'); and phencyclidine ('clicker'; 'p-funk'; 'spacebase').[25]

Consumption

Crack smoking ('hitting the pipe'; 'puffing'; 'beaming up (to Scotty)') is commonly performed with utensils such as pipes ('bowl'; 'devil's dick'; 'glass dick'; 'horn'; 'Uzi'); improvised pipes made from a plastic bottle ('Masarati'); water pipes ('bong'; 'hubbly-bubbly'); and laboratory pipettes ('demo').[25]

Legal status

U.S. Food and Drug Administration anti-crack poster

Cocaine is listed as a Schedule I drug in the United Nations 1961 Single Convention on Narcotic Drugs, making it illegal for non-state-sanctioned production, manufacture, export, import, distribution, trade, use and possession.[26] In most states (except in the U.S.) crack falls under the same category as cocaine.

Australia

In Australia, crack falls under the same category as cocaine, which is listed as a Schedule 8 controlled drug, indicating that any substances and preparations for therapeutic use under this category have high potential for abuse and addiction. It is permitted for some medical use, but is otherwise outlawed.

Canada

As a Schedule I substance under the Controlled Drugs and Substances Act, crack is not differentiated from cocaine and other coca products. However, the court may weigh the socio-economic factors of crack usage in sentencing. As a guideline, Schedule I drugs carry a maximum 7-year prison sentence for possession for an indictable offense and up to life imprisonment for trafficking and production. A summary conviction on possession carries a $1000–$2000 fine and/or 6 months to a year imprisonment.

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United States

In the United States, cocaine is a Schedule II drug under the Controlled Substances Act, indicating that it has a high abuse potential but also carries a medicinal purpose.[27][28] Under the Controlled Substances Act, crack and cocaine are considered the same drug.

The Anti-Drug Abuse Act of 1986 increased penalties for crack cocaine possession and usage. It mandated a mandatory minimum sentence of five years without parole for possession of five grams of crack; to receive the same sentence with powder cocaine one had to have 500 grams.[29] This sentencing disparity was reduced from 100-to-1 to 18-to-1 by the Fair Sentencing Act of 2010.

Europe

In the United Kingdom, crack is a Class A drug under the Misuse of Drugs Act 1971. In the Netherlands it is a List 1 drug of the Opium Law.

Political scandals

Rob Ford, the 64th mayor of Toronto, was filmed smoking crack while he was in office. Marion Barry, Mayor of Washington D.C., was filmed smoking crack in 1990 in a sting operation.[30]

See also

Look up crack cocaine in Wiktionary, the free dictionary.
Wikimedia Commons has media related to Crack cocaine.
  • Cocaine paste ('paco')
  • Structurally related chemicals: proparacaine, tetracaine, lidocaine, procaine, hexylcaine, bupivacaine, benoxinate, mepivacaine, prilocaine, etidocaine, benzocaine, chloroprocaine, propoxycaine, dyclonine, dibucaine, and pramoxine.

