Modeling Opioid Abuse: A Case Study of the Opioid Crisis in New England.

For the past two decades, the USA has been embroiled in a growing prescription drug epidemic. The ripples of this epidemic have been especially apparent in the state of Maine, which has fought hard to mitigate the damage caused by addiction to pharmaceutical and illicit opioids. In this study, we construct a mathematical model of the opioid epidemic incorporating novel features important to better understanding opioid abuse dynamics. These features include demographic differences in population susceptibility, general transmission expressions, and combined consideration of pharmaceutical opioid and heroin abuse. We demonstrate the usefulness of this model by calibrating it with data for the state of Maine. Model calibration is accompanied by sensitivity and uncertainty analysis to quantify potential error in parameter estimates and forecasts. The model is analyzed to determine the mechanisms most influential to the number of opioid abusers and to find effective ways of controlling opioid abuse prevalence. We found that the mechanisms most influential to the overall number of abusers in Maine are those involved in illicit pharmaceutical opioid abuse transmission. Consequently, preventative strategies that controlled for illicit transmission were more effective over alternative approaches, such as treatment. These results are presented with the hope of helping to inform public policy as to the most effective means of intervention.

Education to legality and doping.

When planning actions to prevent doping in the general population, public health operators may collide against the interests of criminal organizations involved in illicit trafficking of drugs. In addition to technical and professional expertise, or clinical and pharmacological skills, also a deep knowledge of legal and social issues is strongly required to face the problem and assure the effectiveness of the preventive actions. Sports competitions, athletes training or adapted physical activity may all represent conditions and environments at risk for misusing or abusing drugs and dietary supplements. A correct approach to sport and physical activity implies respect of competition rules, attention to own body limits and knowledge of risk factors. Health education campaigns and preventive actions should also consider education to legality in the different settings. The comprehension of the complex net that is available to access doping, locally or globally through online Internet sites, is essential as well as the awareness of the huge economic burden of crime interests behind the illicit trafficking of drugs. A modern whole rounded approach needs to consider doping not only as a violation of sport rules but also of the own body health, representing almost a form of addiction involving individuals and communities, and being supported by crime. Within this frame, doping is considered not just as a sport violation or a risk factor for individual's health, but as a disease of the society, in the society, against the society. A peculiar equilibrium seems to prevail between crime external pressures and resigned internal acceptance, according to the 'mafia hypothesis' model, where hosts accept parasitism to avoid retaliation. Here, main contributes and topics from the Erice 53rd Course are summarized and reviewed, providing links and references for further studies in the field. Health education and education to legality represent two sides of a same question, concerning both the general population and the health authorities. In conclusion, education to legality is a key component for prevention of doping and a priority for public health operators involved in protecting population health.

Tobacco industry's elaborate attempts to control a global track and trace system and fundamentally undermine the Illicit Trade Protocol.

BACKGROUND: The Illicit Trade Protocol (ITP) requires a global track and trace (T&T) system to reduce tobacco smuggling. Given the tobacco industry's (TI) historical involvement in tobacco smuggling, it stipulates that T&T 'shall not be performed by or delegated to the tobacco industry'. This paper explores the rationale for & nature of the TI's effors to influence the ITP & its T&T system. METHODS: Analysis of leaked TI documents and publicly available data; ,investigation of front groups, trademark and patent ownership. FINDINGS: Growing & diverse sources of evidence indicate that the TI remains involved in tobacco smuggling and that TI cigarettes account for around two-thirds of the illicit cigarette market. The TI therefore has a vested interest in controlling the global T&T system aimed to curtail this behaviour. To this end, Philip Morris International (PMI) adapted its pack marker system, Codentify, to meet T&T requirements, licensed it for free to its three major competitors who then collectively promoted it to governments using front groups and third parties including companies claiming to be independent despite clear TI links. PMI also sought to suggest Codentify was independent by selling some parts of its intellectual property on Codentify while retaining others, leaving a complex web of shared interests. In Africa, British American Tobacco used payments to obtain data suggesting its smaller competitor companies were evading taxes and secure influence with tax authorities. Regulatory capture has been enhanced by a public relations effort involving TI funding for conferences, training, research, and international police and anti-corruption organisations. Collectively this has created public messaging and a powerful network of organisations supportive of the TI's misleading postion on illicit. CONCLUSIONS: Governments should assume the TI seeks to control T&T systems in order to avoid scrutiny and minimise excise tax payments and that any T&T system based on Codentify, on intellectual property currently or previously owned by the TI, or being promoted or implemented by companies with TI links, is incompatible with the ITP and would not serve to reduce illicit trade.

