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Esposito M, Liberto A, Zuccarello P, Ministeri F, Licciardello G, Barbera N, Sessa F, Salerno M. Heart rupture as an acute complication of cocaine abuse: a case report. Leg Med (Tokyo) 2022; 58:102084. [DOI: 10.1016/j.legalmed.2022.102084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
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2
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Serinelli S, Bonaccorso L, Furnari C, Gitto L. Double Suicide Due to the Ingestion of Levamisole-Adulterated Cocaine: Case Report and Review of the Literature. Acad Forensic Pathol 2022; 12:23-30. [PMID: 35694007 PMCID: PMC9179001 DOI: 10.1177/19253621211065334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 11/02/2021] [Indexed: 12/15/2022]
Abstract
Suicide is a major public health issue and the risk of attempting and committing suicide increases with age. We present the case of an elderly couple who decided to commit suicide together by self-poisoning using levamisole-adulterated cocaine. The choice of committing a double suicide, the method selected (self-poisoning), the drug self-administered (cocaine), and the route of administration (ingestion) are events rarely encountered in the forensic pathology practice, especially not in combination. In this article, we will review the literature regarding the frequency and features of these methods of suicide. An overview of the effects and mechanism of action of levamisole is also provided, highlighting the importance of including this substance and its metabolites in the routine toxicological analyses for cocaine deaths.
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Affiliation(s)
- Serenella Serinelli
- Serenella Serinelli, MD, PhD, Department of Pathology, State University of New York–Upstate Medical University, 750 East Adams St. 13210, Syracuse, NY,
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3
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Laposchan S, Kranenburg RF, van Asten AC. Impurities, adulterants and cutting agents in cocaine as potential candidates for retrospective mining of GC-MS data. Sci Justice 2022; 62:60-75. [PMID: 35033329 DOI: 10.1016/j.scijus.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 10/04/2021] [Accepted: 11/22/2021] [Indexed: 12/28/2022]
Abstract
Cocaine is one of the most widely used illicit drugs worldwide. Cocaine powders seized by the Police may contain numerous other substances besides the drug itself. These can be impurities originating from the coca plant or the production process, or be purposely added to the drug formulation as adulterants and cutting agents. In forensic laboratories, identification of cocaine is routinely done through GC-MS analysis, but other components are often ignored even if the method allows for their detection. Yet, they can provide valuable insight into the history of a seizure and its potential connection to other samples. To explore this idea, an extensive review of common impurities and adulterants encountered in cocaine is presented. Based on their incidence, concentration in the end product and compatibility with GC-MS methods, their overall usefulness as candidates for the statistical investigation of existing forensic data is evaluated. The impurities cis- and trans-cinnamoylcocaine, tropacocaine, norcocaine and N-benzoylnormethylecgonine as well as the adulterants lidocaine, procaine, tetracaine, benzocaine, caffeine, acetylsalicylic acid, phenacetin, ibuprofen, levamisole, hydroxyzine and diltiazem are promising candidates to provide additional forensic intelligence. Future research on optimized routine GC-MS methods, signal reproducibility, comparison, statistics and databases is suggested to facilitate this concept. Ultimately, such an approach may significantly advance the amount of information that is extracted from routine casework data, elucidate developments in the cocaine markets in the past and facilitate Police work in the future. Preliminary assessment of existing data from the forensic laboratory of the Amsterdam Police has been included to show that the detection of the identified target impurities is feasible, and that small adjustments to the analysis method could significantly increase the detectability of these analytes in prospective drug screenings. Forensic intelligence based on retrospective data mining of cocaine containing casework samples may thus be realized with minimal additional laboratory efforts by using already available instrumentation, samples and data.
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Affiliation(s)
- Sophia Laposchan
- Dutch National Police, Unit Amsterdam, Forensic Laboratory, Kabelweg 25, Amsterdam 1014 BA, The Netherlands; Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Postbus 94157, Amsterdam 1090 GD, The Netherlands
| | - Ruben F Kranenburg
- Dutch National Police, Unit Amsterdam, Forensic Laboratory, Kabelweg 25, Amsterdam 1014 BA, The Netherlands; Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Postbus 94157, Amsterdam 1090 GD, The Netherlands.
