Association between coca (Erythroxylum coca) chewing habit and oral squamous cell carcinoma: a case-control study from Argentina.

OBJECTIVE: Previous isolated reports have hypothesized that chewing coca leaves, a pre-Columbian tradition found in certain regions of South America, may be associated with the development of oral squamous cell carcinoma (OSCC). Coca chewing (CC) is a habit that shares many characteristics with the well-known practice of betel chewing observed in Asia. The aim of this study is to analyze the association between CC and OSCC among patients who attended the Señor del Milagro Hospital in Salta, Argentina. STUDY DESIGN: A case-control study was conducted from 2013 to 2018. For each case of OSCC, three healthy control patients were included. Odds ratios were calculated to compare demographics, concurrent oral conditions, and other classical risk factors for OSCC. RESULTS: A total of 62 cases and 180 controls were included, adjusted for sex and age. OSCC was significantly associated with tobacco use (27.4% vs 9.4%, P = .001), CC (62.9% vs 32.2%, P < .001), and poor oral condition (81.1% vs 67.7%, P = .02). In the multivariate analysis, smoking (OR = 2.77, 95% CI 1.23-6.25, P = .0139), CC (OR = 2.98, 95% CI 1.58-5.63, P = .0007), and poor oral condition (OR = 3.1, 95% CI 1.62-5.85, P = .0006) remained independently associated with OSCC development. CONCLUSIONS: Chewing coca leaves could be considered a risk factor for oral cancer in a subset of Argentinean patients. Further studies are necessary to validate our findings and to elucidate the underlying pathways linking this habit to oral carcinogenesis.

Navigating Chemical Toxicity in Coca Production in the Colombian Borderlands of Putumayo.

In Putumayo, a jungle borderland in southern Colombia, thousands of farmers derive their livelihood from the cultivation and processing of coca leaf, exposing themselves to fertilizers, pesticides, and other toxic chemicals on a daily basis. In this article, we show how the coca growers' relationship with chemicals and the health risks to which they are exposed, are politically and institutionally structured. We discuss the specific impact of anti-narcotics policy in a broader context of deep inequalities and document the emergent and adaptive day-to-day attempts of the farmers to navigate the structural risk environment.

The political economy of a failed drug reform: Insights from Peru's main legal coca valley.

As the world's second largest coca producer, Peru has a flourishing market for coca for non-narcotic uses. With more than 20,000 hectares and approximately 35,000 officially registered farmers in the Peruvian legal scheme for coca cultivation and commercialization, this market is formally under the monopoly of the National Enterprise of Coca (ENACO). Nonetheless, ENACO only captures 2% of all coca produced nationally and has experienced a sustained reduction of farmers' participation and coca purchases within the legal trade. At different times, these problems have opened the way to demands from left-wing political parties, subnational governments, coca growers' organizations and even Peru's central drug control institutions to reform the legal coca market in Peru. However, none of these attempts have succeeded. Based on a policy analysis of the legal coca trade and analysis of official data, together with a case study of Peru's main legal coca valley (La Convención) this article seeks to understand the current crisis of the legal coca trade as well as the repeated failures of reform. Peru's political centralism and the historical marginalization of Andean culture help to explain the successful blocking of reform attempts to the legal coca trade.

The post-conflict expansion of coca farming and illicit cattle ranching in Colombia.