Oncology drugs in the crosshairs of pharmaceutical crime.

Oncology drugs clearly have become a target for pharmaceutical crime. In 2016, falsified oncology drugs ranked fifth in the most commonly falsified drug category among the reports received by the Pharmaceutical Security Institute. Although the prevalence of illicit oncology drugs in the legal supply chains appears to be small, these drugs are difficult to detect, particularly in clinical practice. Forthcoming countermeasures to detect illicit drugs in high-income countries include compulsory antitampering devices and product verification technology for a risk-based selection of medicines. Health-care professionals must implement these new procedures into their workflow and remain vigilant about those medicines that are not selected. Although countermeasures should firmly tighten supply chain security, there are concerns about how quickly pharmaceutical crime will adapt to these protections. Because patients and health-care professionals have shown a lenient attitude towards purchasing medicines from unreliable sources, measures against the highly accessible illegal medicine supply chain remain necessary. To improve detectability in clinical practice, reporting of ineffectiveness and unusual drug effects as adverse events or adverse drug reactions is essential.

[securPharm e. V. - a protective shield against falsified medicines]. / securPharm e. V. ­ der Schutzschild gegen gefälschte Arzneimittel.

It is the declared objective of the Falsified Medicines Directive 2011/62/EU to further improve the protection of patients from falsified pharmaceuticals. Therefore, it stipulates measures based on which falsified medicines in the supply chain can be more easily identified. This is the European legislature's reaction to an increase in falsified medicines. The EU Falsified Medicines Directive aims to create a uniform, standardized solution for protection from falsified drugs. From 9 February 2019 onward (according to the EU Regulation No. 2016/161), manufacturers may only release prescription drugs bearing two safety features into circulation and pharmacies may only dispense these drugs to patients following a successful authentication.The EU legislature demands that each EU member state establish a non-profit national medicines verification organisation (NMVO) that sets up and operates a national medicines verification system (NMVS) for the authentication of pharmaceuticals. In Germany, this is securPharm e. V., an alliance of the pharmaceutical industry, wholesalers and pharmacies. securPharm e. V. was established in 2011. Since 2013, pharmaceutical companies, wholesalers and pharmacies have been able to use the securPharm system for testing purposes. This article provides an overview of the current project progress of securPharm e. V. as of June 2017.

Is the New Heroin Epidemic Really New? Racializing Heroin.

Heroin abuse as an outcome of the prior use of painkillers increased rapidly over the past decade. This "new epidemic" is unique because the new heroin users are primarily young White Americans in rural areas of virtually every state. This commentary argues that the painkiller-to-heroin transition could not be the only cause of heroin use on such a scale and that the new and old heroin epidemics are linked. The social marketing that so successfully drove the old heroin epidemic has innovated and expanded due to the use of cell-phones, text messaging and the "dark web" which requires a Tor browser, and software that allows one to communicate with encrypted sites without detection. Central city gentrification has forced traffickers to take advantage of larger and more lucrative markets. A second outcome is that urban black and Latino communities are no longer needed as heroin stages areas for suburban and exurban illicit drug distribution. Drug dealing can be done directly in predominantly white suburbs and rural areas without the accompanying violence associated with the old epidemic. Denial of the link between the new and old heroin epidemics racially segregates heroin users and more proactive prevention and treatment in the new epidemic than in the old. It also cuts off a half-century of knowledge about the supply-side of heroin drug dealing and the inevitable public policy measures that will have to be implemented to effectively slow and stop both the old and new epidemic.