| | - Arian C van Asten
- Van 't Hoff Institute for Molecular Sciences, University of Amsterdam, Postbus 94157, Amsterdam 1090 GD, The Netherlands; Co van Ledden Hulsebosch Center (CLHC), Amsterdam Center for Forensic Science and Medicine, Postbus 94157, Amsterdam 1090 GD, The Netherlands
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4
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White CM, Browne T, Nafziger AN. Inherent Dangers of Using Non-US Food and Drug Administration-Approved Substances of Abuse. J Clin Pharmacol 2021; 61 Suppl 2:S129-S141. [PMID: 34396559 DOI: 10.1002/jcph.1860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022]
Abstract
Use of US Food and Drug Administration-approved substances of abuse has innate risks due to pharmacologic and pharmacokinetic properties of the medications, but the risk when using nonapproved drug products is much greater. Unbeknownst to the user, the dose of active ingredients in substances of abuse can vary substantially between different products because of manufacturing practices or improper storage. Even naturally occurring substances of abuse can have extensive dosage variability because of effects of the growing season and conditions, or differences in harvesting, storage, or manufacture of the finished products. Many illicit substances are adulterated, to make up for intentional underdosing or to enhance the effect of the intended active ingredient. These adulterants can be dangerous and produce direct cardiovascular, neurologic, hematologic, or dermatologic reactions or obscure adverse effects. Finally, an illicit substance can be contaminated or substituted for another one during its manufacture, leading to differences in adverse events, adverse event severity, or the drug interaction profile. Substances can be contaminated with microbes that induce infections or heavy metals that can damage organs or cause cancer. This milieu of undisclosed substances can also induce drug interactions. For reasons that are discussed, individuals who use substances of abuse are at increased risk of morbidity or mortality if they develop coronavirus disease 2019. Health professionals who treat patients with acute, urgent events associated with substances of abuse, or those treating the chronic manifestations of addiction, need to appreciate the complex and variable composition of substances of abuse and their potential health effects.
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Affiliation(s)
- C Michael White
- Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA.,HOPES Research Group, UConn and Hartford Hospital, Hartford, Connecticut, USA
| | - Thom Browne
- Rubicon Global Enterprises & Colombo Plan Secretariat, Huachuca City, Arizona, USA
| | - Anne N Nafziger
- Bertino Consulting, Schenectady, New York, USA.,Department of Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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5
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Lelièvre B, Suply B, Schmitt F, Marcorelles P, Drevin G, Maillart CR. A fatal case after an intravenous injection of levamisole. Forensic Sci Med Pathol 2020; 17:130-135. [PMID: 33180273 DOI: 10.1007/s12024-020-00336-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
Levamisole is a drug originally prescribed as an antihelmintic. Because of the occurrence of severe cases of agranulocytosis and leukoencephalitis it was removed from the French market in 1998 for human use, while it remains available for veterinary use. Nowadays in France its only use in humans is regulated by authorization for temporary use for its immunomodulatory properties in the treatment of nephritic syndrome.A 52-year-old man was found dead at his farm. Injection points were observed on his arm and a syringe containing a dark orange-brown liquid was found near the body. At his home, the discovery of a letter highlighted suicidal intent. Analysis of the aforementioned liquid, peripheral blood and urine confirmed the unique presence of levamisole. The femoral blood concentration of levamisole was of 25 mg/L whereas the femoral blood concentrations reported in cases of fatalities after cocaine use do not exceed 0.0056 mg/L. In humans, levamisole can be detected in biological samples after cocaine use as this drug is also an adulterant and one of its metabolites (aminorex) seems to have amphetamine-like properties. In this case, the man consumed levamisole from time to time for its stimulant and strengthening effects.Cases of fatal poisoning using levamisole are very rare and poorly documented, which makes the interpretation of postmortem blood levamisole concentration difficult.
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Affiliation(s)
- Bénédicte Lelièvre
- Pharmacology-Toxicology Laboratory, CHU Angers, 49933, Angers, France. .,Groupe d'Etude Des Interactions Hôte-Pathogène, UNIV Angers, UNIV Brest, Institut de Biologie en Santé-IRIS, (EA 3142) SFR ICAT 4208 , Angers, France.
| | - Benoit Suply
- Forensic Unit of CHU Brest, Antenne GHBS Lorient, Lorient, France
| | | | | | - Guillaume Drevin
- Pharmacology-Toxicology Laboratory, CHU Angers, 49933, Angers, France
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6
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Jones NS, Comparin JH. Interpol review of controlled substances 2016-2019. Forensic Sci Int Synerg 2020; 2:608-669. [PMID: 33385148 PMCID: PMC7770462 DOI: 10.1016/j.fsisyn.2020.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022]
Abstract
This review paper covers the forensic-relevant literature in controlled substances from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20Papers%202019.pdf.
