INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION C I C A D
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1 INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION C I C A D Secretariat for Multidimensional Security FIFTY-SEVENTH REGULAR SESSION April 29 - May 1, 2015 Washington, D.C. OEA/Ser.L/XIV.2.57 CICAD/doc.2167/15 30 April 2015 Original: English TOXIC ADULTERANTS AND PUBLIC HEALTH IMPLICATIONS
2 Toxic Adulterants and Public Health Implications CICAD 57 Thom Browne, Jr. Bureau of International Narcotics and Law Enforcement Affairs U.S. Department of State April 2015
3 Cocaine Manufacturing Process Coca Leaves Calcium Oxide Kerosene Sulfuric Acid (Battery Acid) Sodium carbonate Cocaine Paste Base Hydrochloric Acid Sodium carbonate Cocaine Base Sulfuric Acid Potassium permanganate Ammonium Hydroxide Hydrochloric Acid Sodium carbonate Heat/Cool Free-Base Ammonium Hydroxide Merla Hydrochloric Acid Sodium carbonate Acetone Hydrochloric Acid Cocaine Hydrochloride Crack Sodium carbonate Heat/Cool
4 SOME COCAINE BY-PRODUCTS Kerosene Gasoline Battery Acid Lime Benzene Potassium Permanganate Toluene
5 Some Cocaine Adulterants PHENACETIN: pain reliever / fever reducer PARACETAMOL: a pain reliever AMINOPYRINE: analgesic, anti-inflammatory ANFEPRAMONA: similar to amphetamine BENZOCAINA: a local anesthetic LIDOCAINA: a local anesthetic LEVAMISOLE: used to expel parasitic worms HYDROXYZINE: an antihistamine ACETAMINOPHEN: pain reliever / fever reducer 5
6 Chemical Profile of Cocaine Samples Brazil 2012
7 Chemical Profile of Cocaine Samples in the Southern Cone Brazil Chile Paraguay Uruguay Argentina No. Samples Tested: Average Purity (Range) (29.7% -89.6%) (15.8% %) (4.6% 84.6%) (35.8% %) (17.4% %) Number (%) with Adulterants 30 (75%) 8 (40%) 17 (85%) 9 (100%) 15 (100%) Phenacetin 26 (65%) 1 (5%) 13 (65%) 2 (22%) 15 (100%) Levamisole 1 (3%) 1 (5%) 2 (22%) Other 3 (7%) 7 (35%) 3 (15%) 5 (55%) Aminopyrine + Phenacetin 16 (40%) - 8 (40%) 1 (11%)
8 Chemical Profile of Cocaine Samples in Sao Paulo Nov (1144 samples) Adulterants Crack HCl Phenacetin 60% 6% Aminopyrine 25% 1% Levamisole 1% 50%
9 Amostras Forma Benzo caina Parace tamol Fenace tina Cafei na Lido caina Amino pirina Leva misol Procai na Hidroxi zina Dilitia zem Cocaina Ciscinamoil cocaina Transcinamoil cocaina _11_PR_3 Base 0,0 0,0 20,3 0,0 0,0 0,0 0,0 0,0 0,0 0,0 54,3 0,0 2, _11_PR_4 Base 0,0 0,0 11,8 0,0 0,0 0,0 0,0 0,0 0,0 0,0 62,4 0,7 2, _11_PR_5 Base 0,0 0,0 12,2 0,0 0,0 0,0 0,0 0,0 0,0 0,0 62,7 0,5 3, _11_PR_6 Base 0,0 0,0 12,8 0,0 0,0 0,0 0,0 0,0 0,0 0,0 62,0 0,8 2, _11_PR_7 Base 0,0 0,0 12,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 63,6 0,9 1, _11_PR_8 Base 0,0 0,0 12,6 0,0 0,0 0,0 0,0 0,0 0,0 0,0 65,2 1,0 1, _11_PR_9 Base 0,0 0,0 10,6 0,0 0,0 0,0 0,0 0,0 0,0 0,0 61,3 0,8 2, _11_PR_2 Base 0,0 0,0 47,2 0,0 0,0 17,0 0,0 0,0 0,0 0,0 12,9 0,0 3, _11_PR_3 Base 0,0 0,0 47,3 0,0 0,0 16,9 0,0 0,0 0,0 0,0 12,0 0,0 3, _11_PR_4 Base 0,0 0,0 58,4 0,0 0,0 1,8 0,0 0,0 0,0 0,0 27,1 0,0 0, _11_PR_4 Base 0,0 0,0 13,6 0,0 0,0 2,3 0,0 0,0 0,0 0,0 71,1 2,4 1, _11_PR_6 HCl 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 94,7 1,4 1, _11_PR_7 Base 0,0 0,0 13,9 0,0 0,0 0,0 0,0 0,0 0,0 0,0 66,6 0,8 1, _11_PR_8 Base 0,0 0,0 48,8 0,0 0,0 16,0 0,0 0,0 0,0 0,0 15,9 0,0 2, _11_PR_9 HCl 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 94,4 1,3 0, _11_PR_10 Base 0,0 0,0 32,6 0,0 0,0 0,0 0,0 