Attitudes towards drug policies in Latin America: Results from a Latin-American Survey.

BACKGROUND: In recent years Latin American countries have increasingly rejected the traditional prohibitionist paradigm of drug policy, reflecting its failure to reduce either consumption or trafficking. The extent to which these policy trends currently command pubic support is unclear, however. This article goes some way to filling this gap, providing a snapshot of public attitudes towards drug policies in nine Latin American countries. METHODS: The 2014 Annual Survey of the Observatory of Drug Policies and Public Opinion, which has representative population samples, was used to measure public opinion. Country comparisons are made using descriptive and inferential statistics. RESULTS: Countries fall into three groups: Peru, Bolivia and El Salvador are the most conservative countries on drug policy and perceptions of risks of cannabis use; they also score lowest on Human Development Index. On the other hand, the public in Chile and Uruguay are more likely to support drug policy reform. The remaining four countries (Argentina, Colombia, Mexico and Peru) tend to occupy the middle ground between these extremes. In addition, cannabis legalization is explained by its recreational use, being this the main meaning attached to cannabis policy among Latin American citizens. CONCLUSION: There is a significant heterogeneity in attitudes towards drug policies in Latin American countries, which suggests that people are questioning the policies that set the norm in Latin America without achieving any consensus regarding future measures for each country.

The Dangerous Drugs Act Amendment in Jamaica: Reviewing goals, implementation, and challenges.

BACKGROUND: After decades of internal discussion, the Government of Jamaica recently amended its laws to create a regulated and licensed cannabis industry for medical and scientific purposes. The new law also decriminalizes personal possession and use of cannabis; allows cannabis to be used by individuals for religious, medical, scientific and therapeutic purposes; and permits home cultivation of up to five plants. METHODS: We first describe the statutory changes under the Dangerous Drugs (Amendment) Act of 2015 and compare it with other jurisdictions. We provide an analytical framework for understanding how the DDA Amendment affects key populations and achieves its stated goals, drawing on publicly available information and unstructured interviews with non-governmental stakeholders in Jamaica. RESULTS: The Amendment's primary goals are to deliver economic impact and reduce criminal justice costs. A relaxed policy of enforcement toward possession and use seems to have occurred even before the law's passage; after the law's passage, enforcement remains limited. To access medical cannabis under the DDA residents must receive authorization from a certified health professional in Jamaica; tourists may self-declare their medical need; and Rastafarians may grow and exchange non-commercially for religious purposes. CONCLUSION: Internally, many see "ganja" as an industry sorely needed to drive economic growth in Jamaica. Indeed, the potential impacts could be large, especially if Jamaica draws additional tourism or creates a viable export industry. A growing cannabis-related tourism industry seems more realistic. We maintain that policymakers and observers should proceed in an orderly fashion, continuing to identify and resolve remaining uncertainties, initiate new types of data collection, and make decisions based on realistic assessments of potentials for economic impact.

Harm reduction as a complex adaptive system: A dynamic framework for analyzing Tanzanian policies concerning heroin use.

