Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0143
Trends in Psychiatry and Psychotherapy
Brief Communication

Adulterants in crack cocaine in Brazil

Adulterantes no crack vendido na “Cracolândia”

Marcelo Ribeiro; Alisson Paulino Trevizol; Rosana Frajzinger; Ariadne Ribeiro; Hannelore Speierl; Luciana Pires; Maristela Andraus; Lolita Tsanaclis; Ana Leonor Sala Alonso; Quirino Cordeiro; Ronaldo Laranjeira

Downloads: 0
Views: 384

Abstract

Abstract Introduction Brazil is the world’s biggest consumer of crack cocaine, and dependence is a major public health issue. This is the first study to investigate the prevalence of potentially harmful adulterants present in hair samples from Brazilian patients with crack cocaine dependence. Method We evaluated adulterants in hair samples extracted by convenience from 100 patients admitted at the 48 hour-observation unit of Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Brazil’s largest center for addiction treatment. A cross-sectional analysis was performed with the data obtained. Results Adulterants were found in 97% of the analyzed hair samples. The most prevalent adulterant was lidocaine (92%), followed by phenacetin (69%) and levamisole (31%). Conclusion Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. This points to a need to monitor adverse effects in the clinical setting in order to provide this high-risk group of patients with prompt and effective care related to the acute and chronic complications associated with these adulterants.

Keywords

Cocaine, crack cocaine, adulterants, substance use disorders, toxicology

Resumo

Resumo Introdução O Brasil é o maior consumidor mundial de crack, e a dependência é um grande problema de saúde pública. Este é o primeiro estudo a investigar a prevalência de adulterantes potencialmente nocivos presentes em amostras de cabelo de pacientes brasileiros com dependência de crack. Métodos Foram avaliados adulterantes em amostras de cabelos extraídos por conveniência de 100 pacientes internados na unidade de observação de 48 horas do Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), o maior centro de tratamento de dependência do Brasil. Uma análise transversal foi realizada com os dados obtidos. Resultados Foram encontrados adulterantes em 97% das amostras de cabelo analisadas. O adulterante mais prevalente foi a lidocaína (92%), seguida da fenacetina (69%) e levamisol (31%). Conclusão Os adulterantes foram amplamente prevalentes em amostras de cabelo de usuários de crack tratados no CRATOD: pelo menos um adulterante estava presente em praticamente todas as amostras de cabelo coletadas. Isso aponta para a necessidade de monitorar os efeitos adversos no ambiente clínico, a fim de proporcionar a esse grupo de pacientes de alto risco cuidados imediatos e efetivos relacionados às complicações agudas e crônicas associadas a esses adulterantes.

Palavras-chave

Crack, cocaína, transtornos por uso de substâncias, toxicologia

References

Ribeiro M, Dunn J, Laranjeira R, Sesso R. High mortality among young crack cocaine users in Brazil: a 5-year follow-up study. Addiction. 2004;99:1133-5.

Ribeiro M, Dunn J, Sesso R, Dias AC, Laranjeira R. Causes of death among crack cocaine users. Rev Bras Psiquiatr. 2006;28:196-202.

Duailibi LB, Ribeiro M, Laranjeira R. Profile of cocaine and crack users in Brazil. Cad Saude Publica. 2008;24(^sSuppl 4):s545-57.

Ribeiro M, Duailibi S, Frajzinger R, Alonso AL, Marchetti L, Williams AV. Abuse and addiction: crack. Rev Assoc Med Bras. 2012;58:141-53.

Ribeiro M, Duailibi S, Frajzinger R, Alonso AL, Marchetti L, Williams AV. The Brazilian “Cracolandia” open drug scene and the challenge of implementing a comprehensive and effective drug policy. Addiction. 2016;111:571-3.

Abdalla RR, Madruga CS, Ribeiro M, Pinsky I, Caetano R, Laranjeira R. Prevalence of cocaine use in Brazil: data from the II Brazilian national alcohol and drugs survey (BNADS). Addict Behav. 2014;39:297-301.

Carvalho DG de, Mídio AF. Quality of cocaine seized in 1997 in the street-drug market of São Paulo city, Brazil. Rev Bras Cienc Farm. 2003;39:71-5.

Tanner-Smith EE. Pharmacological content of tablets sold as “ecstasy”: results from an online testing service. Drug Alcohol Depend. 2006;83:247-54.

Human Development Reports. .

Brunt TM, Nagy C, Bucheli A, Martins D, Ugarte M, Beduwe C. Drug testing in Europe: monitoring results of the Trans European Drug Information (TEDI) project. Drug Test Anal. 2017;9:188-98.