Illicit cattle ranching and coca farming have serious negative consequences on the Colombian Amazon's land systems. The underlying causes of these land activities include historical processes of colonization, armed conflict, and narco-trafficking. We aim to examine how illicit cattle ranching and coca farming are driving forest cover change over the last 34 years (1985-2019). To achieve this aim, we combine two pixel-based approaches to differentiate between coca farming and cattle ranching using hypothetical observed patterns of illicit activities and a deep learning algorithm. We found evidence that cattle ranching, not coca, is the main driver of forest loss outside the legal agricultural frontier. There is evidence of a recent, explosive conversion of forests to cattle ranching outside the agricultural frontier and within protected areas since the negotiation phase of the peace agreement. In contrast, coca is remarkably persistent, suggesting that crop substitution programs have been ineffective at stopping the expansion of coca farming deeper into protected areas. Countering common narratives, we found very little evidence that coca farming precedes cattle ranching. The spatiotemporal dynamics of the expansion of illicit land uses reflect the cumulative outcome of agrarian policies, Colombia's War on Drugs, and the 2016 peace accord. Our study enables the differentiation of illicit land activities, which can be transferred to other regions where these activities have been documented but poorly distinguished spatiotemporally. We provide an applied framework that could be used elsewhere to disentangle other illicit land uses, track their causes, and develop management options for forested land systems and people who depend on them.

From strong leadership to active community engagement: Effective resistance to illegal coca crops in Afro-Colombian collective territories.

In this paper, we study whether leadership and community organisation can explain differences in the presence and expansion of coca crops in rural Afro-Colombian collective territories. Following a mixed-method approach that combines the analysis of satellite imagery, semi-structured interviews and household surveys, our results suggest that leadership and community organisation help explain differences in the presence of illegal coca crops by activating pre-existing 'stocks' of social capital that enable rural Afro-Colombian communities in the country's southern Pacific region to resist the penetration and/or expansion of illegal coca crops. Results also show that resistance is more effective when the interests and strategies of leadership and communities are aligned. We argue that the effectiveness and sustainability of resistance depend on: (a) the stock of social capital that determines organisational capabilities, (b) the specific normative content with which this capital is infused, (c) the legitimacy and influence of leadership on the community, and (d) synergies among different levels of grass-root community organisation. We conclude that investing in social capital and community capabilities is thus one way to reorient policy interventions, a goal to which the Colombian state can only partially contribute given its policy priorities and structural limitations.

Advances in cocaine signature methodology: Alkaloid and isotope profiles of coca grown in Puno, Peru.

Drug Enforcement Administration's (DEA) Cocaine Signature Program previously identified 19 coca-growing regions within South America and developed methodology to geo-source cocaine using a combination of trace cocaine alkaloids, stable isotopes, and multivariate statistics. Twenty-nine coca leaf samples collected in 2016 and 2019 from a previously unanalyzed coca-growing region located in Puno, Peru, were analyzed with this methodology. Trace cocaine alkaloids and stable isotopes were compared with other Peruvian regions. Minor differences were observed in the extracted cocaine alkaloid profiles when compared with samples collected from the Ucayali-Huallaga Valley and Cusco-Apurimac regions while the stable isotopes of δ2 H (-177.1‰) and δ18 O (23.8‰) were enriched. Puno's alkaloid and stable isotope results are presented in this publication to assist forensic laboratories and enhance their cocaine geo-sourcing capabilities.

Risk factors for acute mountain sickness in travellers to Cusco, Peru: coca leaves, obesity and sex.

BACKGROUND: Acute mountain sickness (AMS) may occur after rapid ascents to altitudes >2500 m. Cusco (3350 m) in Peru is a popular destination for altitude inexperienced travellers. This study aimed at evaluating the incidence and risk factors for AMS among a cohort of foreign Spanish language students in Cusco. METHODS: We performed a cohort study among young healthy foreign Spanish language students arriving to Cusco between 2012 and 2016. Consenting students answered an enrollment questionnaire on demographics, travel history and intended AMS preventive behaviour within 48 h of arrival. At 4-5 days after enrollment participants answered a second questionnaire about actual preventive behaviour before symptoms and the development of symptoms compatible with AMS during their first 48 h in Cusco. We used the 2018 Lake Louise Scoring System for AMS diagnosis. Participants with headache and a score ≥ 3 were considered to have AMS. RESULTS: We enrolled 142 language students, the median age was 21 years (interquartile range 20-25) and 57% were female. Participants decreased physical activity (38%), increased fluid intake (34%), drank coca leaf tea (34%), took acetazolamide (16%) and acclimatized at a lower altitude (6%) to prevent AMS. Thirty-nine percent had AMS. In the multivariate analysis, obesity [odds ratio (OR) 14.45 (2.33-89.6)] and female sex [OR 4.32 (1.81-10.28)] were associated with increased risk of AMS. Taking acetazolamide [OR 0.13 (0.03-0.56)] was associated with decreased AMS risk. Consumption of coca leaf tea was not associated with decreased risk of AMS. CONCLUSIONS: In our cohort, AMS affected two out of five travellers. Obesity and female sex were associated with increased risk. Drinking coca leaf tea for prevention did not decrease the risk of AMS. Acetazolamide prophylaxis was associated with decreased risk of AMS.