0,0 0,0 0,0 53,4 1,2 1, _11_PR_1 Base 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 72,6 1,9 1, _11_PR_2 Base 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 79,2 3,6 2, _11_PR_3 Base 0,0 0,0 8,4 0,0 0,0 17,3 0,0 0,0 0,0 0,0 52,8 0,8 0, _11_PR_4 Base 0,0 0,0 8,1 0,0 0,0 0,0 0,0 0,0 0,0 0,0 72,0 1,3 1, _11_PR_5 Base 0,0 0,0 7,7 0,0 0,0 0,0 0,0 0,0 0,0 0,0 74,9 1,3 2, _11_PR_6 Base 0,0 0,0 8,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 74,9 1,6 2, _11_PR_7 Base 0,0 0,0 8,3 0,0 0,0 17,2 0,0 0,0 0,0 0,0 50,2 0,7 0, _11_PR_1 Base 0,0 0,0 17,9 0,0 0,0 0,0 0,0 0,0 0,0 0,0 66,6 4,5 4, _11_PR_10 Base 5,1 0,0 26,9 0,0 0,0 3,4 0,0 0,0 0,0 0,0 47,0 1,6 2, _11_PR_11 HCl 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 95,6 1,3 1, _11_PR_12 HCl 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 96,0 1,2 1, _11_PR_13 HCl 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 96,0 1,2 1, _11_PR_2 Base 3,0 0,0 29,3 0,0 0,0 3,7 0,0 0,0 0,0 0,0 47,6 1,6 2,3
10 Health Consequences of Cocaine Adulterants Adulterant Phenacetin Levamisole Licit Use Analgesic substance Medication used for expelling worms Potential Reason for use as Adulterant Pain relieving properties; similar physical properties to cocaine Unknown; may give more intense high Lidocaine Local anesthetic Similar, but stronger, anesthetic effects as cocaine; gives impression of higher quality of cocaine Benzocaine Local anesthetic used in dentistry, throat sprays, ointments and suntan lotions Similar anesthetic properties as cocaine Public Health Risks Banned in many countries due to links with renal failure and suspected carcinogen Highly toxic; generally not used with humans; still used in veterinary medicine Adverse cardiovascular and CNS reactions at low dose; Overdose can occur at excessive doses; Increases toxicity of cocaine Overdose can cause rare but serious blood disorder Health Consequences Hemolytic anemia ( < red blood cells ) Kidney Failure Bladder Cancer Fever Agranulocytosis ( < white blood cells ) CNS Problems Nausea Vomiting Dizziness Tremors Convulsions Blood disorder (Methemoglobinemia: inability to release oxygen effectively to body tissues) Aminopyrine Analgesic Anti-inflammatory Pain relieving properties Clinical use sharply curtailed due bone marrow toxicity; Emits toxic fumes when heated Agranulocytosis ( < white blood cells )
11 Levamisole is Toxic Withdrawn from the Canadian (2003)and USA (1999)markets due to toxicity Results in a decrease of white blood cells that can lower immunity and increase opportunist infections Associated with inflammation of blood vessels that can cause severe damage to skin Identified as cocaine adulterant in 2003 Appeared in U.S., Europe, and Latin America
12 Used to cut cocaine A metabolite (aminorex) of levamisole acts to prolonged the high associated with cocaine Has resulted in many reports of cocaine users suffering toxic side effects from levamisole Skin reactions Seizures Low White Blood Cell Count (Granulocytopenia)
13 Levamisole Skin Toxicity
14 Acetaminophen Risks Cases of severe liver damage have occurred in patients who: took more than the prescribed dose in a 24-hour period (i.e., 3 grams or 3,000 mg); took more than one acetaminophen-containing product at the same time; or drank alcohol while taking the product (risk of kidney disease also). FDA recommended dose 325 mg/tablet Effects of Levamisole in combination????????
