Cocaine users warned about flesh-eating additive

CDC says users could lose parts of their nose or ears

There are many good reasons to stay away from cocaine, starting with the fact that it's addictive, expensive and illegal. But the U.S. Centers for Disease Control and Prevention (CDC) is sounding the alarm about another good reason.

Drug dealers increasingly use a veterinary de-worming agent, levamisole, to cut both cocaine and heroin. In a study based on U.S. emergency room reports, CDC says levamisole-contaminated cocaine is "an important emerging public health concern" in view of the nearly two million cocaine users in the U.S.

The drug, also used in the past as a cancer treatment, has caused infectious diseases and skin lesions among cocaine users. In fact, the effects of the drug have, in some cases, caused large patches of flesh to die.

Keeping ERs busy

"Not only is the cocaine causing harm, but the levamisole in it is causing health problems serious enough to bring people to the ER," said the CDC's Sara J. Vagi. "Nearly half of the patients in our case series were admitted to the hospital from the emergency department. There was one death."

Dermatologists were the first to call attention to the problem. Over the last several years they have been called upon to treat gruesome wounds in patients that all reported cocaine use.

The levamisole in the cocaine attacks the blood vessels running through the skin. Without blood, the skin dies. The condition is called necrotising vasculiti, meaning an interruption of blood flow to critical cells.

Used to cut cocaine since 2003

According to the National Institutes of Health (NIH), Levamisole has been identified as a cocaine adulterant in the U.S. since 2003. It's not clear why dealers have chosen that drug as a diluting agent but health officials say it creates a similar effect to cocaine. Rather than cut the cocaine with harmless banking powder, they choose to add a substance that leads the purchaser to believer the cocaine is more pure.

By 2009, the U.S. Drug Enforcement Administration (DEA) estimated that 69% of the cocaine seized contained levamisole. The current estimates of U.S. cocaine containing the drug are as high as 80 percent.

CDC researchers worked with local poison control centers and state health departments to compile case reports of emergency patients with neutropenia who admitted to cocaine or heroin use within a month of their visit to a healthcare facility. Of the 23 cases, more than half were from Michigan, 10 were from New Mexico and one was from Minnesota.

Nineteen of the 23 cases of levamisole-induced neutropenia and skin necrosis were reported from emergency rooms. More than half had infectious illnesses and nearly half reported active skin lesions. Other health problems included fever, sore throat, body aches, abscesses and chest pain.

On the front lines

"The serious health effects associated with levamisole, the substantial associated health care costs and the large number of people using cocaine in the United States put emergency physicians on the front line of this public health problem," Vagi said. "Our small sample size is likely an underestimation of the problem, given reports from the U.S. Drug Enforcement Administration showing that more than two-thirds of cocaine seized before arriving in the U.S. is laced with this dangerous contaminant."

The effects vary depending one the user's immune system and how much of the drug is consumed. Wounds caused by the drug do not heal, leaving a shiny scar. In some cases, large patches of the nose and earlobe may turn brown and die.

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