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Affiliation(s)
- Nicole S. Jones
- RTI International, Applied Justice Research Division, Center for Forensic Sciences, 3040 E. Cornwallis Road, Research Triangle Park, NC, 22709-2194, USA
| | - Jeffrey H. Comparin
- United States Drug Enforcement Administration, Special Testing and Research Laboratory, USA
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7
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Gameiro R, Costa S, Barroso M, Franco J, Fonseca S. Toxicological analysis of cocaine adulterants in blood samples. Forensic Sci Int 2019; 299:95-102. [DOI: 10.1016/j.forsciint.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 11/28/2022]
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8
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Fiorentin TR, Krotulski AJ, Martin DM, Browne T, Triplett J, Conti T, Logan BK. Detection of Cutting Agents in Drug‐Positive Seized Exhibits within the United States. J Forensic Sci 2018; 64:888-896. [DOI: 10.1111/1556-4029.13968] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Taís R. Fiorentin
- The Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation 2300 Stratford Ave Willow Grove PA 19090
| | - Alex J. Krotulski
- The Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation 2300 Stratford Ave Willow Grove PA 19090
| | - David M. Martin
- Drug Enforcement Administration Educational Foundation 2020 Pennsylvania Ave Washington DC 20006
| | - Thom Browne
- The Colombo Plan 31 Wijerama Mawatha Colombo 7 Sri Lanka
| | - Jeremy Triplett
- Kentucky State Police Central Forensic Laboratory 100 Sower Blv Frankfurt KY 40601
| | - Trisha Conti
- Vermont Forensic Laboratory 45 State Drive Waterbury VT 05671
| | - Barry K. Logan
- The Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation 2300 Stratford Ave Willow Grove PA 19090
- NMS Labs 3701 Welsh Road Willow Grove PA 19090
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9
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Abstract
Aminorex (5-phenyl-4,5-dihydro-1,3-oxazol-2-amine) and 4-methylaminorex (4-methyl-5-phenyl-4,5-dihydro-1,3-oxazol-2-amine) are psychostimulants that have long been listed in Schedules IV and I of the UN Convention on Psychotropic Substances of 1971. However, a range of psychoactive analogues exist that are not internationally controlled and therefore often classified as new psychoactive substances (NPS). Aminorex analogues encompass failed pharmaceuticals that reemerged as drugs of abuse, and newly synthesized substances that were solely designed for recreational use by clandestine chemists. NPS, sometimes also referred to as "designer drugs" in alignment with a phenomenon arising in the early 1980s, serve as alternatives to controlled drugs. Aminorex and its derivatives interact with monoaminergic neurotransmission by interfering with the function of monoamine transporters. Hence, these compounds share pharmacological and neurochemical similarities with amphetamines and cocaine. The consumption of aminorex, 4-methylaminorex and 4,4'-dimethylaminorex (4-methyl-5-(4-methylphenyl)-4,5-dihydro-1,3-oxazol-2-amine) has been associated with adverse events including death, bestowing an inglorious fame on aminorex-derived drugs. In this Review, a historical background is presented, as well as an account of the pharmacodynamic and pharmacokinetic properties of aminorex and various analogues. Light is shed on their misuse as drug adulterants of well-established drugs on the market. This Review not only provides a detailed overview of an abused substance-class, but also emphasizes the darkest aspect of the NPS market, i.e., deleterious side effects that arise from the ingestion of certain NPS, as knowledge of the pharmacology, the potency, or the identity of the active ingredients remains obscure to NPS users.
