A veterinary deworming agent, levamisole, found in both cocaine and heroin has caused infectious diseases and skin lesions requiring emergency care. A case series published online yesterday in Annals of Emergency Medicine calls levamisole-contaminated cocaine “an important emerging public health concern” in view of the nearly two million cocaine users in the United States (“Passive Multistate Surveillance for Neutropenia after Use of Cocaine or Heroin Possibly Contaminated with Levamisole”, PDF).
“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 lead study author Sara J. Vagi, PhD, of the Centers for Disease Control and Prevention in Atlanta, Georgia. “Nearly half of the patients in our case series were admitted to the hospital from the emergency department. There was one death.”
Working with local poison centers and state health departments, researchers compiled 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 (12) 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 departments. More than half (12) had infectious illnesses and nearly half (10) reported active skin lesions. Other health problems included fever, sore throat, body aches, abscesses and chest pain.
“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,” said Dr. Vagi. “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.”
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.