References

  1. ^ abcdefghManual of Adolescent Substance Abuse Treatment, Todd Wilk Estroff, M.D., 2001 (306 pages), pp. 44–45, (describes cocaine/crack processing & melting points): p.44 has 'cannot be smoked because..melting point of 190 °C'; p.45 has 'It is the most addictive form of cocaine', webpage: [1], p. 44, at Google Books
  2. ^Reinarman, Craig; Levine, Harry G. (1997). 'Crack in Context: America's Latest Demon Drug'. In Reinarman, Craig; Levine, Harry G. (eds.). Crack in America: Demon Drugs and Social Justice. Berkeley, CA.: University of California Press.
  3. ^ abcdefghA.M. Costa Rica, July 2008, Crack rocks offer a short but intense high to smokers.
  4. ^Kinzie, Erik (April 2009). 'Levamisole Found in Patients Using Cocaine'. Annals of Emergency Medicine. 53 (4). Retrieved 2009-08-18.
  5. ^ ab'Officials warn of life-threatening cocaine in area', Stacy O'Brien, Red Deer Advocate, December 2008, webpage: reddeer-officials[permanent dead link]: notes cocaine with the worming medicine levamisole.
  6. ^Treadwell, SD; Robinson, TG (June 2007). 'Cocaine use and stroke'. Postgraduate Medical Journal (Review). 83 (980): 389–94. PMC2600058. PMID17551070.
  7. ^'Cocaine Abuse & Addiction'. www1.nyc.gov. City of New York.
  8. ^ abcdefghijklmnop'DEA, Drug Information, Cocaine', United States DOJ Drug Enforcement Administration, 2008, webpage: DEA-cocaineArchived 2008-06-22 at the Wayback Machine.
  9. ^ abWhite Mischief: A Cultural History of Cocaine, Tim Madge, 2004, ISBN1-56025-370-3, link: [2], p. 18, at Google Books.
  10. ^ abc 'Life or Meth – CRACK OF THE 90'S', Salt Lake City Police Department, Utah, 2008, PDF file: Methlife-PDFArchived 2007-10-31 at the Wayback Machine.
  11. ^ abScheidweiler KB, Plessinger MA, Shojaie J, Wood RW, Kwong TC (2003). 'Pharmacokinetics and pharmacodynamics of methylecgonidine, a crack cocaine pyrolyzate'. J. Pharmacol. Exp. Ther. 307 (3): 1179–87. doi:10.1124/jpet.103.055434. PMID14561847. Retrieved 2008-02-24.
  12. ^Yang Y, Ke Q, Cai J, Xiao YF, Morgan JP (2001). 'Evidence for cocaine and methylecgonidine stimulation of M(2) muscarinic receptors in cultured human embryonic lung cells'. Br. J. Pharmacol. 132 (2): 451–60. doi:10.1038/sj.bjp.0703819. PMC1572570. PMID11159694.
  13. ^Fandiño AS, Toennes SW, Kauert GF (2002). 'Studies on hydrolytic and oxidative metabolic pathways of anhydroecgonine methyl ester (methylecgonidine) using microsomal preparations from rat organs'. Chem. Res. Toxicol. 15 (12): 1543–8. doi:10.1021/tx0255828. PMID12482236.
  14. ^Cole, Claire; Jones, Lisa; McVeigh, Jim; Kicman, Andrew; Syed, Qutub; Belis, Mark A. (2010). Cut: A Guide to Adulturants, Bulkinh Agents and other Contaminants found in Illicit Drugs. Centre for Public Health, Liverpool John Moores University. pp. 6–25.
  15. ^ abLengel, Allan (April 5, 2006). 'A Rose With Another Name: Crack Pipe'. The Washington Post. Retrieved May 28, 2017.
  16. ^ abMégarbane, B; Chevillard, L (5 December 2013). 'The large spectrum of pulmonary complications following illicit drug use: features and mechanisms'. Chemico-Biological Interactions. 206 (3): 444–51. doi:10.1016/j.cbi.2013.10.011. PMID24144776.
  17. ^ abcd 'Delusional Parasitosis', The Bohart Museum of Entomology, 2005, webpage: UCDavis-delusional[permanent dead link].
  18. ^Morton, W. Alexander (August 1999). 'Cocaine and Psychiatric Symptoms'. Primary Care Companion to the Journal of Clinical Psychiatry. 1 (4): 109–113. doi:10.4088/pcc.v01n0403. PMC181074. PMID15014683.
  19. ^Okie, Susan (2009-01-27). 'The Epidemic That Wasn't'. The New York Times.
  20. ^'Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure, Frank et al. 285 (12): 1613 – JAMA'. Jama.ama-assn.org. 2001-03-28. Retrieved 2010-12-22.
  21. ^NIDA – Research Report Series – Cocaine Abuse and AddictionArchived September 26, 2007, at the Wayback Machine
  22. ^'Street Drugs and pregnancy'. March of Dimes. Retrieved 2009-05-26.
  23. ^Morgan, John P.; Zimmer, Lynn (1997). 'Social Pharmacology of Smokeable Cocaine'. In Reinarman, Craig; Levine, Harry G. (eds.). Crack in America: Demon Drugs and Social Justice. Berkeley, Ca.: University of California Press.
  24. ^Reinarman, Craig; Waldorf, Dan; Murphy, Sheigla B.; Levine, Harry G. (1997). 'The Contingent Call of the Pipe: Bingeing and Addiction Among Heavy Cocaine Smokers'. In Reinarman, Craig; Levine, Harry G. (eds.). Crack in America: Demon Drugs and Social Justice. Berkeley, Ca.: University of California Press.
  25. ^ abcTom Dalzell (2009), The Routledge Dictionary of Modern American Slang and Unconventional English, Routledge, ISBN978-0-415-37182-7
  26. ^'Single Convention on Narcotic Drugs, 1961'(PDF). International Narcotics Control Board. Archived from the original(PDF) on 2008-05-09. Retrieved 2008-05-01.
  27. ^'DEA, Title 21, Section 812'. Usdoj.gov. Archived from the original on 2008-08-22. Retrieved 2008-09-05.
  28. ^21 U.S.C.§ 812(b)(2)Retrieved 2008-05-01.
  29. ^Sterling, Eric. 'Drug Laws and Snitching: A Primer'. PBS. Retrieved 20 May 2013.
  30. ^LaFraniere, Sharon (January 19, 1990). 'Barry Arrested on Cocaine Charges in Undercover FBI, Police Operation'. The Washington Post. p. A1.