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Affiliation(s)
- Julian Maier
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
| | - Felix P. Mayer
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
| | - Simon D. Brandt
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Harald H. Sitte
- Medical University of Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Währingerstraße 13A, 1090, Vienna, Austria
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Sharma R, Kumar J. Development and validation of a high-performance thin-layer chromatographic method for the simultaneous determination of levamisole and cocaine in seized cocaine sample. JPC-J PLANAR CHROMAT 2018. [DOI: 10.1556/1006.2018.31.5.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Rahul Sharma
- Chemistry and Toxicology Division Forensic Science Laboratory, Rohini, New Delhi, India
| | - Jitendra Kumar
- Chemistry and Toxicology Division Forensic Science Laboratory, Rohini, New Delhi, India
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11
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Pope JD, Drummer OH, Schneider HG. The cocaine cutting agent levamisole is frequently detected in cocaine users. Pathology 2018; 50:536-539. [DOI: 10.1016/j.pathol.2018.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 01/11/2023]
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12
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Analysis of illicit drugs seized in the Province of Florence from 2006 to 2016. Forensic Sci Int 2018; 284:194-203. [PMID: 29408729 DOI: 10.1016/j.forsciint.2018.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 11/21/2022]
Abstract
Comprehension of illicit drug market's features at local level is useful to plan and to correctly set-up specific informative and contrast activities. In this paper we report trends, purities and consumption estimations of illicit substances available on the Florentine territory from 2006 to 2016. These data were obtained by the analysis of 10,451 samples seized by the Law Enforcement Agencies in case of personal use offence. Analytical procedures consisted in targeted and untargeted analyses by gas chromatography-flame ionization detector, gas chromatography-mass spectrometry and liquid chromatography-tandem mass spectrometry. The most detected substances were: cannabis (78.0%; resin: 51.7%; herb: 26.3%), cocaine (10.4%), opiates (6.6%; heroin: 6.5%; morphine: 0.1%), ketamine (1.4%), amphetamines (1.3%; 3,4-methylenedioxymethamphetamine - MDMA -: 0.7%; methamphetamine: 0.6%; amphetamine: <0.1%) and methadone (1.3%). Cocaine, heroin and methamphetamine purities were higher than their mean values estimated for the Italian and European market, while THC content in cannabis seizures was unexpectedly below the European mean values. Starting from 2015, a total of 5 new psychoactive substances (NPS) were detected in seized material, mainly composed of white powders (pentedrone, 3-methylmethcathinone, 4-fluoroamphetamine, methoxethamine and AB-FUBINACA). Most of the seizures (75.5%) were from young male adults (14-34 years old). These data contribute to highlight new trends in the illicit drug market in the Tuscany area, but also to verify the persistence of old habits of drug consumption, confirming the need for more effective counteraction and prevention plans, especially among young people, where the diffusion of the legal highs is worrisome, also in consideration of the young age and the unconsciousness of the possible health effects.
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Kudlacek O, Hofmaier T, Luf A, Mayer FP, Stockner T, Nagy C, Holy M, Freissmuth M, Schmid R, Sitte HH. Cocaine adulteration. J Chem Neuroanat 2017; 83-84:75-81. [PMID: 28619473 PMCID: PMC7610562 DOI: 10.1016/j.jchemneu.2017.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/03/2017] [Accepted: 06/10/2017] [Indexed: 12/20/2022]
Abstract
Cocaine is a naturally occurring and illicitly used psychostimulant drug. Cocaine acts at monoaminergic neurotransmitter transporters to block uptake of the monoamines, dopamine, serotonin and norepinephrine. The resulting increase of monoamines in the extracellular space underlies the positively reinforcing effects that cocaine users seek. In turn, this increase in monoamines underlies the development of addiction, and can also result in a number of severe side effects. Currently, cocaine is one of the most common illicit drugs available on the European market. However, cocaine is increasingly sold in impure forms. This trend is driven by cocaine dealers seeking to increase their profit margin by mixing ("cutting") cocaine with numerous other compounds ("adulterants"). Importantly, these undeclared compounds put cocaine consumers at risk, because consumers are not aware of the additional potential threats to their health. This review describes adulterants that have been identified in cocaine sold on the street market. Their typical pharmacological profile and possible reasons why these compounds can be used as cutting agents will be discussed. Since a subset of these adulterants has been found to exert effects similar to cocaine itself, we will discuss levamisole, the most frequently used cocaine cutting agent today, and its metabolite aminorex.
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Affiliation(s)
- Oliver Kudlacek
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Waehringerstrasse 13a, 1090 Vienna, Austria
| | - Tina Hofmaier
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Waehringerstrasse 13a, 1090 Vienna, Austria
| | - Anton Luf
- Medical University of Vienna, Clinical Department of Laboratory Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Felix P Mayer
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Waehringerstrasse 13a, 1090 Vienna, Austria
| | - Thomas Stockner
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Waehringerstrasse 13a, 1090 Vienna, Austria
| | - Constanze Nagy
- checkit!-Suchthilfe Wien gGmbH, Gumpendorferstraße8, 1060 Vienna, Austria
| | - Marion Holy
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Waehringerstrasse 13a, 1090 Vienna, Austria
| | - Michael Freissmuth
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Waehringerstrasse 13a, 1090 Vienna, Austria
| | - Rainer Schmid
- Medical University of Vienna, Clinical Department of Laboratory Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Harald H Sitte
- Medical University Vienna, Center for Physiology and Pharmacology, Institute of Pharmacology, Waehringerstrasse 13a, 1090 Vienna, Austria; Center for Addiction Research and Science - Medical University Vienna, Waehringerstrasse 13A, 1090 Vienna, Austria.
