Levamisole, a common cutting agent in cocaine, made the news recently for its apparent skin-destroying properties – but there's a lot more to the substance than that.

A case study from the 'British Medical Journal' of a woman whose skin and flesh is rotting due to the presence of levamisole in the cocaine she had been taking. Photo courtesy BMJ

Corrupted cocaine sold in Britain is making people's skin rot. Or so we were told last week, when a series of reports warned of the 'flesh eating' cocaine causing people to suffer from a rare blood disorder that makes their flesh decompose and their ears go black. The stories came with images from a gruesome case study in the British Medical Journal, of a woman covered in dark blotches and open sores, looking like something out of a medieval physician's casebook.

Newspapers revealed the culprit: levamisole, a cattle de-worming drug found in '80 percent of cocaine' in the UK. The message being: do a bit of a gear and you'll lose all your skin.

Of course, where there are drugs, a scare story is never far behind – and the first myth to blow away here is that levamisole is any great danger to the general cocaine-snorting public. Despite the hype, the chances of cocaine giving you a blood disorder or rotting your skin are incredibly remote. Unless, that is, you're from northern Finland (which I'll get to later).

Levamisole has, over the last decade, become a major cutting agent in the world's cocaine supplies. Depending on where you live, between 40 to 90 percent of cocaine contains the drug. The British government says around 80 percent of seized cocaine shipments in 2014 contained levamisole. In Spain, a 2012 study found the drug in 57 percent of cocaine, and in Denmark in the same year it was in 90 percent of samples. In Holland, the figure is 60 percent, and in the US the DEA puts it at 73 percent.

While the substance might be found frequently, that doesn't mean cocaine is packed with the stuff. Cocaine purity research carried out by Lana Brockbals at drug identification firm TICTAC, seen exclusively by VICE, found that out of 106 samples of cocaine from an unnamed British festival last year, 83 contained traces of the de-wormer. However, the average concentration of levamisole in each wrap was just over five percent, with most samples containing between 1.5 and five percent of levamisole.

Tests on 5,000 street cocaine samples in the Netherlands between 2011 and 2014 found an average concentration of nine percent. In Spain last year, concentration was found to be, on average, 11.9 percent. The DEA says levamisole takes up nine percent of the average American bag of cocaine. An analysis last year of 103 random cocaine samples from around the world, conducted by the Energy Control drug testing service, found that the average concentration was 11 percent.

So does snorting cocaine that contains five, 10 or even 20 percent levamisole warrant the media hype? After all, there are up to an estimated 21 million cocaine users on the planet – you'd expect the hospitals to be rammed with people losing all their skin. But they're not.

I spoke to Dr Lindy-Anne Korswagen, one of the authors of the BMJ study mentioned in all the papers last week, and a doctor at Sint Franciscus Gasthuis Hospital in Rotterdam. 'Given the fact that many people use cocaine, of which large percentages are adulterated with levamisole, our case is rare,' she said. 'The risk of side effects such as agranulocytosis or levamisole-induced vasculopathy with skin ulcers and serious organ damage is small. Between 2011 and 2014, there were 210 cases reported worldwide, of which three have died.'

Dr Korswagen did warn that there may be undiagnosed cases out there.

(Photo by Andoni Lubaki)

The authors of a similar case study (someone suffering from a levamisole-induced skin disease) published in a US medical journal in 2013 said most victims they had come across were heavy cocaine users. 'Many of these affected individuals are chronic, habitual cocaine users, suggesting a large cumulative exposure to cocaine and, by association, levamisole, possibly over an extended period of time.'

Toxicologist Dr Robert Hoffman, an expert in levamisole from the New York University Langone Medical Center, told me the amount of the drug found in the average bag of cocaine 'is probably too low' to affect most users, and that when levamisole was used as a legitimate pharmaceutical in medical trials, most patients tolerated full therapeutic doses without a problem. 'Let's say the typical dose of cocaine might be 100mg, so there could be 10mg of levamisole in each dose of cocaine used. Currently, there are still trials where levamisole is used and a dose might be on the order of 150mg over a day. To get that much levamisole, you would have to use a lot of cocaine,' he said. 'So yes, to an extent, the low concentration is somewhat protective in that the total daily dose will be low.'

But it turns out it may not just be about dose; Dr Hoffman told me the evidence points to some people having a genetic vulnerability to the toxic effects of the drug. 'The literature suggests that some patients have a unique genetic predisposition that increases their risk of toxicity,' he said. 'There is always some consideration for dose, but it is a combination of dose plus susceptibility that sets the risk. Luckily for cocaine users, the known responsible genetic abnormality is very uncommon.'

