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Cocaine additive is tied to disease

Health officials issue warning

By Milton J. Valencia
Globe Staff / September 1, 2009

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Public health officials have sent out warning alerts to hospitals, health specialists, and cocaine users after a Boston-area user, for the first known time, contracted a serious, acute blood disease through a dangerous agent used in the cutting of cocaine.

The patient, who was not identified, has recovered from the disease, agranulocytosis, and is in good health. But his case, never before seen in Massachusetts, has state officials trying to alert doctors and users of the dangers - not only of cocaine - but of the cutting agent, levamisole. It has proven deadly elsewhere in the country, most recently in Washington state and has sickened countless others.

“This can be very serious,’’ said Dr. Al DeMaria, the state’s chief epidemiologist. “Why someone would be using this in cocaine, no one really knows.’’

Patients who have contracted agranulocytosis through the use of cocaine or crack cocaine have showed symptoms of high fever, chills, weakness, swollen glands, or painful sores.

The disease is characterized by a significant drop in white blood cells - the disease-fighting cells - leaving patients vulnerable to even the slightest infections.

The use of levamisole in cutting, or breaking down the purity of, cocaine for resale is not new. A federal Drug Enforcement Administration sampling of street cocaine showed some 30 percent was cut with levamisole, leading investigators and health officials to suspect the agent was added during the original production and packaging of the drug, rather than in one particular market.

But it was only recently that health officials have tied levamisole to agranulocytosis among cocaine users who showed no other explanation for contracting the disease.

The doctors who cared for the Boston-area patient did not determine the cause of the disease until studying cocaine-related cases that have been publicized only recently.

In June, the Department of Public Health in Seattle and King County, Washington, sent out a warning after three people became ill. A woman in her 40s later died.

DeMaria said health officials have not determined why only some users would contract agranulocytosis when others have not, surmising one person could have different sensitivities to its chemicals.

But the revelation that it could be contracted through snorting or smoking cocaine has state officials alerting doctors and cocaine users of the dangers.

Levamisole has no medicinal value.

It has been used in veterinary medicine in the deworming of livestock animals, and it was originally studied for the treatment of colon cancer. But, “it turns out it wasn’t very effective for anything,’’ DeMaria said.

Officials also do not know why it would be used as a cutting agent when it would be more expensive than other agents. Some researchers have suspected that it could enhance the doping effects of cocaine, but no research supports that theory.

Milton Valencia can be reached at mvalencia@globe.com.