Further reading

  • Cooper, Edith Fairman, The emergence of crack cocaine abuse, Nova Publishers, 2002
Retrieved from 'https://en.wikipedia.org/w/index.php?title=Crack_cocaine&oldid=895370103'
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Bluelight Crew
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A VERY large percentage of cocaine worldwide at the moment contains levamisole, even if it's not very much. Levamisole severely weakens your immune system and makes you susceptable to illness and disease. It is an antibiotic/animal dewormer, and has many negative side effects. The worst part is that many medical professionals are not trained to know levamisole is in the cocaine, and do not realize that may be causing the symptoms when people go to the ER.
One of my friends who has been doing coke daily for years got leukemia, and the drug affects bone marrow and key white blood cells. The worst part is I'm watching him kill himself, he has bruising from toxicity and he still wont quit. The shit is bad, and absolutely unbelievably horrible for anyone who is addicted or a regular user.
Why can't the US just END THE WAR ON DRUGS? IT'S SO SIMPLE !!!!
No more cocaine cut with this toxic bullshit.
You can read more here:
http://www.erowid.org/chemicals/cocaine/cocaine_article2.shtml
Cocaine Adulterated with Levamisole on the RiseStatus as of September 2009
by the Erowid Crew
Oct 1, 2009
Citation: Erowid Crew. 'Cocaine Adulterated with Levamisole on the Rise: Status as of September 2009' Erowid.org. Oct 1, 2009. http://www.erowid.org/cocaine/cocaine_article2.shtml
It has long been a practice, particularly among street-level dealers, to 'cut' cocaine with diluents in order to increase profits. In the past, cuts have commonly been fairly innocuous materials, such as lactose, mannitol, or niacinamide, chosen because they match the appearance of cocaine, or chemicals such as benzocaine, lidocaine, or procaine, chosen because they cause a localized numbing effect similar to that produced by cocaine. However, in recent years there has been an upsurge in the use of more pharmacologically active chemicals as cocaine adulterants, including compounds such as acetaminophen, atropine, caffeine, hydroxyzine, methylephedrine, diltiazem, methylphenidate (Ritalin), and phenacetin.[DEA microgram 2004] [Vroegop 2009] [Elias 2007] One of the more concerning adulterants that has become increasingly prevalent over the last few years is levamisole, a pharmaceutical veterinary dewormer and a research immunomodulator.
Levamisole is Not New
Although levamisole has been a known adulterant in cocaine since at least 2002,[SAMHSA 2009] on September 21, 2009, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) made the surprising announcement that levamisole had been found in 'over 70 percent of the illicit cocaine analyzed [by the DEA] 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.'[SAMHSA 2009]
Following the SAMHSA alert, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) also sent out an email alert, which claimed that levamisole was found in over 50% of cocaine samples tested in the United Kingdom and the Netherlands during a period in 2009.[Ventura 2009] Previous reports by the DEA and testing conducted by a number of other organizations had shown levamisole present in cocaine, but in a much smaller percentage of tested samples than reported by the DEA in August/September 2009. For example, in October 2008, the DEA reported detecting levamisole in 30% of the bricks of cocaine that they analyzed,[DEA Microgram Oct 2008] and Health Canada reported 11% of cocaine samples from April to December 2008 were contaminated with levamisole.[Zhu 2009]
Levamisole Media Blitz
Beginning in late August 2009, a surge of media stories warned about negative health effects and deaths associated with levamisole as a cocaine adulterant, with Google News showing 606 stories in September alone. The death of a popular DJ and Los Angeles club owner, Adam Goldstein 'DJ AM', in late August kept the issue in the news because autopsy-related forensic toxicology results included levamisole among a long list of other drugs detected.
Levamisole Health Risks