Tsanaclis L, Wicks JFC. Differentiation between drug use and environmental contamination when testing for drugs in hair. Forensic Sci Int. 2008;176:19-22.

Brunt TM, Rigter S, Hoek J, Vogels N, van Dijk P, Niesink RJ. An analysis of cocaine powder in the Netherlands: content and health hazards due to adulterants. Addiction. 2009;104:798-805.

Barrio G, Saavedra P, de la Fuente L, Royuela L. Purity of cocaine seized in Spain, 1985-1993: variations by weight, province and year of seizure. Forensic Sci Int. 1997;85:15-28.

Fucci N, De Giovanni N. Adulterants encountered in the illicit cocaine market. Forensic Sci Int. 1998;95:247-52.

Cole C, Jones L, McVeigh J, Kicman A, Syed Q, Bellis M. Adulterants in illicit drugs: a review of empirical evidence. Drug Test Anal. 2011;3:89-96.

Buchanan JA, Oyer RJ, Patel NR, Jacquet GA, Bornikova L, Thienelt C. A confirmed case of agranulocytosis after use of cocaine contaminated with levamisole. J Med Toxicol. 2010;6:160-4.

Magalhaes EJ, Nascentes CC, Pereira LS, Guedes ML, Lordeiro RA, Auler LM. Evaluation of the composition of street cocaine seized in two regions of Brazil. Sci Justice. 2013;53:425-32.

Maldaner AO, Botelho ÉD, Zacca JJ, Melo RCA, Costa JL, Zancanaro I. Chemical profiling of street cocaine from different Brazilian regions. J Braz Chem Soc. 2016;27:719-26.

Chang A, Osterloh J, Thomas J. Levamisole: a dangerous new cocaine adulterant. Clin Pharmacol Ther. 2010;88:408-11.

Hofmaier T, Luf A, Seddik A, Stockner T, Holy M, Freissmuth M. Aminorex, a metabolite of the cocaine adulterant levamisole, exerts amphetamine like actions at monoamine transporters. Neurochem Int. 2014;73:32-41.

Cheng YC, Po HL. Leukoencephalopathy after levamisole for the treatment of verrucae. Acta Neurol Taiwan. 2011;20:262-6.

Abeyagunawardena AS, Karunadasa U, Jayaweera H, Thalgahagoda S, Tennakoon S, Abeyagunawardena S. Efficacy of higher-dose levamisole in maintaining remission in steroid-dependant nephrotic syndrome. Pediatr Nephrol. 2017;32:1363-7.

Collister D, Sathianathan C, Ryz K, Karpinski M, Bernstein K, Gibson IW. ANCA-associated vasculitis secondary to levamisole-adultered cocaine with associated membranous nephropathy: A case series. Am J Nephrol. 2017;45:209-16.

Hernandes MR, Moraes LC, Ribeiro EB, Fagundes DL, Honorio-Franca AC, Franca EL. In vitro immunomodulatory effects of microemulsions with levamisole delivery systems on blood phagocytes interacting with Giardia lamblia. Parasitol Int. 2017;66:299-304.

Xu N, Zhou W, Shuy L, Zhou G, Zhang N. Clinical and MRI characteristics of levamisole-induced leukoencephalopathy in 16 patients. J Neuroimaging. 2009;13:326-31.

Bianco F, Iacovelli E, Tinelli E, Lepre C, Pauri F. Recurrent leukoencephalopathy in a cocaine abuser. Neurotoxicology. 2011;32:410-2.

Gonzalez-Duarte A, Williams R. Cocaine-induced recurrent leukoencephalopathy. Neuroradiol J. 2013;26:511-3.

Vosoughi R, Schmidt BJ. Multifocal leukoencephalopathy in cocaine users: a report of two cases and review of the literature. BMC Neurol. 2015;15.

Larocque A, Hoffman RS. Levamisole in cocaine: unexpected news from an old acquaintance. Clin Toxicol. 2012;50:231-41.

Gertner E, Hamlar D. Necrotizing granulomatous vasculitis associated with cocaine use. J Rheumatol. 2002;29:1795-7.

McKinney CD, Postiglione KF, Herold DA. Benzocaine-adultered street cocaine in association with methemoglobinemia. Clin Chem. 1992;38:596-7.

Chakladar A, Willers JW, Pereskokova E, Beaumont PO, Uncles DR. White powder, blue patient: methaemoglobinaemia associated with benzocaine-adulterated cocaine. Resuscitation. 2010;81:138-9.

6166052ea9539519636f3912 trends Articles
Links & Downloads

Trends Psychiatry Psychother

Share this page
Page Sections