Levamisole: A New Cutting Agent?

An old drug called levamisole is exacerbating health risks for cocaine users in the United States. From the early 2000s to recently, traces of levamisole have been found in various shipments of cocaine. The Drug Enforcement Agency (DEA) estimated that 80% of cocaine is cut with levamisole, which is linked to debilitating and often fatal immunologic side effects in cocaine users.¹ At our Clearbrook Pennsylvania rehab, we treat people with substance use disorders like cocaine addiction, and we wanted to look at this commonly used cutting agent, how it affects the body, and why it’s used to cut cocaine.

What Is Levamisole?

Also known as levamisole hydrochloride, levamisole is an antihelminthic drug or immunomodulatory agent, previously used to treat parasitic, viral, and bacterial infections before being approved by the FDA as a supplemental treatment for colon cancer. Anthelmintics are a group of drugs that are used to expel parasitic worms (helminths) from the body by causing as slight damage to the host as possible. As an immunomodulatory drug, levamisole also changes the body’s immune system by either activating or suppressing certain functions. Due to its immunomodulatory side effects, it’s been studied as an option for treatment in various immune-related diseases. However, back in 2000, levamisole was pulled from the market in the United States due to its adverse side effects and because it was found in many traces of cocaine.

Some common levamisole side effects include:

• Nausea
• Vomiting
• Diarrhea
• Mouth sores
• Loss of appetite
• Stomach aches and pains
• Fatigue
• Dizziness
• Muscle aches and pains
• Fever
• Chills
• Weakness
• Sore throat
• Headache
• Skin rash

Although levamisole is no longer available for sale in the U.S., except for use in veterinary medicine, it’s become a cutting agent in cocaine.

Levamisole in Cocaine

Currently, levamisole is only approved as an anthelmintic drug in veterinary practice; however, despite its limited availability, authorities have come across many bricks of cocaine laced with levamisole. Cocaine abuse has been a public health crisis in the U.S. for years. Roughly 5 million Americans use cocaine regularly.² Reports of cocaine cut with levamisole began to break out when users experienced adverse skin reactions to the drug. Several cases of severe drug-induced skin disorders like agranulocytosis were reported in cocaine users. By July 2009, the DEA reported that over 69% of cocaine trafficked into the United States contained levamisole. In the United Kingdom, levamisole powder was found in over 50% of cocaine samples tested.²

A cutting agent is used to increase the weight or volume of a drug product, modify it, or increase its potency. Then why is levamisole used to cut cocaine? One theory is that levamisole powder looks similar to cocaine, making it cheaper for dealers and manufacturers to produce more products and also making it easier for them to gain more profit with less product. Levamisole is also cheaper to obtain than cocaine, making this veterinary pharmaceutical easily accessible, plus it shares similar chemical properties to cocaine.

A second possible reason why levamisole is used to cut cocaine is that it can enhance the effects of cocaine or modify its pharmacological properties. Levamisole’s nicotinic acetylcholinergic effects are thought to play a role in this. It’s believed to prolong the euphoric side effects of cocaine by acting as nicotine would on the central nervous system (CNS). It can enhance cocaine’s effects on dopamine levels, boosting the user’s high. Because using levamisole in cocaine has become such a common practice for drug dealers, individuals with cocaine addictions are more likely to suffer the adverse effects of this combination. Those who are dependent on coke should receive medically monitored detox to begin regaining their health.

Levamisole Coke Symptoms

People who use coke cut with levamisole may experience certain adverse side effects. The most common side effect of levamisole cocaine is agranulocytosis, a rare condition in which your bone marrow doesn’t make a sufficient amount of a certain kind of white cell, most often ones called neutrophils. These are the type of white blood cells that the body needs to fight off infections. They also make up the largest portion of white blood cells in the human body. The levamisole-cocaine combination is known not only for producing dermatological effects but also for causing skin damage and stroke. These side effects are why it was pulled from the market and is only used for veterinary medicine.

Some additional cocaine levamisole symptoms include:

• High fever, chills, or fatigue
• Swollen glands
• Painful sores in the mouth and anus
• An infection that won’t heal or quickly worsens
• Thrush (a white coating in the mouth, tongue, or throat)
• Pneumonia
• Abscesses
• Ulcers
• Skin lesions (also called levamisole skin lesions) of retiform purpura, a patch of skin that’s experienced necrosis (cell death) and ulceration due to skin ischemia (insufficient blood supply to an organ or tissue)
• Arthralgia
• Cutaneous eruptions (red, bumpy, scaly, or itches, rashes, or patches of skin that commonly occur due to an adverse reaction to medication)
• Leukopenia (a condition in which the body does not have enough leukocytes in the blood or a white blood cell count)
• Anemia
• Hematuria (blood in the urine)
• Vasculitis (inflammation of the blood vessels)
• Skin necrosis (cell death or skin death)
• Neutropenia (low count of white blood cells called neutrophils, increasing susceptibility to infection)

Levamisole is also believed to enhance users’ dopaminergic responses to cocaine while it is also metabolized into an amphetamine-like chemical, boosting the drug’s overall side effects. While the side effects of levamisole can be horrifying, it’s not the only drug used as a cocaine-cutting agent. Other substances are used as cutting agents in cocaine, including fentanyl and even common household chemicals. Individuals who abuse this drug and do not receive cocaine treatment are more likely to experience physical complications like agranulocytosis or overdose.

One of the most common myths about cocaine is that it’s a glamorous drug, but, of course, this isn’t true. Like other drugs of abuse, cocaine is highly addictive and dangerous. If you or a loved one is battling a drug or alcohol problem, we can help. Call Clearbrook Treatment Centers Pennsylvania now at 570-536-9621 to learn more about our inpatient rehab programs in Pennsylvania.