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This is the first study to investigate the prevalence of potentially harmful adulterants present in hair samples from Brazilian patients with crack cocaine dependence. A cross-sectional analysis was performed with the data obtained. Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. This points to a need to monitor adverse effects in the clinical setting in order to provide this high-risk group of patients with prompt and effective care related to the acute and chronic complications associated with these adulterants. Keywords Cocaine; crack cocaine; adulterants; substance use disorders; toxicology. High mortality among young crack cocaine users in Brazil: a 5-year follow-up study. Causes of death among crack cocaine users. Rev Bras Psiquiatr. Profile of cocaine and crack users in Brazil. Cad Saude Publica. Abuse and addiction: crack. Rev Assoc Med Bras. Addict Behav. Most of the cocaine and crack cocaine traded contains adulterants and diluents in variable proportions. Some adulterants have similar effects to cocaine or are used to enhance the effect of the drug and reduce the amount of cocaine used, thus reducing production costs and maximizing profit. Rev Bras Cienc Farm. The most popular adulterants present in crack cocaine are caffeine, lidocaine, phenacetin, levamisole, benzocaine, procaine and hydroxyzine. Tanner-Smith EE. Drug Alcohol Depend. Drug Test Anal. Although other studies have looked into adulterants present in samples of cocaine confiscated in Brazil, this is the first study to evaluate the absorption of such substances by Brazilian crack cocaine users. We used a cross-sectional design in a convenience sample. Samples were collected from the posterior vertex region during the first 48 hours of observation. Differentiation between drug use and environmental contamination when testing for drugs in hair. Forensic Sci Int. The analyses were performed using liquid chromatography-mass spectrometry Agilent, Santa Clara, U. The sample could be classified into 13 groups on the basis of adulterants present in the hair samples Figure 1. The most common combination was phenacetin and lidocaine, followed by lidocaine only. Figure 1 - Grouping of patients based on adulterants present in hair samples. The large body of research available on adulterants and diluents present in cocaine has provided robust evidence of their use and its clinical consequences. A study carried out in the Netherlands 12 An analysis of cocaine powder in the Netherlands: content and health hazards due to adulterants. In 9, samples collected in Spain between and , lidocaine was the main adulterant, present in Conversely, lidocaine was absented from samples collected between and , with caffeine being the most prevalent adulterant. Purity of cocaine seized in Spain, variations by weight, province and year of seizure. Fucci N, De Giovanni N. Adulterants encountered in the illicit cocaine market. This combined the consumer-targeted drug testing systems of the European Union with data from Spain, Switzerland, Austria, the Netherlands, Brussels, and Portugal and found differences in terms of the purity and composition of drugs. Several adulterants were found in illicit cocaine, with levamisole being the most commonly detected adulterant in , followed by phenacetin and caffeine. In the U. Adulterants in illicit drugs: a review of empirical evidence. The first report of levamisole as an adulterant in the U. Since the early studies, the reported prevalence of adulteration of cocaine with levamisole, diltiazem or hydroxyzine has increased from 6. A confirmed case of agranulocytosis after use of cocaine contaminated with levamisole. J Med Toxicol. Evaluation of the composition of street cocaine seized in two regions of Brazil. Sci Justice. Maldaner et al. Chemical profiling of street cocaine from different Brazilian regions. J Braz Chem Soc. Levamisole was originally developed in the s as an antihelminthic agent; it has immuno-stimulant properties that increase endogenous opiate levels and alter monoaminergic function — these effects may be responsible for its popularity as a cocaine adulterant. In in vivo research using the conditioned place preference paradigm to investigate the combination of cocaine and levamisole showed a marked synergistic effect. Levamisole is also very cheap, so using it as an adulterant substantially increases profit. It has also been postulated that levamisole acts as a monoamine oxidase inhibitor and increases dopamine transmission. Aminorex, a psychoactive metabolite of levamisole, has a potent amphetamine-like effect on dopamine and norepinephrine transporters. Levamisole: a dangerous new cocaine adulterant. Clin