As a cocaine adulterant, levamisole is dangerous primarily because it suppresses the immune system of those who are exposed to it. It is also possible that levamisole interacts with cocaine's stimulant effects and increases acute cardiovascular toxicity, though this is still speculation based on levamisole metabolites (such as aminorex) that have been found to occur in horses. Such metabolites have not been confirmed in humans.
Though it has been used therapeutically in humans for decades, levamisole can cause agranulocytosis (acute neutropenia), a blood disorder characterized by the disappearance of certain types of white blood cells necessary for the proper functioning of the immune system. Agranulocytosis/neutropenia can result in a wide range of problems associated with a weakened immune system including infections throughout the body, high fever, chills, swollen glands, painful sores, and wounds that don't heal. Left untreated, the condition can result in death. Agranulocytosis can be treated if detected and diagnosed properly.
Because the symptoms of agranulocytosis can be so wide-ranging, because it is an unusual condition, and because levamisole contamination of cocaine is a relatively new problem, it is essential that those seeking medical care for a condition like high fever be honest with their health care providers about the illicit substances they have taken, in order to improve their chances of being diagnosed properly and recovering quickly.
It is likely that people whose immune systems are already compromised by disease or genetic background are more susceptible to the risk of agranulocytosis from levamisole exposure.
Diagnosis and Detection Difficulties
Levamisole's half-life in blood plasma is short, less than six hours, but its immune suppression can last much longer. This makes it difficult to positively diagnose that a patient's agranulocytosis is a result of levamisole exposure, as blood or urine tests may come back negative for levamisole even when immune suppression has resulted from levamisole ingestion. Medical centers are currently forced to rule out other causes of immune problems such as HIV (AIDS), leukemias, and parvovirus. If the patient admits to cocaine use or has used cocaine recently enough that levamisole is still present in their blood or urine, some tests for unlikely conditions may be avoided.[Babu 2009]
As of Oct 1, 2009, there is no nationwide data on the number of cases of levamisole poisoning. Many health care providers are unaware of the problem, though poison control centers and the U.S. Centers for Disease Control are currently on the lookout for new cases.
General Contaminant Problems
For most pharmacologically active adulterants, the potential risks related to interactions with cocaine (and/or with each other) are unknown. Additionally, none of those compounds--when used medicinally in humans--are insufflated or smoked, and there may be increased risks based on such routes of consumption. A paper by Brunt et al. in 2009 analyzed data about street cocaine use in the Netherlands and found that 'Adulterated cocaine was associated more frequently with reported adverse effects than unadulterated cocaine.'[Brunt et al. 2009]
Unfortunately, the nature of black market substances makes it difficult or impossible to be sure that any sample of street cocaine is free from adulterants.
The DEA's message is simply 'Don't use cocaine; it's a dangerous drug',[Knierim, 2009] a position criticized by those who see drug prohibition as the cause of the difficulties, similar to the problems associated with contaminated and low-quality alcohol during the U.S. alcohol Prohibition of the 1920s.[Sullum 2009]
Levamisole Background Information
Levamisole is an antihelminthic (dewormer, anti-parasitic) used in large livestock and aquarium fish. Levamisole is also an antineoplastic (a drug that inhibits abnormal cell growth that can produce potentially malignant tumors) used in the treatment of colo-rectal cancer in humans. However, this use has been discontinued in the United States and many other countries. It acts on the central and peripheral nervous systems, and has cholinesterase inhibitory properties. Side effects from therapeutic doses of levamisole include nausea, diarrhea, dermatitis, taste perversion, fatigue, vomiting, arthralgia, infection, leucopenia,[PDR 1998] and much more rarely agranulocytosis.
