Cocaine additives, like levamisole, can cause severe chronic diseases that have fatal consequences for people who use drugs.

Drug additives, like cocaine cutting agents, may be responsible for short and long-term chronic diseases. In their 2018 Drug Threat Assessment, the U.S. Drug Enforcement Administration reported that 41% of seized cocaine had been diluted with other ingredients. As much as 40% of the adulterated cocaine was cut with levamisole or a mixture of levamisole and dexamisole. Their report explains that in 2017, 93% of the cocaine seized and tested was from Colombia, 4% from Peru and 3% from unknown sources. The retail cost of cocaine has decreased by 8% between 2012 and 2017. Some officials wonder if the opioid crisis is eclipsing a quietly deadly cocaine epidemic.

There are many ways in which cocaine itself is harmful to your health. The addition of other ingredients may escalate the onset or severity of certain diseases. Ingesting cocaine cut with levamisole can result in different diseases, including drug-induced renal disease and other conditions. Researchers at the Mayo Clinic explain that levamisole was historically used to treat cancers before being taken off the market in the United States in 2000 because it had too many negative health effects. Ingesting cocaine laced with levamisole may lead to:

  • Neutropenia, which can lead to infection
  • Skin necrosis
  • Joint pain
  • Lesions and blockages
  • Decreased white blood count

Symptoms such as lesions have been seen to resolve after a person stops using cocaine. Other symptoms may be fatal.

International Trends Point to Deadly Cutting Agents Contaminating Drug Supplies

The United Nations Office on Drugs and Crime explains that, while opioid trafficking has decreased internationally, cocaine manufacturing is at record levels. The number of cocaine seizures in the past 10 years has increased by 74%. Their report says that, in 2017, there were 18 million people used cocaine worldwide.

Like other drugs, cocaine is often cut with additives to make it more profitable. Two common adulterants, or cutting agents, are phenacetin and levamisole. Phenacetin cocaine is a combination of the drug phenacetin, which is related to acetaminophen and cocaine. Levamisole cocaine is a combination of the off-the-market cancer drug levamisole and cocaine.

How to Tell if Coke Is Cut With Levamisole

Cocaine may have been cut with levamisole and appear completely normal. Levamisole is white and mimics the appearance and texture of cocaine. The additive may be included in the composition of cocaine before it reaches its final, ingestible state. This may mean that it is virtually undetectable to the consumer. The only way to accurately verify the contents of cocaine is to have it tested in a lab.

U.S. Drug Analysis Doesn’t Test for Atypical Ingredients

Due to the significant number of annual drug seizures in the United States, regular testing for atypical ingredients cannot occur. This is why cocaine laced with levamisole and other additives has led to hospital admissions and news stories about flesh-eating cocaine. Levamisole vasculitis is a serious condition that can result from consuming cocaine with levamisole. This condition causes the ears, tongue or other parts of the body to turn black and look like they are rotting.

In March of 2019, officials began noticing and issuing warnings about pink cocaine, a synthetic form of the drug from Argentina that has similar effects to MDMA. The origin and nature of these dangerous drug combinations present a serious public health crisis.

Cocaine and Meth Trends Hide in the Shadows of the Opioid Epidemic

According to the National Institute on Drug abuse, opioid overdose deaths in the United States were just over 70,000 in 2017. While the number continues to increase, the level of increase has plateaued in many areas. Federal, state and local officials are all heavily concentrated on combating opioid addiction.

Cocaine use statistics indicate that the drug may have been quietly growing in popularity while attention was diverted to address opioid addiction. Homemade drugs, cocaine cut with additives and other dangerous combinations of drugs can present dangerous and even fatal consequences to people who use them.

Overdose Deaths Quietly Increase

Drug overdose deaths can impact people from all walks of life and can result from any combination or type of substance. Meth or coke cut with fentanyl can make an overdose even more likely. Historically, street or homemade drugs like methamphetamines have had unpredictable ingredients with disastrous effects. Because the origin of most street drugs is unknown, it’s nearly impossible to know what a substance is truly made of. The National Institute on Drug Abuse reports that 15% of drug overdose deaths in 2017 were the result of a meth overdose. Meth deaths per year are a steady and tragic reminder that drug use and addiction can impact people from anywhere.

Drug Industry Moves Toward Dangerous Synthetic Options

The dangers of synthetic narcotics are significant. Cutting drugs and ingesting synthetic street drugs could have fatal consequences. As more drug distributors cut drugs with other substances to reduce costs, it is ever more vital that effective addiction treatment options are widely available for people who need them.

Joy Youell
By – Joy Youell
Joy Youell is a writer and content developer with a background in educational research. Using sound pedagogical approaches and expert-backed methods, Joy has designed and delivered adult learning content, professional development, and company training materials for organizations. Read more
Renee Deveney
Editor – Renee Deveney
As a contributor for Advanced Recovery Systems, Renee Deveney is passionate about helping people struggling with substance use disorder. With a family history of addiction, Renee is committed to opening up a proactive dialogue about substance use and mental health. Read more

Abdul-Karim, Raghad; et al. “Levamisole-induced vasculitis.” Baylor University Medical Center Proceedings, April 2013. Accessed September 22, 2019.

Asmann, Parker. “Synthetic ‘Pink Cocaine’ Crossing fr[…]gentina Into Uruguay.” InSight Crime, March 1, 2019. Accessed September 22, 2019.

California Poison Control System. “Levamisole-contaminated Cocaine.” December 3, 2014. Accessed September 22, 2019.

Lee, Kachiu C; et al. “Complications Associated With Use of Lev[…]lic Health Challenge.” Mayo Clinic Proceedings, June 2012. Accessed September 22, 2019.

National Institute on Drug Abuse. “Methamphetamine.” May 2019. Accessed September 22, 2019.

National Institute on Drug Abuse. “Overdose Death Rates.” January 2019. Accessed September 22, 2019.

U.S. Drug Enforcement Administration. “2018 National Drug Threat Assessment.” October 2018. Accessed September 22, 2019.

United Nations Office on Drugs and Crime. “4 Stimulants 2019 World Drug Report.” 2019. Accessed September 22, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.