The gene in question, HLA-B27, is present in about eight percent of caucasians, four percent of North Africans, two to nine percent of Chinese and 0.1 to 0.5 percent of Japanese. Oddly, in Lapland in northern Finland, a quarter of people have the gene.

That levamisole is far less of a threat to human health than the media is making out is really no surprise. In such a hugely profitable business as the cocaine trade, you're not going to do all that well making a product that turns your global customer base into a mass of sick or dying invalids – Imperial Tobacco and Philip Morris excluded. Instead, the use of a cattle de-wormer in cocaine is an indicator of how astute the cocaine cartels really are, because they appear to have unearthed the most efficient cocaine-cutting agent of all time.

READ ON MOTHERBOARD: I Went on a 'Make Your Own Cocaine' Tour in Colombia

A report due to be published later this year by a specialist unit dedicated to monitoring the chemicals used to produce cocaine, attached to the UN Office on Drugs and Crime (UNODC), found the use of levamisole to be far from anomalous. It is a strategy based on a firm business and scientific footing.

Conducted by PRELAC (Prevention of the Diversion of Chemical Precursor Substances of Drugs in the Latin America and the Caribbean Countries), the study reveals Colombian firms were the first to start using levamisole a decade ago. Now it's also used by cartels in Peru and Bolivia as the 'cut' of preference for bulking out cocaine before it's exported. In cocaine, levamisole is usually mixed with two other chemicals, such as diltiazem, phenacetin, hydroxyzine and caffeine. For the US and European markets, cocaine is cut 20 percent. If it's going to other countries in South America, such as Brazil, it can be cut to as much as 50 percent.

The authors of the report, 'Dynamics of chemical use in the production of cocaine in the Andean Region', say there are a number of reasons why levamisole has become the number one cut. It's easy to mix with cocaine, has a similar 'fish scale' appearance to high quality cocaine flake and gives the impression of having a greater volume than it actually possesses. It also gives a false positive in street tests for cocaine, so bulk buyers are not able to spot the cocaine has been cut, and is relatively cheap and easily available in bulk from cities across the Andean countries. According to an expert working for the UNODC in Colombia, the drug is regularly purchased at £32 per kilo in Bogota, Cali and Medellin, compared to £1,500 for a kilo of cocaine.

According to the UNODC, levamisole is incorporated into cocaine hydrochloride in two stages of the process: before converting cocaine base to cocaine hydrochloride, and later, when the hydrochloride has already been obtained but has not yet dried. So it's in almost everyone's cocaine, even the super rich – although I'd guess there are a few mega-mansions in Colombia and Miami where the cocaine is as pure as it comes.

WATCH: Cooking Cocaine in Lima

But the game changer – an asset of levamisole of which cartel chemists will be fully aware – is its ability to potentiate the action of cocaine in the body. A metabolite of levamisole called aminorex has amphetamine-like properties, and a growing body of research is beginning to suggest what the Colombian chemists may have known all along: cocaine mixed with levamisole creates an additional high when it's snorted.

'[The cocaine cartels] have extensive financial networks, and we must assume that this drug adds to the potency or addicting qualities of cocaine in a way we have yet to fully determine,' said Dr Hoffman. 'They have access to animal labs and thousands of human subjects, and therefore the addition of levamisole to cocaine is undergoing more testing than most approved drugs.'

These days, cartel chemists are a very different breed to the TV depiction of a guy in a baseball cap stirring a bucket in the middle of the Amazon rainforest. 'It's a mistake to think Colombian cocaine producers are peasants in a jungle lab,' says Mike Power, a journalist and author who has investigated the Colombian cocaine trade. He told me the much-filmed rural farmers (cocaleros) are only part of a big supply line from farmyard to nostril, involving chemistry, airplanes, murder and corruption.

'It would be astonishing if the narco-cartels didn't know about the emerging evidence around the stimulant effects of levamisole,' Power said. 'Four years ago in Colombia, I saw how the crystallisation [of the paste] process was moving from the jungles to underground urban labs, in well guarded apartment blocks. This is a complex science. If they can increase their profits by 10 percent by including an active cut that ticks all the boxes, then it's a no-brainer. And because most of it is being added at end of the process, before export, we know it's being facilitated by people at the high end of the trade. They know exactly what they are doing.'

But, as Power says, the end result for many cocaine users is that while the powder might be white, it's anything but pure. 'The fact is, if you've been using coke,' he said, 'you've been snorting cattle de-wormer for years now, and you're paying through the nose for the privilege.'