Why Adulterate with Levamisole?
According to the DEA, levamisole--as well as other adulterants--is apparently present in some shipments of cocaine intercepted before they are broken up for further distribution to consumers. Considering that, in one batch, only 6% by weight of the total product sold as cocaine was levamisole, it seems possible it is more than simply a bulking agent. One theory is that levamisole or other adulterants boost the effects of cocaine, permitting material to pass for higher-quality product despite additional cuts made down the line. Another theory is that levamisole or other adulterants are added as chemical signatures used to track distribution of material.[Fucci 2007] It may be that levamisole has been used because it has similar solubility properties to cocaine and therefore is difficult to remove and has not previously been considered a serious health hazard. As of October 1, 2009, there is no definitive answer as to why it is used as a cocaine adulterant.
Can You Tell if Cocaine is Contaminated with Levamisole?
Unfortunately, there is no currently available easy, on-site test to determine if street cocaine is adulterated with levamisole. DanceSafe.org has indicated that they are working on a field test that can be used, but it is not yet available. Thin Layer Chromatography (TLC) could be used by trained individuals to check for contaminants, but requires the use of lab standards and is therefore impractical for the general public.
As of September 2009, EcstasyData.org is accepting submissions of cocaine samples in capsules, which will be analyzed by a lab that can identify levamisole. Testing costs $120 per submitted sample, which must be paid by the submitter. Unfortunately, the DEA currently restricts testing and does not allow the lab to quantify the amount of contaminants in street drugs. So far, EcstasyData has received one cocaine sample, sent from Butte, Montana, which was found to contain levamisole.
Where has Levamisole Been Found?
Data from the following countries is not inclusive of all levamisole findings, but represents a brief survey of information available showing how widespread levamisole-tainted cocaine is.
AUSTRALIA # -- From 70 seizures, 59% of cocaine seized during 2005 and 2006 was of Colombian origin. Adulterants found included levamisole (10% of adulterated seizures), which was noted as the 'most interesting' along with diltiazem and hydroxyzine, 'as they had not been observed previously in border-level seizures of cocaine'.[Australian Federal Police 2005/6]
CANADA # -- Zhu et al. reported in February 2009: that, 'Levamisole contaminated [..] 11% of cocaine samples tested in Alberta, Canada, from April to December 2008.'.[Zhu et al 2009] In January 2009, Alberta Health Services reported that the public health department had become aware of cases of agranulocytosis related to cocaine and levamisole. 67% of the cases were females, with the first confirmed case in August 2008, and the first 'probable case' in April 2007. Following hospitalizations in Alberta, public health notices went out in several Canadian cities, warning about tainted cocaine and the symptoms to watch for.
COLOMBIA # -- Multiple batches of cocaine sourced from or tested in Colombia have contained levamisole. In February 2009 a Miami, Florida DEA lab tested a magazine page that was coated with a thick plastic 'protective' covering that they determined contained cocaine and levamisole. The page had originated from Bogotá, Colombia.[DEA Microgram February 2009]
FRANCE (& BELGIUM) # -- Samples in which levamisole was detected in 2004 were seized in Guyana, the Antilles, and a shipment coming from Venezuela. Système National d'Identification des Toxiques et Substances (SINTES) reported seizures of levamisole-tainted cocaine in Belgium.[OFDT 2005] Their data shows that levamisole is a less common adulterant (present in only 11-12% of seized cocaine) than phenacetin, diltiazem, caffeine, and hydroxyzine, though it is slightly more common than lidocaine and procaine. All of these are showing up increasingly in adulterated samples, with the exception of lidocaine, which is waning.[OFDT 2008]
