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Drug suspected in death

FRIDAY, JUNE 5, 2009

Cocaine user’s symptoms suggest contamination; three others show signs

Health officials suspect that contaminated cocaine has killed one Spokane woman and sickened three others in the area.

A muted response by the Spokane Regional Health District – which knew about the contamination for more than a month without issuing a broad health advisory – is the subject of an internal review launched Thursday by new health officer Dr. Joel McCullough.

“We need to do better,” he said.

The contaminant is called levamisole. It was used years ago in combination with other drugs to fight colorectal cancer.

Its application now is primarily in veterinary medicine, to de-worm hogs in Mexico and elsewhere. How it came to be mixed with cocaine is a mystery, McCullough said.

Levamisole causes people to lose white blood cells, a condition called agranulocytosis, decreasing their ability to fight infection. Symptoms include high fever, chills, swollen glands, oral and anal sores, and a white coating of the mouth and tongue. Health officials say three people in the area show signs of levamisole poisoning.

“People need to stop using cocaine,” McCullough said, if for no other reason than bad batches of the drug could be deadly.

Spokane internist Dr. Jeremy Graham began investigating the odd case of a Spokane woman in her mid-40s two years ago. She made repeated hospital visits and each time she had two common issues: She had low white blood-cell counts, and she tested positive for cocaine.

Doctors were stumped at the cause of her problems, which included rashes. Graham and others ordered biopsies that failed to yield answers.

Last year the woman was transferred to Harborview Medical Center in Seattle, where specialists in the hospital’s burn unit attempted to help her severe and worsening rashes with skin grafts and other treatments.

The efforts failed, and the woman died.

The case continued to bother Graham, who sought links between the fatal condition and the woman’s positive cocaine tests. He attempted to collect urine samples from cocaine users, but found they had little interest in participating.

Then, in March, he read an article in the Annals of Internal Medicine written by researchers from the University of Alberta in Edmonton.

The article reported that 30 percent of the cocaine seized by the U.S. Drug Enforcement Agency during the summer of 2008 was contaminated with levamisole.

The findings, Graham said, suggested the answer to what had killed the woman.

He noted that there have been no chemically confirmed cases in the Spokane region, but added, “there are people whom I am worried about.”

Graham said he called the health district regarding the published research and his concerns that others may have been be in danger.

Based on those warnings, the district tried to notify recipients of its needle-exchange program of the danger. But the formal notification of a public health advisory to alert the medical community, media and others was not issued until Dr. McCullough – who started in late April – was advised Thursday.

Patients elsewhere in the United States, including Seattle, have been poisoned in similar circumstances.

“It’s a serious condition and certainly something that the public needs to know about,” McCullough said.

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