Contrary to popular belief, policies on drug use are not always based on scientific evidence or composed in a rational manner. Rather, decisions concerning drug policies reflect the negotiation of actors' ambitions, values, and facts as they organize in different ways around the perceived problems associated with illicit drug use. Drug policy is thus best represented as a complex adaptive system (CAS) that is dynamic, self-organizing, and coevolving. In this analysis, we use a CAS framework to examine how harm reduction emerged around heroin trafficking and use in Tanzania over the past thirty years (1985-present). This account is an organizational ethnography based on of the observant participation of the authors as actors within this system. We review the dynamic history and self-organizing nature of harm reduction, noting how interactions among system actors and components have coevolved with patterns of heroin us, policing, and treatment activities over time. Using a CAS framework, we describe harm reduction as a complex process where ambitions, values, facts, and technologies interact in the Tanzanian sociopolitical environment. We review the dynamic history and self-organizing nature of heroin policies, noting how the interactions within and between competing prohibitionist and harm reduction policies have changed with patterns of heroin use, policing, and treatment activities over time. Actors learn from their experiences to organize with other actors, align their values and facts, and implement new policies. Using a CAS approach provides researchers and policy actors a better understanding of patterns and intricacies in drug policy. This knowledge of how the system works can help improve the policy process through adaptive action to introduce new actors, different ideas, and avenues for communication into the system.

Orphans of the Mexican drug war: insights on a public health challenge / Huérfanos víctimas de la lucha contra el narcotráfico en México: apreciaciones sobre un reto en materia de salud pública

OBJECTIVE: To describe how the Government of Mexico and other direct stakeholders perceive children orphaned by the drug war; to determine the current measures addressing this as a public health problem; and to compare these measures to international frameworks so that relevant recommendations can be identified. METHODS: This was an exploratory, descriptive case study using qualitative methods. Semi-structured interviews were performed with key informants at the federal, state, and municipal government levels in Mexico, as well as non-governmental organizations, and other institutes working with orphans. Participants were identified with a purposive snowball sample. RESULTS: No official definition of "orphan" was identified; nor was there a shared perception among the key informants of what constitutes being an orphan. An official, collective definition is important because it modifies the quantity of children categorized as such within the target population. Although most of the interviewees perceive that the number of orphans and vulnerable children (OVC) has increased in the last 6 years, they acknowledged there is no reliable data to prove it. The increase, they believe, is due not to the drug war, but to a loss of family cohesion. Stakeholders recommend improving public policies, currently identified as the most difficult barrier to overcome due to a perceived inability to modify existing laws. However, the General Law for Victims was recently passed by the Government of Mexico and addresses many of the challenges identified. CONCLUSIONS: When compared to the international frameworks, there are three major issues in Mexico's current situation: coordination among and within stakeholders; emphasis on using community solutions; and putting in place preventive programs. For two of these problems, the General Law of Victims offers solutions.

OBJETIVO: Describir cómo el Gobierno de México y otros interesados directos perciben el tema de los niños huérfanos como consecuencia de la lucha contra el narcotráfico; determinar las iniciativas actuales que abordan este tema como un problema de salud pública; y comparar estas iniciativas con los marcos internacionales con objeto de poder determinar las recomendaciones pertinentes. MÉTODOS: Se trata de un estudio de casos exploratorio y descriptivo que utilizó métodos cualitativos. Se llevaron a cabo entrevistas semiestructuradas con informantes clave a escalas federal, estatal y municipal del gobierno de México, así como con organizaciones no gubernamentales y otras instituciones que colaboraban con los huérfanos. Los participantes fueron seleccionados mediante un muestreo intencionado de bola de nieve. RESULTADOS: No se encontró ninguna definición oficial de "huérfano"; ni existía entre los informantes clave una percepción compartida de lo que constituye ser un huérfano. Es importante que exista una definición oficial y colectiva porque modifica la cantidad de niños clasificados como tales entre la población examinada. Aunque la mayor parte de los entrevistados perciben que el número de niños huérfanos y vulnerables (NHV) ha aumentado en los seis últimos años, también reconocen que no existen datos fidedignos que lo demuestren. Creen que el aumento no se debe a la lucha contra el narcotráfico sino a una pérdida de la cohesión familiar. Los interesados directos recomiendan mejorar las políticas públicas, que actualmente se consideran como la barrera más difícil de superar, dada la incapacidad percibida para modificar las leyes existentes. Sin embargo, el Gobierno de México aprobó recientemente la Ley General de Víctimas, que aborda muchos de los retos señalados. CONCLUSIONES: En comparación con los marcos internacionales, existen tres asuntos principales en la situación actual de México: la coordinación entre y dentro de los distintos grupos de interesados directos; el énfasis en el empleo de soluciones comunitarias; y la implantación de programas preventivos. La Ley General de Víctimas ofrece una solución para dos de estos problemas.

