title: Potential diversion of local anesthetics from dental offices for use as cocaine adulterants.
abstract: BACKGROUND
  Reports of lidocaine and benzocaine in the bloodstreams of people who abuse cocaine with accompanying reports of seizures and methemoglobinemia indicate that there is a potential that local anesthetics are being diverted from dental offices and being used as cocaine adulterants. These adulterants augment the nasal numbness produced by inhaling cocaine.
  
  
  METHODS
  The authors conducted a PubMed search by using the following terms: "adulterants," "benzocaine," "cocaine," "lidocaine" and "methemoglobinemia."
  
  
  RESULTS
  The authors identified two case reports as a result of their PubMed search. Each case involved a patient with symptoms of both cocaine overdose and methemoglobinemia who sought treatment at an emergency department. The results of urine samples from each patient, as well as the results from an analysis of a sample of one patient's cocaine, revealed the presence of many adulterants, including lidocaine and benzocaine.
  
  
  CONCLUSIONS
  Injectable lidocaine and topical benzocaine are cheap and readily available substances found in dental offices that may be diverted by anyone-including dentists, office staff members or patients-to adulterate cocaine.
  
  
  CONCLUSIONS
  Additional research is needed to identify whether dental offices are a common source of cocaine adulterants. The authors recommend that dentists keep track of their local anesthetic supplies.
authors.affiliation: Dr. Saraghi was an instructor of dental anesthesiology, Department of Periodontics, Division of Pediatric Dentistry, and Department of Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, when this article was written. She now is a dentist anesthesiologist, Northwest Dental Anesthesia, 5528 E. Green Lake Way N., #19, Seattle, Wash. 98103, msaraghi@gmail.com.
authors.forename: Mana
authors.initials: M
authors.lastname: Saraghi
authors.forename: Elliot V
authors.initials: EV
authors.lastname: Hersh
mesh_terms: D000779:Anesthetics, Local; D001566:Benzocaine; D019970:Cocaine-Related Disorders; D003770:Dental Offices; D004340:Drug Contamination; D006801:Humans; D008012:Lidocaine; D064226:Prescription Drug Diversion
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D001566:Benzocaine
keywords: Lidocaine; dental anesthetics; drug abuse; drug contamination; drug interactions; drugs; local anesthetics; pharmacology; topical anesthetics