Netherlands National Drug Monitor - Research and Documentation ...

• The total number of deaths among ‘mules’ who have swallowed pellets of cocaine
is unknown. This is partly because the cause-of-death statistics excludes persons
who are not registered in the Netherlands. The Amsterdam Municipal Health Service
(GGD) registered between three and eight cases annually in the period from 2002
to 2006 (7 in 2006). In 2007 only one case was registered, and in 2008, five cases
were registered.
3.8 Supply and market
Composition of cocaine samples
The Drugs Information and Monitoring System (DIMS) monitors the market for illegal
drugs. To this end, it uses analyses of drug samples submitted by users in addiction
care centres to establish which substances are in the drugs. Some of these samples are
identified by the care centre itself. Samples containing unknown substances and all
samples in powder form, such as cocaine, are forwarded to the laboratory for chemical
analysis.
In 2008, 671 powder samples were presented, that had been bought by users as cocaine
Van Dijk, 2009).
• In 2008 96% of all powder samples bought as cocaine did in fact contain that drug
(mainly hydrochloride). The cocaine concentration averaged 55% (in terms of weight).
In 2007, the average was 57 percent.
• 3% of the powder samples sold as cocaine contained no cocaine at all, but one
or more other psychoactive substances instead, and 1% contained no psychoactive
substance whatever.
In recent years, powder samples that were sold as cocaine have increasingly been found
to (also) contain medicines (figure 3.6).
• Close to one in three (32%) samples analysed in 2008 were found to contain phenacetine.
In 2005, 2006 and 2007 the percentages were 37%, 45% and 36% respectively.
Phenacetine was registered until 1984 as a painkiller, but because of possible
carcinogenic effects, it was removed from the market. However, the concentrations of
phenacetine that are used as a mixing agent are far lower than the therapeutic doses
which were feared to induce harmful side-effects.
• There has been an upsurge in the use of the mixing agent levamisol. This drug was
used to treat cancer, but was removed from circulation for human use in 2004 in the
Netherlands. It is still used in veterinary medicine to treat worms. In 2008, 30% of
cocaine samples tested contained levamisol, compared to 11% in 2007. This rose to
as much as half of lab samples analysed in the first half of 2009.
• In North America, use of cocaine mixed with levisamol has been linked to a dangerous
deficiency of white blood cells, which reduces resistance to illness (Zhu et al., 2009;
Knowles et al., 2009).
76 Netherlands National Drug Monitor - NDM Annual Report 2009