New York physicians have identified two female chronic cocaine users who had severe necrosis (death) of tissues in their cheeks and earlobes that the doctors believe is linked to the women's use of cocaine. But it is not the drug itself that is causing the damage; it is another drug that is used to cut the cocaine: levamisole.
Levamisole is used to treat worms in dogs and other animals. Although it was once used in this country in humans as well, its use has been discontinued for several years, although the drug is still available for human use in South America. It was banned because it causes neutropenia, a deficiency of key white blood cells that are important for fighting off infections, and vasculitis, an inflammation of blood vessels that can cut off the flow of blood to tissues.
According to some estimates, as much as 70% of cocaine coming into the United States in recent months was cut with levamisole. (Cutting is the process of diluting the drug with a similar powder to reduce its potency and to enable drug sellers to make more money on a given weight of cocaine.) No one seems to know why levamisole is being used because it is more expensive than other cutting agents and is not known to increase the potency of the drug or to produce desirable side effects. Moreover, it is unusual for cocaine producers to cut the drug before shipping because that increases their shipping costs.
Doctors at the University of Rochester Medical Center and the Monroe County Department of Public Health in New York reported Monday in the journal Annals of Internal Medicine that the two women, one 57 and one 22, sought medical help because of neutropenia and large purplish blotches characteristic of vasculitis on their ear lobes and cheeks, among other sites. Toxicology showed the women tested positive for cocaine, but the physicians did not screen for levamisole. Treatment resolved the issue, with some residual scarring.
Some blogs are suggesting that cocaine users in other locations, especially San Francisco, are also encountering problems with their skin turning black and "sloughing off" but are not contacting doctors for care. A few paranoid people are suggesting that the government is adding the drug to cocaine to damage cocaine users, but that seems unlikely because the drug itself does sufficient damage.
— Thomas H. Maugh II