Pharmacol Ther. Aminorex, a metabolite of the cocaine adulterant levamisole, exerts amphetamine like actions at monoamine transporters. Neurochem Int. Because the half-life of aminorex far exceeds that of cocaine, combining levamisole with cocaine may prolong the duration of the stimulant effects. Because of its immunomodulatory effects, levamisole has been used to treat immune-mediated and inflammatory disorders, such as rheumatoid arthritis, nephritic syndrome, inflammatory bowel disease, aphthous ulcers and colon cancer. Leukoencephalopathy after levamisole for the treatment of verrucae. Acta Neurol Taiwan. Efficacy of higher-dose levamisole in maintaining remission in steroid-dependant nephrotic syndrome. Pediatr Nephrol. ANCA-associated vasculitis secondary to levamisole-adultered cocaine with associated membranous nephropathy: A case series. Am J Nephrol. In vitro immunomodulatory effects of microemulsions with levamisole delivery systems on blood phagocytes interacting with Giardia lamblia. Parasitol Int. As a result, one of the most severe consequences of the adulteration of cocaine with levamisole is leukoencephalopathy. Xu et al. Clinical and MRI characteristics of levamisole-induced leukoencephalopathy in 16 patients. J Neuroimaging. There are previous reports of cases related to the presence of levamisole in urine and blood. Recurrent leukoencephalopathy in a cocaine abuser. Gonzalez-Duarte A, Williams R. Cocaine-induced recurrent leukoencephalopathy. Neuroradiol J. Leukoencephalopathy is similar to other spongiform encephalopathies in which fluid is trapped in small vacuoles within the myelin lamellae. Vosoughi R, Schmidt BJ. Multifocal leukoencephalopathy in cocaine users: a report of two cases and review of the literature. BMC Neurol. White matter lesions are typically found in subcortical and periventricular white matter, but can involve the brainstem and cerebellum. A brain biopsy can demonstrate loss of myelin and accumulation of perivascular lymphocytes. Other clinical consequences, such as neutropenia, agranulocytosis, and dermatological disorders, have also been reported. Larocque A, Hoffman RS. Levamisole in cocaine: unexpected news from an old acquaintance. Clin Toxicol. Since the first case of agranulocytosis was described by Buchanan in , there have been multiple case reports of severe agranulocytosis after chronic abuse of cocaine and crack cocaine. Cutaneous and thrombotic vasculopathy associated with the use of levamisole-adulterated cocaine is more prevalent in female users and is characterized by pronounced retiform purpura with cutaneous necrosis, which can lead to serious deformations and may require amputation. It has previously been hypothesized that there is a synergistic relationship, or cross-sensitization, between cocaine and levamisole, and cocaine alone has been linked to necrotizing granulomatous vasculitis and Churg-Strauss vasculitis. Gertner E, Hamlar D. Necrotizing granulomatous vasculitis associated with cocaine use. J Rheumatol. Another severe complication of chronic cocaine abuse, related to adulteration of cocaine with phenacetin and local anesthetics, is methemoglobinemia, 31 Benzocaine-adultered street cocaine in association with methemoglobinemia. Clin Chem. White powder, blue patient: methaemoglobinaemia associated with benzocaine-adulterated cocaine. This blood disorder is characterized by the presence of circulating methemoglobin in erythrocytes, resulting in reduced tissue oxygen due to a reduction of the oxygen-carrying ability of erythrocytes, and an increased affinity for oxygen in non-affected heme molecules, which impairs the off-loading of oxygen to the tissues. Our findings should be considered in light of the limitations of the study, such as its cross-sectional design, reliance on a single center and the small sample size. Further prospective studies of the consequences of the widespread presence of crack cocaine adulterants in hair samples should be performed, in order to provide a clearer picture of their public health impact. This is the first study of the presence of potentially harmful adulterants in hair samples from Brazilian patients with crack cocaine dependence. Abrir menu Brasil. Trends in Psychiatry and Psychotherapy. Abrir menu. Conclusion Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. Methods We used a cross-sectional design in a convenience sample. History Received 08 Dec Accepted 27 Aug This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cansford Laboratories, Cardiff, United Kingdom. Correspondence: Alisson Paulino Trevizol. Figures 1 Tables 1. Google Google Scholar. Adulterants in crack cocaine in Brazil.

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