15
16 A range of verifiable toxicological test data have enabled INL to document the world s first detected instances of child drug use, ranging from infancy to 12 years of age, with many instances observed in children five to eight years old. Global Child Drug Use
17 Drug Exposure Active Use direct smoking Second-hand Exposure inhalation of smoke in the environment Third-hand Exposure residual drug contamination of surfaces
18 Home Surface, Air, and Hair Results Year 2 (ng per swab, cartridge, or pg/mg) Sample MOR COD 6-AM HC HM Pillow NA 0 0 Mattress NA 0 0 Cradle NA 0 0 Pillar NA 0 0 Blanket NA 0 0 Air, smoking 562, , Hair, 35 F 15,011 15,485 1,680 2,612 1,187 Hair, 10 M 3,768 1, Hair, 5 M 15,554 8,360 1,
19 Afghan Children Positive Opiate Hair Results (pg/mg) Home Age Sex COD MOR 6-AM HC HM 1 12 y.o. M , y.o. F , mo F , y.o. M y.o. M y.o. F y.o. F y.o. M y.o. M , y.o. F y.o. F mo M y.o. M 2,422 3, y.o. M 6,477 8, y.o. F 4,652 8,350 5, y.o. M 2,403 3,802 1, y.o. F
20 Afghan Children Testing Positive for Drugs in Six Women and Children Drug Treatment Centers (All results based on hair testing unless specifically noted)
21 Programs and Innovative Projects Specialized Training for Special Populations: Children Who Use Drugs Project: Child Treatment Protocols and Training Child addiction not limited to Afghanistan. Opiate drug use among children and adolescents in India, Pakistan, and Bangladesh. Crack cocaine use by street children in the Southern Cone and South Africa INL has initiated a global child drug use program which assesses the issue of child drug use on a city-by-city basis, delivering a specialized treatment curriculum based on the children s protocols developed by international organizations (UN, WHO, OAS, Colombo Plan) and international universities, and conducts routine follow-up mentoring with organizations providing treatment and social support services to children.
22 Crack Use by Street Children Abundant Supply: 25 cents $1 per dose Crack cheaper than solvents & glues, with more pleasurable mind altering effects Exposure to drugs, toxic adulterants, and chemical impurities can result in problems with learning, behavior, and development
23 Crack and Children (Con t.) Adulterants and chemical impurities can cause greater harm and at lower doses in the child and adolescent brain Children s metabolisms and developing immune systems mean their bodies are less able to get rid of contaminants or reduce the toxicity of selected adulterants Adulterants that suppress the immune system are an especially ominous threat to these children
24 COCAINE ADULTERANT DETECTION GC/MS older technology, screen, confirm LC/MS/MS faster, more compounds
25 COCAINE ADULTERANT FIELD DETECTION Levamisole, Phenacetin, and Aminopyrine Detected in Hair, Saliva and Urine - Lab based Detected in Drugs Lab based No field test available (drug or biological)
26 Exams and Tests Complete blood count CT scan of the kidney Intravenous pyelogram (IVP): X-Ray of the kidney and bladder Toxicology screen Urinalysis Kidney ultrasound
27 Quick Test for Adulterants
28
29 Future Initiatives Globalize Adulterant Study Determine Composition of New Drug Combinations (e.g., Whoonga/Nyaope in South Africa; Fly-Wing Cocaine in South America) Determine Composition of Crack Cocaine in Central America Develop Instant Field Tests for New Adulterants Study Health Effects of Multiple Adulterants Pyrolysis Studies
30 Drug Use Around the World Today On a global level, drug use is stable. 243 million people (5.2% of world population) used an illicit drug at least once in the previous year. 27 million people (0.5% of world population) are problem drug users Source: UNODC World Drug Report (2014).
31 Global Drug Use 5% 95% No Não No Yes Sim Si
IMPACT OF DRUGS AND SECURITY IN THE CARIBBEAN
INTER AMERICAN DRUG ABUSE CONTROL COMMISSION C I C A D Secretariat for Multidimensional Security FORTY EIGHTH REGULAR SESSION December 6 8, 2010 Washington, D.C. OEA/Ser.L/XIV.2.48 CICAD/doc.1823/10 6
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