Recently, a batch of cocaine containing a hog dewormer known as levamisole made 10 people seriously ill in southwestern B.C. The province’s health officer has confirmed that testing is now available for people with a fever who believe they may have used contaminated cocaine.
Dr. Perry Kendall told the Georgia Straight by phone that the B.C. Centre for Disease Control has developed an agreement with a lab in Edmonton to test for levamisole. “If people send us urine from people who have developed agranulocytosis [with fever] and taken cocaine within 48 hours, we’ll freeze it and we can send it off to Alberta,” Kendall said. “We haven’t had any yet.”
Agranulocytosis, which can occur when people ingest levamisole, results in a weakened immune system, making infections more likely.
On December 10, the Fraser Health Authority sent out a notice about the cases of agranulocytosis, three of which were found within the authority’s boundaries. Kendall said those who fell ill weren’t tested for levamisole because it doesn’t stay in the urine long.
“If we get future cases, we will be able to draw that link,” he said. “The only way we will know about it is if we make this known to people, and make it known to doctors.”
Kendall added that he and his staff “really don’t have enough information of the recent cases to know if it’s associated with snorting, smoking crack, or with injecting”.
“The drug itself [levamisole] causes an immune reaction [in] people who are sensitive to it.”
Dean Wilson, president of the Vancouver Area Network of Drug Users, said he is not unduly worried about the effect this strain of contaminated cocaine could have on the Downtown Eastside’s drug-using population. “I don’t think it’s going to come down here anytime soon,” Wilson told the Straight on December 17. “If it is, it’s going to be just as sporadic as it is now.”
Kendall pointed out that levamisole suppresses the production of a “very important branch of white cells” in bone marrow. “So you can have a normal white count, but what you are actually missing is a bunch of cells called granulocytes, which are critical when it comes to fighting off infections,” he said. “So the people who are snorting cocaine depress their white-cell count where they are really susceptible to infections.”
He suggested that a malnourished injection-drug user or crack-cocaine smoker is probably most at risk. “People in the general community could come into contact with staphylococcal and strep or meningococcal infections, which are carried quite commonly in people’s noses,” Kendall said.
Wilson said that immune suppression is “one of the worst things that could happen” among the population VANDU serves, as “everybody’s either hep[atitis] C–positive or HIV–positive.”
“We don’t need our immune systems compromised any more than they are right now,” Wilson said. “So, I’m just glad that people like Perry Kendall”¦have got on it so quickly. Our medical-health officer is on it, and I think we’ll be fine.”
Added Wilson, “One thing about living down here is, not only can people find out where the best dope is within minutes, they also find out information about deadlier stuff within minutes. The way we get messages back and forth works, and we are getting the message out.”
According to Dr. Helena Swinkels, medical-health officer with the Fraser Health Authority, anyone who ingests cocaine would be susceptible to agranulocytosis. “It is something that you might not notice right away,” Swinkels told the Straight by phone. “What happens is, you get an infection, something that your body would otherwise fight off, and it becomes very serious very quickly.”¦There are two ways to prove the link. One is to find the levamisole in the actual cocaine—so to do testing on the cocaine itself. The other one is to find the levamisole in people who have abused cocaine and have the immune suppression.”
Aside from “street-oriented drug users” who are smoking crack or injecting it, Kendall said there are two other groups of cocaine users that could be at risk: the clubgoing party crowd and the recreational weekend user “with money”.
“If you see somebody who didn’t look like a street-oriented drug-using person and they had one of these particular conditions, you would treat them, but you wouldn’t necessarily think to ask them if they were a recreational cocaine user,” he said. “It’s not the sort of thing that somebody will tell their doctor.”
A spokesperson for the Vancouver Coastal Health Authority said that holidays like New Year’s pose no greater risk than usual. “We always say it’s never safe to take or inject illicit drugs, as that is a given,” Anna Marie D’Angelo told the Straight. “We have a supervised-injection site, where there are nurses to supervise and show people how to do it as safely as possible. Nurses and staff are there for people who OD, so there is a lot of help should something happen.”
When asked about increased risks at New Year’s, Wilson scoffed. “Oh, Christ, there is tons of cocaine being consumed here right as I speak, you know?” he said. “The thing is, it’s not a party down here, so one day doesn’t mean anything different to another day. It’s a serious fucking problem down here, it’s really shitty, and we do drugs every day down here. So it’s not like, oh, all of a sudden it’ll be Christmas and there will be a lot more of this.”