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14
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Solomon N, Hayes J. Levamisole: A High Performance Cutting Agent. Acad Forensic Pathol 2017; 7:469-476. [PMID: 31239995 DOI: 10.23907/2017.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/23/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Abstract
Levamisole is an imidazothiazole chemical most frequently used as an antihelminthic agent in cattle. Over the last decade, levamisole has been increasingly encountered as an additive in both powder and crack cocaine. A white powder with a "fish scale" appearance, the chemical is physically similar to powder cocaine. In vivo, levamisole is metabolized to aminorex, a compound with amphetamine-like psychostimulatory properties and a long half-life; a priori, this property allows levamisole to potentiate and prolong the stimulatory effects of cocaine while bulking up the drug to increase profit for the dealer. As use of cocaine cut with levamisole becomes more prevalent, complications directly attributable to the chemical are increasingly being recognized.
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Affiliation(s)
- Nadia Solomon
- St. George's University School of Medicine, Windward Islands Research and Education Foundation
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15
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Martello S, Pieri M, Ialongo C, Pignalosa S, Noce G, Vernich F, Russo C, Mineo F, Bernardini S, Marsella LT. Levamisole in Illicit Trafficking Cocaine Seized: A One-Year Study. J Psychoactive Drugs 2017; 49:408-412. [PMID: 28813206 DOI: 10.1080/02791072.2017.1361558] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cocaine use is increasing around the world and its purity is frequently altered through dilution, substitution, contamination, and adulteration. Sugars, talc, starch, and carbonates represent the principal diluents of cocaine, while phenacetin, levamisole, caffeine, and lidocaine are its major adulterants in Europe. Levamisole is used because it is an odorless powder, with physical properties similar to cocaine, and it has reasonable cost and availability, being widely used in veterinary medicine. For this study, we analyzed 88 cocaine samples. The seized cocaine analyzed showed an average purity of 55% and the most frequent adulterants identified were: levamisole (31.8%), caffeine (6.8%), lidocaine (2.3%), acetaminophen (2.3%), and phenacetin (1.1%). Our aim is the study of the presence of levamisole, over other adulterants in seized cocaine samples, due to its recognized human toxicity. The chronic use of levamisole-adulterated cocaine represents a serious public health issue because it may be responsible for side-effects such as dermal vasculopathy, leukoencephalopathy, leukopenia, agranulocytosis, pulmonary hemorrhage, multiple emboli, and several other effects. Moreover, aminorex can cause idiopathic pulmonary hypertension, presenting another harmful and mostly lethal side-effect from cocaine cut with levamisole. In conclusion, levamisole determination should be performed in routine toxicological analysis in deaths due to cocaine use.
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Affiliation(s)
- Simona Martello
- a Pharmacist, Department of Biomedicine and Prevention, Section of Legal Medicine, Social Security and Forensic Toxicology , University of Rome Tor Vergata , Rome , Italy
| | - Massimo Pieri
- b Biologist, Department of Experimental Medicine and Surgery, Section of Clinical Biochemistry and Molecular Biology , University of Rome Tor Vergata , Rome , Italy
| | - Cristiano Ialongo
- c Medical Doctor, Department of Experimental Medicine and Surgery, Section of Clinical Biochemistry and Molecular Biology , University of Rome Tor Vergata , Rome , Italy
| | - Stefano Pignalosa
- b Biologist, Department of Experimental Medicine and Surgery, Section of Clinical Biochemistry and Molecular Biology , University of Rome Tor Vergata , Rome , Italy
| | - Gianluca Noce
- d Chemist, Department of Biomedicine and Prevention, Section of Legal Medicine, Social Security and Forensic Toxicology , University of Rome Tor Vergata , Rome , Italy
| | - Francesca Vernich
- e Biologist, Department of Biomedicine and Prevention, Section of Legal Medicine, Social Security and Forensic Toxicology , University of Rome Tor Vergata , Rome , Italy
| | - Carmelo Russo
- b Biologist, Department of Experimental Medicine and Surgery, Section of Clinical Biochemistry and Molecular Biology , University of Rome Tor Vergata , Rome , Italy
| | - Federico Mineo
- f Biotechnologist, Department of Biomedicine and Prevention, Section of Legal Medicine, Social Security and Forensic Toxicology , University of Rome Tor Vergata , Rome , Italy
| | - Sergio Bernardini
- g Full Professor, Department of Experimental Medicine and Surgery, Section of Clinical Biochemistry and Molecular Biology , University of Rome Tor Vergata , Rome , Italy
| | - Luigi Tonino Marsella
- h Associate Professor, Department of Biomedicine and Prevention, Section of Legal Medicine, Social Security and Forensic Toxicology , University of Rome Tor Vergata , Rome , Italy
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16
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Adverse effects of levamisole in cocaine users: a review and risk assessment. Arch Toxicol 2017; 91:2303-2313. [DOI: 10.1007/s00204-017-1947-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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