Condición juvenil en tiempos de guerra: relatos desde la ruralidad colombiana / Youth condition in times of war: Stories from Colombian rurality (1995-2005) / Condição juvenil em tempos de guerra: relatos da ruralidade colombiana (1995-2005)

Resumen (analítico) El artículo analiza las implicaciones de la guerra en la configuración del ser joven rural en Colombia en La Merced (Caldas) y Vista Hermosa (Meta). Es una investigación cualitativa con enfoque narrativo, que indaga en las experiencias de tres sobrevivientes de la violencia entre los años 1995 y 2005, por medio de marcadores de juventud. De los resultados se desprende que la guerra trazó cursos de vida a los jóvenes rurales, como ser cultivadores de hoja de coca e integrantes de grupos armados, marcándose transiciones en las que se restringieron las capacidades para agenciar posibilidades de futuro fuera de los marcos de la guerra, pero también cursos de vida en resistencia vinculados a la acción colectiva con otros jóvenes.

Abstract (analytical) This article analyzes the implications of war in the configuration of rural youth in Colombia in La Merced, Caldas and Vista Hermosa, Meta. It describes qualitative research that uses a narrative approach to analyze the experiences of three survivors of violence between 1995 and 2005 through the telling of significant events that occurred during their youth. The results show that the war established specific life courses for rural youth, such as growing coca leaf and being a member of armed groups. These transitions demonstrate how their capacity to pursue possible life paths outside the frame-work of war were restricted, but also highlight life paths involving resistance to the war that were linked to collective action with other young people.

Resumo (analítico) O artigo analisa as implicações da guerra na configuração da juventude em zonas rurais da Colômbia, em La Merced, Caldas e Vista Hermosa, Meta. É uma pesquisa qualitativa com abordagem narrativa a partir da qual são analisadas as vivências de três sobreviventes de violência entre 1995 e 2005, por meio dos marcadores juvenis. Os resultados mostram que a guerra traçou rumos de vida para a juventude rural, como ser cultivadores de folha de coca e membros de grupos armados, marcando transições em que se restringiam as capacidades de encontrar possibilidades de futuro fora dos marcos da guerra, mas também, cursos de vida em resistência vinculados à ação coletiva com outros jovens.

Personal Doses of Cocaine and Coca Paste are Adulterated in Cartagena de Indias (Colombia).

