Editing Cocaine (section)

==== Lacing ====
{{also|Gray death}}

[[File:Flavcocaine.jpg|thumb|Cocaine adulterated with fruit flavoring]]

Street cocaine is often [[Lacing (drugs)|laced]] or "cut" with cheaper substances to increase bulk, including [[talc]], [[lactose]], [[sucrose]], [[glucose]], [[mannitol]], [[inositol]], [[caffeine]], [[procaine]], [[phencyclidine]], [[phenytoin]], [[lidocaine]], [[strychnine]], [[levamisole]], and [[amphetamine]].<ref>{{Citation | vauthors = Pillay VV | title=Modern Medical Toxicology | edition=4th | year=2013 | publisher=Jaypee | isbn=978-93-5025-965-8 | pages=553–554}}</ref> [[Fentanyl]] has been increasingly found in cocaine samples.<ref>{{cite journal | vauthors = Wagner KD, Fiuty P, Page K, Tracy EC, Nocera M, Miller CW, Tarhuni LJ, Dasgupta N | title = Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services | journal = Drug and Alcohol Dependence | volume = 252 | pages = 110985 | date = November 2023 | pmid = 37826988 | doi = 10.1016/j.drugalcdep.2023.110985 | pmc = 10688611 }}</ref>

Because of the nature of trafficking, cocaine typically passes through many intermediaries-sometimes a dozen or more-each seeking to earn a profit, which is why lacing with adulterants becomes so common. This makes it virtually impossible for end consumers to know whether or how the drug has been adulterated. Even when purity tests are performed, it remains difficult to determine if the cocaine is truly pure, as all families of potent chemicals and adulterants must also be specifically tested to detect their presence.

The extent of cutting can vary significantly over time but for the last 15 years drugs such as cocaine ranged in Europe on average from 32% to 65% in purity.<ref>{{cite web |url=https://www.euda.europa.eu/data/stats2024/ppp_en#displayTable:PPP-01-1-1-1-5-3 |website=European Union Drugs Agency |access-date=25 February 2025 |title=Statistical Bulletin 2024 — price, purity and potency &#124; www.euda.europa.eu }}</ref>

A problem with illegal cocaine use, especially in the higher volumes used to combat fatigue (rather than increase euphoria) by long-term users, is the risk of ill effects or damage caused by the compounds used in adulteration. Cutting or "stepping on" the drug is commonplace, using compounds which simulate ingestion effects, such as [[Novocain]] (procaine) producing temporary anesthesia, as many users believe a strong numbing effect is the result of strong and/or pure cocaine, ephedrine or similar stimulants that are to produce an increased heart rate. The normal adulterants for profit are inactive sugars, usually mannitol, [[creatine]], or glucose, so introducing active adulterants gives the illusion of purity and to 'stretch' or make it so a dealer can sell more product than without the adulterants, however the purity of the cocaine is subsequently lowered.<ref name="q884">{{cite journal | vauthors = Ribeiro M, Trevizol AP, Frajzinger R, Ribeiro A, Speierl H, Pires L, Andraus M, Tsanaclis L, Alonso AL, Cordeiro Q, Laranjeira R | title = Adulterants in crack cocaine in Brazil | journal = Trends in Psychiatry and Psychotherapy | volume = 41 | issue = 2 | pages = 186–190 | date = July 2019 | pmid = 31314858 | doi = 10.1590/2237-6089-2017-0143 | doi-access = free }}</ref><ref name="t678">{{cite book |  vauthors = ((United Nations Office on Drugs and Crime. Laboratory and Scientific Section)) | title=Methods for Impurity Profiling of Heroin and Cocaine | publisher=United Nations Publications | date=2005 | isbn=978-92-1-148206-5}}</ref> The adulterant of sugars allows the dealer to sell the product for a higher price because of the illusion of purity and allows the sale of more of the product at that higher price, enabling dealers to significantly increase revenue with little additional cost for the adulterants. A 2007 study by the [[European Monitoring Centre for Drugs and Drug Addiction]] showed that the purity levels for street purchased cocaine was often under 5% and on average under 50% pure.<ref>{{Cite web|title=EMCDDA Retail Cocaine Purity Study|year=2007|author=EMCDDA|url=https://www.emcdda.europa.eu/stats09/ppptab7a|access-date=31 December 2013|url-status=live|archive-url=https://web.archive.org/web/20140101041854/https://www.emcdda.europa.eu/stats09/ppptab7a|archive-date=1 January 2014}}</ref>

