Michael SWERLOWYCZ 1 Brett FLETCHER 2, Roger JACKSON 2 1 Forensic Toxicology Laboratory, Division of Analytical Laboratories, Sydney, NSW, Australia 2 Drugs & Driving Toxicology Laboratory, Division of Analytical Laboratories, Sydney, NSW, Australia Division of Analytical Laboratories
COWS ON COKE
Levamisole: A livestock de-wormer in cocaine
Introduction Recent DDL specimens (January 2009 onwards) were examined in Levamisole ((S)-6-phenyl-2,3,5,6-tetrahydroimidazo[2,1-b][1,3]thiazole) order to obtain comparison levamisole data from a range of living has gained attention overseas subjects. These were mostly cocaine-positive “drug/drive” in recent years as a cutting cases, as well as a number of fatal accident, sexual assault and agent for illicit cocaine. murder cases. Interestingly, levamisole appears to be more common Levamisole, or ( l) -Tetramisole, in samples from living subjects, but generally at lower concentrations is a drug used in the treatment than the coronial samples. of colon cancer, but primarily it has a veterinary use as an anthelmintic, to Prevalence of Levamisole in Cocaine-positive Cases (DDL) control parasites in livestock. January 2009 - June 2010
25 70
60 20
50 Levamisole in drug/drive Levamisole around the world and other police 15 40 specimens (DDL). Recently the US Drug Enforcement Administration (DEA) reported a 30 2009 – 2010 10 Percentage (%)
significant increase in the prevalence of the drug. In late 2008 the DEA Number of Cases
20 found as much as 30% of illicit cocaine hydrochloride exhibits contained Mean concentration in 5 levamisole, and by mid-2009 this figure had risen to 70%. This trend has 10 blood = 0.035mg/L been seen in other countries around the world and is reflected in illicit 0 0 cocaine exhibits received by Australian laboratories. Jan-09 Apr-09 Jul-09 Oct-09 Jan-10 Apr-10 Quarter
Prevalence of Levamisole in Cocaine HCl Bricks Cocaine Positive Cases Levamisole Positive Cases %
35
30 25 Levamisole in seized 20 Case Studies
15 cocaine bricks. Data 10 from the US DEA A man in his early 40’s was found hanging in his backyard. Analysis of Percent of Bricks 5 (ref. 11) preserved blood produced the following: 0 Cocaine 0.05mg/L Jul-05 Jul-06 Jul-07 Jul-08 Jan-05 Apr-05 Jan-06 Apr-06 Jan-07 Apr-07 Jan-08 Apr-08 Oct-05 Oct-06 Oct-07 Oct-08 Benzoylecgonine 0.18mg/L Quarter Levamisole 0.06mg/L Other drugs present: Alcohol, Sertraline Reports of serious illness and death in relation to levamisole-laced cocaine were seen last year in Canada and the USA, and the drug is A woman in her early 20’s found dead of a suspected drug overdose. receiving significant attention worldwide. Analysis of preserved blood produced the following: Cocaine 4.9mg/L Benzoylecgonine 3.4mg/L Levamisole 4mg/L Other drugs present: Methylecgonine, Alprazolam, Delta-9-THC Acid, Lignocaine
A man in his early 50’s found dead in his bathtub with a self inflicted wound to his wrist. Analysis of preserved blood produced the following: Cocaine <0.05mg/L Benzoylecgonine 0.81mg/L Levamisole 0.3mg/L Other drugs present: Cocaethylene, Alcohol, Diazepam, Nordiazepam, Temazepam, Quinine Yes, but what does it mean to us? A study was undertaken to determine the prevalence of levamisole where cocaine and/or benzoylecgonine was detected in coronial What should we do next? specimens received at the Forensic Toxicology Laboratory (FTL) and the Drugs & Driving Toxicology Laboratory (DDL), Division of Analytical Levamisole has become a drug of interest for the Forensic Toxicology Laboratories. Laboratory. The negative health effects and increasing prevalence in conjunction with cocaine has made Our Results it necessary for the laboratory to Cocaine-positive coronial cases (FTL) from January 2006 onwards were incorporate levamisole screening into re-examined to determine the presence of levamisole. Very few cases in which cocaine or cocaine positive cases were found prior to 2009. The following graph shows metabolites are present. the increasing prevalence of levamisole in cocaine-positive cases.
Prevalence of Levamisole in Cocaine-positive Cases (FTL) January 2006 - June 2010 References
40 40 1. Brunt TM, Rigter S, Hoek J, et al. "An analysis of cocaine powder in the Netherlands: content and health hazards due to adulterants". Addiction . May 2009;104(5):798-805. 35 35 2. Elias R. "Cancer-causing painkiller found in 60% of British cocaine hauls". The Scotsman . Aug 26, 2007. Levamisole in coronial 3. Etches V. "Emergency Department Memo: Agranulocytosis in Cocaine Users". Ottowa Health and Support specimens (FTL). 30 30 Services. Apr 9, 2009. 4. Lintemoot J. "Levamisole: An Unusual Finding in a Cocaine Related Fatality". ToxTalk . Society of Forensic 25 25 2006 – 2010 Toxicologists. Dec 2005.
20 20 5. Morley SR, Hall CJ, Forrest ARW, et al. "Levamisole as a contaminant of illicit cocaine". J Clandestine Lab Mean concentration in Investigating Chem Assoc . 2006;16(4):11. Percentage (%) 15 15 6. SAMHSA. "Nationwide Public Health Alert Issued Concerning Life-Threatening Risk Posed by Cocaine Laced Number of Cases blood = 0.56mg/L with Veterinary Anti-Parasite Drug". Press Release. Sep 21, 2009 10 10 7. Valentino AMM, Fuentecilla K. "Levamisole: An Analytical Profile". DEA Microgram . Jul-Dec 2005. 8. Zhu NY, LeGatt DF, Turner AR. "Agranulocytosis After Consumption of Cocaine Adulterated With Levamisole" 5 5 Ann Intern Med . Feb 17, 2009;150(4):287-9 9. New Mexico Department of Health. “Department of Health Investigates Unusual Condition that Harms 0 0 Jan-06 Jun-06 Jan-07 Jun-07 Jan-08 Jun-08 Jan-09 Jun-09 Jan-10 Immune System Potential Cocaine Contamination Could Be Cause” Press release, January 16, 2009 Half-year 10.Shari Roan “Cocaine laced with veterinary drug causing serious illness” . Los Angeles Times September 24, Cocaine-positive Cases Levamisole Positive Cases % 2009 11.http://stopthedrugwar.org/chronicle/2010/feb/19/tainted_supply_cocaine_laced_lev