@Narcomania

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Alberta Cocaine Crisis[edit]

Somebody should add some information about the current crisis in Alberta with cocaine tainted with levamisole. 24.65.95.239 (talk) 20:28, 29 November 2008 (UTC)

-- Just found another article about Levamisole being a soft kill weapon added to the cocaine by eugenicists to cull the human herd. www.infowars.com/operation-softkill-street-drugs-used-for-population-control/ ^{infowars.com is fringe, does not meet our sourcing guidelines and should not be used} How did this potentially deadly combination magically become the cut of choice for two-thirds of America's cocaine?

Cocaine Laced With Cow-Worming Drug Sickens Americans (Update1) By Ellen Gibson Dec. 17 (Bloomberg) -- Two-thirds of cocaine smuggled into the U.S. is laced with a cattle-worming drug linked to a rare immune disorder in a rash of cases, a report says. The veterinary drug, levamisole, was connected to new cases of the immune disorder agranulocytosis in Canada a year ago. Public health officials in New Mexico and Washington now blame tainted cocaine for a cluster of 21 cases of the illness, including one death, according to the weekly morbidity and mortality report from the U.S. Centers for Disease Control and Prevention, in Atlanta. http://www.bloomberg.com/apps/news?pid=20601124&sid=aN454DsoGaj4

Levamisole just so happens to have very nasty side effects to alcohol. http://www.answers.com/topic/levamisole which is important because cocaine users won't think twice of mixing cocaine and alcohol. If alcohol presents itself the cocaine user has a high probability of drinking.

—Preceding unsigned comment added by Oneil (talk • contribs) 05:12, 23 December 2009 (UTC)

You could do it. Here are two good sources: [1][2] --64.180.31.86 (talk) 06:18, 1 December 2008 (UTC)

The customary dose for Levamisole when used in combination with 5-fluorouracil was 50mg 3x daily [PDR, 1996]. Not unlike other pharmaceuticals, it has adverse side effects that are more pronounced in proportion to overdose. It is interesting to note that current MSDS data sheets from MP Biomedicals are replete with dire warnings even though it was once administered to treat helminths, rheumatism, and tested on varieties of cancer. Getting back to its use as cutter stock for cocaine, the volume of drug that would be consumed to equal the daily dose of Levamisole is 300mg - assuming 50% Levamisole by weight. If it was severely cut, more than 50%, the dose would be pushed upward achieve the same effect from cocaine. It's hard to imagine why Levamisole would be used as cutter stock when there are other inert products available. The negative publicity handed out for Levamisole raises at least a couple of questions: 1.) Was Levamisole unexpectedly effective in the treatment of certain types of cancer and hence a threat to more profitable drugs? 2.) If doses significantly above 150mg of Levamisole are potentially toxic, wouldn't it be idiotic for a street-drug manufacturer/dealer to eradicate his customers? Neither of these questions rule out the possibility of rogue programs and pogroms being instigated by federal agencies - either side of the border. There remain many medications on the market despite even more injurious side effects, so the focus on Levamisole seems arbitrarily disproportionate. — Preceding unsigned comment added by VauschnVachs (talk • contribs) 04:52, 20 March 2011 (UTC)

Just be careful with the edits, i'm not sure if it was determined which enantiomer -levamisole or dextramisole - the cocaine was laced with. (and apparently, the two substances can have different effects). 198.103.172.9 (talk) 19:38, 2 January 2009 (UTC)

I am surprised that I found this page when I search for 'Decaris'. Decaris is a French painter and engraver (can be found on French Wikipedia). Nothing to do with levamisol ! Yet, I do not know how to correct this bug, the more as I did not found any reference to Decaris in the page.

Jmarc.boussard (talk) 16:35, 15 March 2009 (UTC)

melting point[edit]

This page previously reported the melting point of this substance to be sixty-one degrees celsius. It is not. Multiple sources report it to melt over a range of 226 to 233. I changed the entry in the drugbox template from 61 to 230 (If I list the full range, the template's algorithm converts it to negative 150 farenheit). The 170 degree error is not innocuous here, given this substance's application as a cocaine adulterant. —Preceding unsigned comment added by Trueno Peinado (talk • contribs) 23:56, 4 December 2009 (UTC)

According to DanceSafe, it is likely that Levamisole is used to cut cocaine instead of other substances because it stays mixed with the cocaine after an acid->base->acid purification cycle, unlike many other cuts, and thus gives the moderately industrious cocaine user the impression of a higher-quality product. Not sure how I should cite something out to a twitter account, though.208.54.15.83 (talk) 21:51, 17 March 2010 (UTC)

That sounds like a believable explanation!

