When we recently collaborated with our colleagues in Brazil in a study*, we found a terrible truth about dangerous adulterants commonly added to cocaine and crack cocaine.
The results of the analysis of 172 hair samples confirmed cocaine use but we also detected phenacetin in 44% of hair samples and levamisole in 20% of the hair samples.
We also found that the samples with higher levels of the adulterants showed cocaine at lower levels. This finding suggests that users might be taking larger doses of the adulterants and smaller doses of cocaine, than they believe they are.
Although the knowledge that cocaine/crack cocaine is adulterated is nothing new, it is usually cut with inert agents of a range of compounds. The problem we have ucovered here is that the presence of the active pharmaceutical ingredients in the samples.
These two compounds we studied above are only the tip of the iceberg. Many other active and dangerous compounds have been found in apprehended cocaine. The list is long. Examples are: Local Anaesthetics (Benzocaine, Procaine, Tetracaine, Bupivacaine, Etidocaine, Lidocaine, Mepivacaine, Dibucaine, Prilocaine; Stimulants (Caffeine, Teophillyne, Ergotamine, Stricnine, Ephedrine, Phenylpropanolamine, Methylphenidate, Amphetamines); Hallucinogenic and Opiates (PCP, Codeine, Heroin).
The trouble is that the two compounds found in our study is that they are highly toxic, and cocaine users are most probably unaware of the dangers.
Levamisole is a veterinary antihelminthic drug and its chronic use is associated with muscle pain, headache, fever, insomnia, dizziness and convulsions.
Phenacetin is an analgesic, which has been banned in many countries for its carcinogenic properties, and is associated with nephrotoxicity.
Clinical use of the detection of adulterants in hair samples of drug users
Because of their toxicity there is particular clinical concern about the chronic use of these pharmaceutical ingredients present in cocaine sold in the streets.
The main point is that when people go to se their doctor with symptoms and tell them that they have been using cocaine, the doctors won’t know (nor the users!) that actually they have been taking such adulterated cocaine and therefore are not likely to give the right treatment as they will wrongly suspect that the symptoms are caused by the cocaine, not the adulterants.
Greater publicity of the way cocaine is regularly largely adulterated would be of great help to users and the medical professionals who treat them.
The detection of levamisole and phenacetin in hair samples could be an important tool for clinicians to diagnose the cause of symptoms in patients not related to crack cocaine use, but to the toxicity associated to these adulterants. Using hair tests would enable medical professionals to diagnose correctly the cause of the symptoms and give the right treatment.
*Paper presented at the Meeting of the Society of Hair Testing (SoHT) in May 2015: “Detection of adulterants in hair samples as a diagnostic aid in clinical practice” M. Andraus, L. Tsanaclis, M. Ribeiro, R. Laranjeira, C. Pisaneschi, M. Salvadori, J. Wicks