Espaços interqualificantes e prevenção do envolvimento dos jovens no tráfico de drogas / Espaces inter-qualifiants et prévention de l'implication des jeunes dans le trafic de drogues / Spaces professional exchange and prevention of young people involvement in drug trafficking

A irrupção do tráfico de drogas em bairros populares desestabiliza cotidianamente ações de numerosos profissionais (professores, educadores, animadores etc.). Alguns dentre eles recusam acomodar-se a tal situação. Em Marselha, Paris e em Seine-Saint-Denis, algumas instituições decidiram criar espaços de troca em torno do tema da prevenção do envolvimento dos jovens no tráfico, a fim de sustentar seus engajamentos. Chamado a animar esses grupos, o autor se apoiou em um dispositivo próprio da clinica sociológica, baseado na construção de saberes. A partir de então, os participantes desses grupos dispõem de uma leitura mais fina sobre as redes de tráfico de drogas e sobre a participação dos jovens nessas redes. Eles construíram um posicionamento profissional mais solidário no cotidiano e desenvolvem cooperações horizontais mais fecundas. Eles também criaram pistas originais de trabalho. Finalmente, o autor se interroga sobre a maneira pela qual tal iniciativa pode ser útil - não apenas aos participantes, mas também a todos que são (ou serão) confrontados com esses problemas em seus espaços de intervenção...

L'irruption de trafics de drogues dans les quartiers populaires déstabilise au quotidien les pratiques de nombreux professionnels (enseignants, éducateurs, animateur etc.). Certains d'entre eux refusent de s'accommoder d'une telle situation. A Marseille, à Paris et en Seine Saint Denis, des institutions ont décidé de mettre en place des espaces d'échange autour du thème de la prévention de l'implication des jeunes dans les trafics afin d'étayer leur engagement. Sollicité pour les animer, l'auteur a pris appui sur un dispositif propre à la clinique sociologique qui repose sur la co-construction des savoirs. Les participants à la démarche disposent désormais d'une lecture plus fine des réseaux de trafics de drogues et de la participation des jeunes à ces derniers. Ils construisent un positionnement professionnel plus aidant au quotidien et développent des coopérations horizontales plus fécondes. Ils ont aussi dégagé des pistes de travail originales. L'auteur s'interroge, in fine, sur la façon dont une telle démarche pourrait être utile non seulement à ces participants mais aussi à tous ceux qui sont aujourd'hui (ou seront demain) confrontés à ces problèmes sur leur territoire d'intervention...

The irruption of drug trafficking in popular districts destabilises the daily practices of many specialists (teachers, educators, leaders, etc.) Some of them refuse to accept this situation. In Marseille, Paris and Seine Saint Denis, institutions have decided to implement spaces for exchange aimed at preventing young people from becoming involved in drug trafficking and to support their commitment. Asked to lead them, the author used a system from clinical sociology based on co-constructing knowledge. The participants in this process now have a finer understanding of drug trafficking networks and how young people are involved in them. They built a professional positioning which is more able to help on a daily basis and which gives rise to more productive horizontal cooperation. They were also able to identify more original possibilities. The author ultimately questions the way in which such a process may be useful, not only for these participants, but also for all those who today are (or tomorrow will be) confronted with these problems in their own areas...

Cannabis use in a Swiss male prison: qualitative study exploring detainees' and staffs' perspectives.