One toxicological report found a cocaine user dead with levamisole, but also metoprolol, sertraline, and norsertraline in the blood. While the other alkaloids in one case can come from anywhere, it's worth noting that each of these has a secondary amine and looks pretty hydrophobic. I wonder if some cocaine cook is tossing in any colorless/tasteless alkaloid he can buy or steal. Interestingly this was another fatality (like [3]) in someone using alprazolam with levamisole..

I was also curious whether levamisole has any effect on field testing of drugs, which I was wondering might be a factor (though obviously it can't be causing police too much trouble, if it's in more than half of the cocaine). The scheme they typically use is here, but I've pretty much abandoned the speculation.

One forum I found looks worth watching in the hope a usable source will turn up, but I wouldn't bet money on it: [4]

The DEA has a chart of the rate of levamisole in seizures (and much other useful analysis) at [5]. Note that one sample was found with 6% levamisole, but an additional 3% of a breakdown product produced by distilling levamisole to dryness while making crack. All the levamisole is of pharmaceutical grade, oddly enough.

While much has been made of the 'expense' of this adulterant, I spotted one site saying it is available for export at $17.55 per kilogram.[6] We have to take a global view of the subject and remember that pharmaceuticals are cheap outside the U.S. Wnt (talk) 17:48, 1 June 2010 (UTC)

The melting point has been changed again - please read my comments in the text. It's important, when citing melting points, to know if you're writing about the free base, or one of its stereoisomers (where applicable), or a particular salt. It's also useful to try to copy the data from a primary source, since secondary sources aren't always explicit on this issue. That said, a melting point isn't as important a criterion of purity as it once (up to about the third quarter of the 20thC) was. Chemists see significant discrepancies between different papers in the literature all the time. M.p.s still have their uses, but purity is better judged these days by chromatographic and spectroscopic methods.

[By the way (and absolutely no offence is intended), the word 'alkaloid' should only be applied to naturally-occurring bases, not synthetic compounds. It's a bit like calling a tennis racquet a 'bat'..]Xprofj (talk) 23:37, 4 May 2012 (UTC) Perfect pitch ear training supercourse review.

Enantiomers are mirror images.. by definition stereochemically pure samples of both the R and S enantiomers will have the same mp (assuming identical crystallization conditions, etc.)L2OrganicChemistry71.202.140.109 (talk) 02:49, 31 July 2012 (UTC)

Levamisol or Levamisole?[edit]

Most other languages call this substance Levamisol. Google image search shows that Levamisol is what is printed on most packages. The first version of the article calls it Levamisole hydrochloride. Which one is correct? -- Petri Krohn (talk) 17:32, 12 March 2013 (UTC)

Your question is a bit confused. In English, the drug is called 'levamisole'. English has this 'silent e' thing; other languages don't, and so yes it is called 'levamisol' in other languages. Many compounds can be made and stored and used in salt form or not, depending on what is needed. The chemical formula for levamisole is C11H12N2S. Levamisole HCL is a salt form of levamisole -- it is levamisole in solution with HCL. Its formula is C11H12N2S, HCL. Same API (active pharmaceutical ingredient), different form. Jytdog (talk) 18:38, 12 March 2013 (UTC)

anonymous postcard on 'the stranger 'slog' blog a reliable source?[edit]

This article currently states: 'In response to the dangers, The Stranger, People's Harm-Reduction Alliance and DanceSafe began producing tests to identify levamisole's presence in cocaine. The kits include a survey postcard, and one revealed its presence in a 1/4-kg block of cocaine, indicating both users and dealers were using the kits.'

I checked the source, and while it does make the claim, it offers no proof that quantity of cocaine was actually tested:

'Levamisole* is still in the world's cocaine supply and our levamisole test kits—which The Stranger, along with the People's Harm-Reduction Alliance and DanceSafe, first launched into the world in 2010—are still around, too.

The anonymous, pre-stamped survey postcards that come with the kits still trickle in from time to time. Today, one arrived that was a little different. It wasn't from an individual user testing a little baggy—this person tested a larger quantity of cocaine. (A quarter kilo? Four kilos? Fourteen kilos?) It had all been cut with levamisole.

levamkilo080_black.jpgTHE STRANGER

In a way, this is exactly what I'd hoped would happen—that levamisole and awareness of its potentially dangerous effects would first start to worry customers, who would then mention that to their dealers, who would pass the concern up the chain. Two years ago, almost nobody had heard of levamisole. Now, at least one person with quantity took the time to get a kit and test his/her product—and make a frowny-face emoticon because it tested positive.'

Maybe whoever sent in the postcard lied and wrote some BS and 'the stranger' jumped at the chance to toot their own horn on their blog? — Preceding unsigned comment added by 68.79.92.24 (talk) 05:08, 1 November 2013 (UTC)

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