GUYANA # -- In February 2009 a New York City DEA lab received 192 churros (fried pastries) that arrived at JFK Airport from Guyana. Each churro contained a plastic-wrapped cylinder of cocaine adulterated with levamisole.[DEA Microgram Feb 2009]
ITALY # -- Italian seizures (published in 2007, without stating when analysis was conducted) showed 'trace amounts of hydroxyzine and levamisole'. It was not clear whether they were co-present.[Fucci 2007]
JAMAICA # -- In April 2009 the DEA reported seizing two packages shipped from Jamaica to addresses in Chesapeake and Portsmouth, Virginia, that contained a total of 323 grams of material, containing cocaine, caffeine, and levamisole.[DEA Microgram Apr 2009]
THE NETHERLANDS # -- The best data comes from a study published in 2009 that examined samples submitted for analysis to the Dutch Drugs Information and Monitoring System (DIMS) between 1999 and 2007. DIMS permits consumers to turn in material, provide information on what it was sold as and what its effects were, and receive results on the material's contents one week later. According to the Dutch research, 2004 was the year levamisole was first found as an adulterant, the same year it was detected in France and Belgium. The Dutch data shows an increase in the percentage of samples containing levamisole between 2004 and 2007 (from 0.6% to 11.6% of samples). Reported adverse effects were likelier in cocaine adulterated with diltiazem, hydroxyzine, and phenacetin. However, the diluents procaine and lidocaine, and the adulterants caffeine and levamisole, were not associated with a higher likelihood of adverse effects.[Brunt et al. 2009]
SPAIN # -- During Summer 2009, the risk reduction group Energy Control detected levamisole in two samples of cocaine that came from Granada, a province in the south of Spain.[Ventura 2009]
SWITZERLAND # -- Two cocaine samples from Zürich subject to quantitative analysis by the harm reduction group Safer Clubbing Switzerland found: 1) cocaine (51.8% ), phenacetin (44.2% ), and levamisole (3.3% ), and: 2) cocaine (21.6% ), phenacetin (41.9% ), levamisole (3.3% ), and caffeine (0.5% ).[Ventura 2009] A Swiss harm reduction group reported in private communication to Erowid that they are commonly testing for levamisole in 2009 and are seeing around 75% of the cocaine they test adulterated with levamisole, though it only constituties 3-4% of the total mass of 'cocaine' powder. They report that phenacetin is even more common and often makes up 30-50% of the powder sold as cocaine. This group first found levamisole in cocaine samples in 2008.[Buecheli 2009]
UNITED KINGDOM # -- Levamisole was first detected in the United Kingdom in April 2005; it was found in cocaine-positive urine collected from deceased individuals.[Morley et al. 2006] Fourteen such cases between 2005 and 2006 were examined; 13 of the decedents were male and 'known drug abusers'. At the time, the researchers had personal-communication intelligence about levamisole-contaminated cocaine seizures in Australia, Europe, and North America. Over a period of one week, when the researchers were collecting urine samples among people in rehab, of those who tested positive for cocaine, no levamisole was detected in the urine samples.
UNITED STATES # -- Data regarding the first appearance of levamisole in cocaine, as reported by the DEA, is not entirely clear. In a 2008 paper, a graph shows April 2005 as the first year that levamisole is present in 'Cocaine HCl Bricks'.[Casale et al. 2008] However, a 2005 paper refers to material analyzed 'over approximately the past two years' and 'containing various amounts of levamisole', which could refer to samples analyzed as early as 2003.[Valentino et al. 2005] The September 2009 SAMHSA report suggests that the DEA had been detecting levamisole as early as 2002. In Delaware, as early as September 2005, it was mentioned that there had been fatalities 'from this drug as well as from crack'.[Delaware Health Alert Network 2005]

I just thought I'd share this with you. Be careful with cocaine, most of it has this stuff, and you don't want to get addicted. Also, if you make crack/freebase, or try to wash it, the levamisole doesn't come out. It will actually stick to the rock if you make crack/freebase, so it's almost impossible to get out