BACKGROUND: Several studies suggest a high prevalence of cannabis use before and during imprisonment, but subjective perspectives of detainees and staff towards its use in prison are lacking. This issue was explored in the framework of an observational study addressing tobacco use in three Swiss prisons in 2009 and 2010 that involved multiple strands (quantitative and qualitative components). This article presents qualitative data on cannabis use collected in one of the settings. METHODS: We used in-depth semi-structured interviews with both detainees and staff to explore their attitudes towards cannabis in one post-trial male Swiss prison. We performed specific coding and thematic analysis for cannabis with the support of ATLAS.ti, compared detainees' and staff's opinions, and considered the results with regard to drug policy in prison in general. RESULTS: 58 participants (31 male offenders, mean age 35 years, and 27 prison staff, mean age 46 years, 33% female) were interviewed. Detainees estimated the current use of cannabis use to be as high as 80%, and staff 50%. Participants showed similar opinions on effects of cannabis use that were described both at individual and institutional levels: analgesic, calming, self-help to go through the prison experience, relieve stress, facilitate sleep, prevent violence, and social pacifier. They also mentioned negative consequences of cannabis use (sleepiness, decreased perception of danger and social isolation), and dissatisfaction regarding the ongoing ambiguous situation where cannabis is forbidden but detection in the urine was not sanctioned. However, the introduction of a more restrictive regulation induced fear of violence, increased trafficking and a shift to other drug use. CONCLUSION: Although illegal, cannabis use is clearly involved in daily life in prison. A clearer and comprehensive policy addressing cannabis is needed, including appropriate measures tailored to individual users. To sustain a calm and safe environment in prison, means other than substance or medication use are required.

Detection of residual packets in cocaine body packers: low accuracy of abdominal radiography-a prospective study.

OBJECTIVE: To evaluate the accuracy of abdominal radiography (AXR) for the detection of residual cocaine packets by comparison with computed tomography (CT). METHODS: Over a 1-year period unenhanced CT was systematically performed in addition to AXR for pre-discharge evaluation of cocaine body packers. AXR and CT were interpreted independently by two radiologists blinded to clinical outcome. Patient and packet characteristics were compared between the groups with residual portage and complete decontamination. RESULTS: Among 138 body packers studied, 14 (10 %) had one residual packet identified on pre-discharge CT. On AXR, at least one reader failed to detect the residual packet in 10 (70 %) of these 14 body packers. The sensitivity and specificity of AXR were 28.6 % (95 % CI: 8.4-58.1) and 100.0 % (95 % CI: 97.0-100.0) for reader 1 and 35.7 % (95 % CI: 12.8-64.9) and 97.6 % (95 % CI: 93.1-99.5) for reader 2. There were no significant patient or packet characteristics predictive of residual portage or AXR false negativity. All positive CT results were confirmed by delayed expulsion or surgical findings, while negative results were confirmed by further surveillance. CONCLUSION: Given the poor performance of AXR, CT should be systematically performed to ensure safe hospital discharge of cocaine body packers. KEY POINTS: • Both abdominal radiography and computed tomography can identify gastrointestinal cocaine packets. • Ten per cent of body packers had residual packets despite two packet-free stools. • Seventy per cent of these residual packets were missed on AXR. • No patient or packet characteristics predicted residual packets or AXR false negativity. • CT is necessary to ensure safe medical discharge of body packers.

Sustancias consideradas adictivas: prohibición, reducción de daños y reducción de riesgos / Substances considered addictive: prohibition, harm reduction and risk reduction

América Latina es actualmente la región con mayor tasa de homicidios a nivel mundial, y gran parte de los asesinatos están vinculados al denominado crimen organizado, especialmente al narcotráfico. El narcotráfico es producto de la ilegalización de ciertas sustancias, la cual -por lo menos en la actualidad- está basada y legitimada en criterios biomédicos que convierten la producción, comercialización y frecuentemente el consumo de ciertas sustancias consideradas adictivas en "delitos contra la salud". En este texto se analizan en forma sucinta las dos políticas formuladas y aplicadas hasta ahora en términos prohibicionistas y de reducción de daños, considerando el fracaso del prohibicionismo, así como las limitaciones de las propuestas de reducción de daños. Respecto del prohibicionismo se señalan sus múltiples y constantes incongruencias y contradicciones, lo cual implica que tomemos con cautela los reiterados señalamientos sobre su "fracaso". El texto propone la aplicación de una política de reducción de riesgos que incluya no solo los comportamientos de sujetos y grupos, sino también la dimensión estructural tanto en términos económico-políticos como culturales.

