Question- What adulterant in cocaine is posited to play a role in the development of aortic dissection related to cocaine use?
Answer- The cited articles note “addressing the specific effect of smoked crack on pulmonary artery pressures, levamisole, an adulterant often found in the mixed powder of crack, is converted after inhalation to aminorex, a substrate strongly related to drug-induced pulmonary hypertension.” (Karch SB et al. Aminorex poisoning in cocaine abusers. 2012 Int J Cardiol 158:344-346 as reported in Havakuk O et al. The cardiovascular effects of cocaine. 2017 J Am Coll Cardiol 70:101-113)