~ There is now significant evidence that cocaine is routinely being mixed with the dangerous veterinarian drug Levamisole that when consumed, can result in severe nasal inflammation and permanent facial deformity ~
TORONTO, Sept. 18, 2013 /CNW/ - Levamisole, a drug no longer approved for human use in Canada, is re-appearing in cut cocaine, and this is poisoning people causing major skin damage and cosmetic deformity secondary to severe inflammation of the nasal and sinus passages following cocaine use. This previously mysterious entity has plagued physicians for several years, with patients experiencing often-excruciating pain and disfigurement not responsive to common therapies. The Canadian Rhinosinusitis Working Group brings this new and startling trend to the attention of our Canadian healthcare providers and the public.
Levamisole-induced vasculitis is marked by the development of severe nasal crusting, swelling and destruction of nasal tissue, with external nasal or cutaneous deformity. Painful skin rashes can present on any area of the body and can lead to necrosis of the affected skin and underlying tissues. This vasculitic condition should be suspected in individuals with a history of cocaine use, even with occasional consumption or so called recreational use.
"Unless we learn to recognize the signs and symptoms, this condition goes untreated to dreadful consequences," said Dr. Martin Desrosiers with the Division of Otolaryngology Head and Neck Surgery Centre, de l'Université de Montréal. "I was unaware that levamisole-lased cocaine was responsible for the severe inflammatory changes seen in some of our patients until a visiting researcher looked at a patient chart and suggested we investigate levamisole. Recognition of levamisole- induced vasculitis in our population with complications of recreational cocaine use has been a revelation as disease was often so severe as to raise a fear of cancer and appropriate treatment not administered." added Desrosiers. "To prevent the development of ulcers and a chronic disease state, both prevention and early recognition of levamisole-induced vasculitis is necessary. We don't always know what our patients are consuming while we are investigating and subjecting these people to surgery and repeated courses of costly medications with limited beneficial effects."
Levamisole suppresses the production of infection-fighting white blood cells. When ingested it causes joint pain and creates red or purple discolorations of the skin or nasal mucosa that is caused by bleeding underneath the skin secondary to vasculitis (blood vessel inflammation). Skin necrosis results which is cell injury causing the premature death of cells in living tissue.
- An estimated 2 million people are identified as current cocaine users in North America suggesting that cocaine abuse is common.
- Levamisole is widely present in the cocaine in North America: Studies report that 46 per cent of cocaine in circulation in Canada and 30 per cent to 71 per cent of cocaine samples circulating in the US contains levamisole.
- Levamisole was marketed as an immunomodulator [agent that increases or decreases the immune response] that is no longer approved for human use in North America. Evidence shows it is now being used to dilute or "cut" cocaine. The drug was withdrawn from the human market in 1999 due to serious side effects including leukopenia, agranulocytosis, and skin vasculitis. It is still available in Canada as a deworming drug for livestock.
- No single effective treatment for levamisole vasculitis has been identified.
Guidance to the Healthcare Provider:
The first recommendation is prevention, by education of the public about this new risk of cocaine use secondary to levamisole exposure. The second recommendation is to raise physician awareness of this emerging disorder. Those patients who present with severe inflammation of the nasal passages or unexplained cutaneous vasculitis or neutropenia should be questioned regarding recreational cocaine use and if suspected, blood testing for levamisole should be undertaken.
Dr. Alan Kaplan, a Family Physician in Richmond Hill and a member of the Family Physician Airways Group of Canada, states, "As a front line physician we may not think about substance abuse when patients come in for inflammatory conditions and low white cell counts; but primary care doctors need to know about the harmful effects of not just the cocaine, but the other drugs that come with it, mostly unknown by the consumer".
Dr. Shaun Kilty, Department of Otolaryngology- Head and Neck Surgery, The Ottawa Hospital, "This information will certainly help clinicians to better identify and manage this potentially severe secondary effect from cocaine use which can lead to suffering and extremely disfiguring consequences for the patient. Patient and physician education will be key to avoiding the development of this dreadful disease in the future. "
About: The Canadian Rhinosinusitis Best Practices and Standards Working Group [CRWG]
Established in 2011 with the release of the Canadian Guidelines, The Canadian Rhinosinusitis Best Practices and Standards Working Group [RWG] has been created to be the single, Canadian authoritative voice on all aspects of rhinosinusitis including but not limited to its diagnosis, treatment and management. Composed of cross-disciplined experts representing the diversity of caregivers involved in the management of patients with sinusitis, the RWG recognizes and responds to the needs of patients, healthcare professionals, governments, and society. Website: www.sinuscanada.com
Note to Editor: The following professionals are senior directors of the CRWG
|Martin Desrosiers, Otolaryngology - Head & Neck Surgery, Montreal||Alan Kaplan, Family Medicine, Richmond Hill|
|Shaun Kilty - Department of Otolaryngology- Head & Neck Surgery, Ottawa||Ian J Witterick, Otolaryngology - Head & Neck Surgery, Toronto|
|Paul K Keith, Allergy and Clinical Immunology, Hamilton||Gerald A Evans, Infectious Diseases, Kingston|
|Marc A. Tewfik, Otolaryngology - Head & Neck Surgery, Montreal|
Image with caption: "Notice to Canadians - If you are going to do THAT - you need to know THIS! Cocaine laced with veterinarian drug Levamisole is an emerging health threat in Canada (CNW Group/The Canadian Rhinosinusitis Best Practices and Standards Working Group (RWG))". Image available at: http://photos.newswire.ca/images/download/20130918_C8198_PHOTO_EN_30970.jpg
SOURCE: The Canadian Rhinosinusitis Best Practices and Standards Working Group (RWG)
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