In February 2022, 24 people in [[Argentina]] died after using cocaine laced with [[carfentanil]].<ref>{{cite news |title=Cocaína 'envenenada' que causou mortes na Argentina tinha anestésico para elefantes |url=https://g1.globo.com/mundo/noticia/2022/02/10/cocaina-envenenada-que-causou-mortes-na-argentina-tinha-anestesico-para-elefantes.ghtml |work=G1 |language=pt-br}}</ref>

===== Levamisole =====
[[File:Levamisole.svg|thumb|Levamisole]]

In the body, [[levamisole]] is converted into [[aminorex]], a substance with [[amphetamine]]-like stimulant effects and a long duration of action.<ref>{{cite journal | vauthors = Solomon N, Hayes J | title = Levamisole: A High Performance Cutting Agent | journal = Academic Forensic Pathology | volume = 7 | issue = 3 | pages = 469–476 | date = September 2017 | doi = 10.23907/2017.039 | pmid = 31239995 | pmc = 6474566 }}</ref>

During the mid-2010s, levamisole was found in most cocaine products available in both the United States and Europe.<ref>{{cite web |title=Cocaine retail markets: multiple indicators suggest continued growth and diversification {{!}} www.euda.europa.eu |url=https://www.euda.europa.eu/publications/eu-drug-markets/cocaine/retail-markets_en |website=www.euda.europa.eu}}</ref> Levamisole is known to cause an acute condition involving a severe and dangerous lowered white blood cell count, known as [[agranulocytosis]], in cocaine users, and may also accentuate cocaine's effects.<ref>{{Cite journal | vauthors = Chang A, Osterloh J, Thomas J | title = Levamisole: a dangerous new cocaine adulterant | journal = Clinical Pharmacology and Therapeutics | volume = 88 | issue = 3 | pages = 408–11 | date = September 2010 | pmid = 20668440 | doi = 10.1038/clpt.2010.156 | s2cid = 31414939 }}</ref><ref>{{Cite journal | vauthors = Tallarida CS, Egan E, Alejo GD, Raffa R, Tallarida RJ, Rawls SM | title = Levamisole and cocaine synergism: a prevalent adulterant enhances cocaine's action in vivo | journal = Neuropharmacology | volume = 79 | pages = 590–5 | date = April 2014 | pmid = 24440755 | pmc = 3989204 | doi = 10.1016/j.neuropharm.2014.01.002 }}</ref> Levamisole-adulterated cocaine has been associated with [[autoimmune disease]].<ref>{{Cite journal | vauthors = Cascio MJ, Jen KY | title = Cocaine/levamisole-associated autoimmune syndrome: a disease of neutrophil-mediated autoimmunity | journal = Current Opinion in Hematology | volume = 25 | issue = 1 | pages = 29–36 | date = January 2018 | pmid = 29211697 | doi = 10.1097/MOH.0000000000000393 | s2cid = 23795272 }}</ref>

Levamisole test kits can be utilized to detect the presence of levamisole in cocaine.

===== Local anesthetics =====

Cocaine is sometimes cut with [[lidocaine]],<ref>{{cite journal | vauthors = Bernardo NP, Siqueira ME, De Paiva MJ, Maia PP | title = Caffeine and other adulterants in seizures of street cocaine in Brazil |year=2003 | journal = International Journal of Drug Policy | volume = 14 | issue = 4 | pages = 331–4 | doi = 10.1016/S0955-3959(03)00083-5 }}</ref><ref name="url599 F.2d 635">{{cite web | url = https://bulk.resource.org/courts.gov/c/F2/599/599.F2d.635.78-5314.html | title = UNITED STATES of America, Plaintiff-Appellee, v. Luis A. CUELLO, Alvaro Bastides-Benitez, John Doe, a/k/a Hugo Hurtado, and Alvaro Carvajal, Defendants-Appellants | date = 25 July 1979 | work = Docket No. 78-5314 | publisher = United States Court of Appeals, Fifth Circuit | url-status = dead | archive-url = https://web.archive.org/web/20120524141840/http://bulk.resource.org/courts.gov/c/F2/599/599.F2d.635.78-5314.html | archive-date = 24 May 2012 }}</ref> and [[procaine]]. <ref>{{cite web | title = Procaine | url = http://www.ecstasydata.org/search.php?substance1=2023 | work = ecstasydata.org }}</ref>