Cocaine cut with the veterinary drug levamisole could be the culprit in a flurry of flesh-eating disease in New York and Los Angeles.
The drug, used to deworm cattle, pigs and sheep, can rot the skin off noses, ears and cheeks. And over 80 percent of the country's coke supply contains it.
"It's probably quite a big problem, and we just don't know yet how big a problem it really is," said Dr. Noah Craft, a dermatologist with Los Angeles Biomedical Research Institute.
In a case study in the Journal of the American Academy of Dermatology, Craft describes six cocaine users recently plagued by the dark purple patches of dying flesh. And while they happened to hail from the country's coastlines, the problem is national.
"It's important for people to know it's not just in New York and L.A. It's in the cocaine supply of the entire U.S.," Craft said.
Craft is one of several doctors across the country who have linked the rotting skin to tainted coke. The gruesome wounds surface days after a hit because of an immune reaction that attacks the blood vessels supplying the skin. Without blood, the skin starves and suffocates.
Eighty-two percent of seized cocaine contains levamisole, according to an April 2011 report by the U.S. Drug Enforcement Administration. Why dealers would stretch their stash with levamisole instead of the more traditional fillers, like baking soda, is unclear, although studies in rats suggest the drug acts on the same brain receptors as cocaine. So it might be added to enhance or extend the cocaine's euphoric effects on the cheap.
Despite the widespread contamination, not all of the country's cocaine users experience the flesh-rotting reaction. It appears that some are more vulnerable to the tainted cocaine's effects.
"We don't know who this is going to happen to," said Dr. Lindy Fox, the University of California, San Francisco, dermatologist who first connected the gruesome lesions on cocaine users to levamisole. Similarly, some patients have more extreme reactions than others. Fox said she once saw a photo of a man whose entire body, face included, was black with dying flesh.
Once the drug is cleared from the body, the wounds do heal, leaving behind a shiny scar.
Although some people might be more vulnerable to the effects of levamisole, the drug doesn't discriminate based on race or socioeconomic status.
"Rich or poor, black or white," anyone who uses cocaine is at risk, Craft said.
As if rotting skin wasn't enough, levamisole also prevents the bone marrow from producing infection-fighting white blood cells.
"It's a little bit like having HIV," said Craft, adding that without medical attention, the condition can be fatal. "About 10 percent of those patients will die from severe infections. They may be walking around like a time bomb."