title: Levamisole-adulterated cocaine: what about in European countries?
abstract: BACKGROUND
  A wide variety of somatic complications is reported or expected among cocaine users because of the adulterant levamisole. Most of the reports come from North America.
  
  
  METHODS
  To update the data on levamisole-adulterated cocaine in European countries, we present here a synthesis of data on samples seized by the police with the detection of levamisole, the amount of levamisole in cocaine samples, European drug information reports, and clinical cases.
  
  
  RESULTS
  Although there is a variation in the percentage of levamisole in cocaine samples between European countries, the trend is an increase of these percentages. As in North America, levamisole is becoming the most common cocaine adulterant. First European cases of complications secondary to the use of adulterated cocaine with levamisole were skin necrosis, vasculitis, and agranulocytosis. Levamisole postmortem data concerned two cases of complications leading to death, possibly related to levamisole or its metabolite (acute coronary syndrome, pulmonary hypertension).
  
  
  CONCLUSIONS
  Even if it is difficult to have a global European view with comparable data, levamisole is present in European cocaine specimens and can lead to severe adverse health effects. However data on the prevalence of toxicity related to levamisole-adulterated cocaine abuse are missing.
authors.affiliation: a Pharmacist, Centre for Evaluation and Information on Pharmacodependance-Addictovigilance, Medical Pharmacology and Toxicology Department , University Hospital of Montpellier , France.
authors.forename: Céline
authors.initials: C
authors.lastname: Eiden
authors.forename: Caroline
authors.initials: C
authors.lastname: Diot
authors.forename: Olivier
authors.initials: O
authors.lastname: Mathieu
authors.forename: Michel
authors.initials: M
authors.lastname: Mallaret
authors.forename: Hélène
authors.initials: H
authors.lastname: Peyrière
mesh_terms: D000293:Adolescent; D000328:Adult; D003042:Cocaine / Q000009:adverse effects*; D004340:Drug Contamination; D005060:Europe; D006801:Humans; D007978:Levamisole / Q000032:analysis*; D008875:Middle Aged
chemical_list: D007978:Levamisole; D003042:Cocaine
keywords: Europe; cocaine; levamisole