Cocaine cut with antibiotic could cause life-threatening infection: health unit

The Canadian Press ~ The News
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TORONTO - Canadians who use cocaine are being warned that drug dealers may have laced it with a veterinary antibiotic and could find themselves in a fight for their lives.
The Peterborough County-City Health Unit in Ontario is the latest health authority in North America to issue a public health warning that people who use cocaine contaminated with levamisole - used to treat worm infections in animals - may be at risk of severe life-threatening infections.
At least three deaths from infections caused by the drug combination in Canada and the U.S. have been reported - one each in New Mexico, Washington and Alberta.
The cocaine-levamisole mix was among the cocktail of drugs found in the body of New York celebrity disc jockey Adam Goldstein, better known as DJ AM, who died Aug. 28 in his Manhattan apartment of an overdose of cocaine and prescription drugs.
U.S. Drug Enforcement Administration documents indicate that 30 per cent of all U.S. cocaine seized is tainted with levamisole, which scientific studies suggest might give cocaine users a more intense high, possibly by increasing levels of dopamine.
The Peterborough health unit was made aware last week of a case of febrile neutropenia/agranulocytosis - in which the body stops producing white blood cells called neutrophils that fight infection - in a young Peterborough woman who reported using cocaine.
"Typically we have 14,000-15,000 of these cells that are identified if I were to do a blood test on you," Dr. Rosana Pellizzari, Medical Officer of Health for the health unit, said in an interview from Peterborough on Friday.
"Well this person who showed up in emergency here in Peterborough with sepsis had one (cell). That's how badly the drug knocked out her white blood cells," said Pellizzari.
The health unit recommends doctors who see cocaine users with symptoms such as high fever, chills and swollen glands or painful oral or anal sores and any skin abscess or lung infection that appear to be developing more rapidly than usual may have acute immunodeficiency, and agranulocytosis should be suspected.
"We're warning physicians that if they see a case of agranulocytosis they should be doing urine testing both for cocaine and also for traces of levamisole," said Pellizzari.
Treatment usually involves a variety of intravenous antibiotics and could even involve a blood transfusion, she said.
The Peterborough patient has since recovered.
"I've heard from our police here in Peterborough that they're going to start testing any cocaine that's seized here for traces of levamisole."
She said there is evidence from other places in Canada that more than 10 per cent of the cocaine seized had levamisole in it.
It is unknown where the Peterborough woman obtained the contaminated cocaine but the health unit is warning residents who use cocaine they may be at risk.
On Sept. 25, Ottawa Public Health said it had been made aware of a suspected case in a cocaine user.
Pellizzari said 19 confirmed cases and two suspected cases had been reported on Vancouver Island and B.C.'s Lower Mainland between Jan. 1, 2008, and March 31, 2009.
Alberta saw 39 cases - 11 confirmed, 28 probable - including in Edmonton, Calgary, Cardston, Stoney Plain, Medicine Hat and Grande Prairie between January 2008 to March 31, 2009, according to Alberta Health Services.
In September, the U.S. Department of Health and Human Services issued a nationwide alert about the life-threatening risk posed by cocaine cut with levamisole, saying there had been 20 confirmed or probable cases of agranulocytosis, including two deaths.
Dr. Rita Shahin, an Associate Medical Officer of Health with Toronto Public Health, said she was not aware of any cases in Toronto but noted such cases do not have to be reported to Public Health.
Pellizzari said not everyone using cocaine will be exposed to levamisole and of those who are exposed to the antibiotic, only a certain percentage will develop agranulocytosis.
"This may just be the beginning of a wave of cases," she said.

Organizations: U.S. Drug Enforcement Administration, Alberta Health Services, U.S. Department of Health and Human Services Toronto Public Health

Geographic location: Peterborough County, TORONTO, Canada U.S. Alberta Ontario North America New Mexico Washington New York Manhattan Vancouver Island Edmonton Calgary Cardston Medicine Hat Grande Prairie

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