Latin America is currently the region with the highest rate of homicides worldwide, and a large part of the killings are linked to so-called organized crime, especially drug trafficking. The trafficking of drugs is a consequence of the illegality of certain substances which - at least presently - is based in and legitimated by biomedical criteria that turns the production, commercialization and often the consumption of certain substances considered addictive into "offenses against health." This text briefly analyzes the two policies formulated and implemented thus far in terms of prohibition and harm reduction, considering the failure of prohibitionism as well as the limitations of harm reduction proposals. The constant and multiple inconsistencies and contradictions of prohibitionism are noted, indicating the necessity of regarding cautiously repeated comments about its "failure." The text proposes the implementation of a policy of risk reduction that includes not only the behavior of individuals and groups, but also the structural dimension, both in economic-political and cultural terms.

Diagnóstico por imagem de Body Packers: relato de caso / Image diagnosis of Body Packers: case report

Introdução: o Brasil é atualmente a principal rota de tráfico de drogas da América Latina. Em aeroportos internacionais, passageiros com perfil considerado como suspeito pela Polícia Federal são conduzidos até serviços de pronto-atendimento para serem avaliados, ainda que assintomáticos e sem alterações visíveis. Objetivos: discutir, a partir de um relato de caso, os métodos de imagem diagnósticos para body packers mais utilizados na prática. Métodos: relato de caso de paciente atendido pelo Centro de Informações e Atendimento Toxicológico (CIAT) do Hospital Pronto-Socorro João XXIII em Belo Horizonte (MG). Resultados: um paciente trazido pela Polícia Federal, que negava ter ingerido pacotes de cocaína e estava assintomático com exame físico normal, foi submetido à propedêutica por imagem. Foi realizado uma tomografia computadorizada (TC) de abdome que evidenciou inúmeros corpos estranhos pelo trato gastrointestinal do paciente. Foi realizado também uma radiografia simples de abdome não foi útil em mostrar com precisão a localização e quantificação dos papelotes. Conclusões: tendo em vista o fato de que a ruptura de um único invólucro pode provocar intoxicação grave e muitas vezes fatal, a ausência de mensuração quantitativa e os falso-negativos da radiografia simples de abdome tornam esse método limitado. Sugerimos que a TC seja o método de imagem inicial, o que garante maior rapidez e precisão no manejo do caso, economia no tempo de estadia do paciente e maior segurança para o mesmo.(AU)

Introduction: Brazil is currently the main drug traffic route of Latin America. At international airports, passengers considered as suspect by the Federal Police are driven to emergency care services to be evaluated, even if asymptomatic and no visible abnormalities. Objectives: discuss, from a case report, the most used in practice diagnostic imaging methods. Methods: case report of patient assisted by the Center for Information and Toxicological Assistance (CIAT), Hospital Pronto-Socorro João XXIII in Belo Horizonte (MG). Results: a patient brought by the Federal Police, denied having ingested packets of cocaine and was asymptomatic with a normal physical examination, underwent imaging workup. A computed tomography (CT) was performed and revealed that many foreign bodies into the gastrointestinal tract of the patient. A plain abdominal x-ray was also made and wasn't helpful in showing the exact location and quantification of packets. Conclusions: considering the fact that the rupture of a single packet can cause severe intoxication, often fatal, the absence of quantitative measurement and the false-negative of plain abdominal x-ray make this method limited. We suggest that CT should be the initial imaging method, which provides greater speed and accuracy in handling the case, reducing the patient's length of stay and providing greater security.(AU)