Knowledge of drug composition consumed on the streets and the identification and quantification of their adulterants is essential for understanding unexpected side effects, tracking routes, and drug profiling. Therefore, this work aimed to determine the purity and to identify and quantify the main adulterants found in personal doses of cocaine (perico) and coca paste (bazuco) in Cartagena de Indias (Colombia). The data collected in this study describe a first attempt to introduce the qualitative and quantitative analyses of adulterants present in street drugs in Cartagena de Indias to improve surveillance. Through gas chromatography coupled to mass spectrometry (GC-MS), the purity and adulterants were quantified in 45 personal doses of cocaine powder and coca paste. 100% of the personal doses in the city were adulterated; caffeine, phenacetin, and levamisole were the main adulterants identified in cocaine. Besides the above, lidocaine was also found in coca paste. The purity of cocaine varied from 8% to almost 70%, with caffeine ranging from 6% to 42%. In the case of coca paste, the maximum content of cocaine found was 60%, while some samples contained as little as 14%. The results are consistent with other research in terms of the widespread use of caffeine as an adulterant, but they also follow the growing trend of the use of levamisole and phenacetin. The wide range of cocaine content in samples sold in the illicit market could cause undesirable effects on cocaine users who do not know the exact intended dose for consumption; so, this study intends to make these results available not only to academic, public health, and national security agencies but also to tourists entering Cartagena de Indias, so that they are aware of what they are consuming and the risks to which they are exposed.

Analysis of Erythroxylum coca Leaves by Imaging Mass Spectrometry (MALDI-FT-ICR IMS).

Matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI IMS) can determine the chemical identity and spatial distribution of several molecules in a single analysis, conserving its natural histology. However, there are no specific studies on the spatial distribution of alkaloids in Erythroxylum coca leaves by MALDI IMS, preserving the histology of the monitored compounds. Therefore, in this work, positive-ion mode MALDI Fourier-transform ion cyclotron resonance imaging mass spectrometry (MALDI(+)FT-ICR IMS) was applied to identify and analyze the distribution of alkaloids on the surface of coca leaves, evaluating the ionization efficiency of three matrices (α-cyano-4-hydroxycinnamic acid (CHCA), 2-mercaptobenzothiazole (MBT), and 2,5-dihydroxybenzoic acid (DHB)). The last was chosen as the best matrix in this study, and it was studied in five concentrations (0.5, 1.0, 2.0, 4.0, and 8.0 mg·mL-1), where 2 mg·mL-1 was the most efficient. The washing of coca leaves with the organic solvents (acetonitrile, methanol, toluene, and dichloromethane) tested did not improve the performance of the ionization process. Finally, a tissue section, 50 µm thick, was used to study the inner part of the leaf tissue, where alkaloids and flavonoid molecules were detected.

Tough Tradeoffs: Coca crops and agrarian alternatives in Colombia.

This paper compares coca with mainstream agrarian economies in Colombia. It shows that the country's legal and illicit sectors share several fundamental characteristics and processes. Due to its very illegality, coca is endowed with positive characteristics that are not easily found elsewhere: it is a productive - even in the absence of basic public goods -, familial, labor intensive, smallholder agriculture, relatively resistant to monoculture. Furthermore, different processes of social change have mitigated some of the typical problems of agrarian frontiers linked to global markets. In turn, its illegal status also imposes extreme costs over peasants and other social sectors. On the one hand, due to coca producers can escape from the "reproductive squeeze" and extreme pattern of land concentration that affect other peasants; on the other, coca becomes an unending source of risk and distress. This contradiction puts peasants in front of very tough tradeoffs, which in turn demand a careful reconsideration of what "alternative" development can mean in the Colombian context.

The substitution program on trial: progress and setbacks of the peace agreement in the policy against illicit crops in Colombia.

BACKGROUND: In 2016 the Colombian government and the country's most important guerrilla group - the FARC - signed a peace agreement that included the "definitive solution to the problem of illicit crops". That solution has not arrived. METHODS: We tracked the design and implementation of the substitution program (PNIS) included in the peace agreement using an original set of in-depth interviews, press reviews and archival material, all of which were collected in different rounds of fieldwork between 2018 and 2020 in Bogotá and three coca growing regions. RESULTS: We show that, as a product of several political pressures, the peace agreement introduced modifications to the standing policy against illicit crops that were favorable to peacebuilding, but also retained regressive aspects of that policy. However, following a shift in the balance of power, the policy returned to what it was during the war period. CONCLUSION: We conclude by discussing the importance of developing a research agenda that explores both resistances to change in illicit crops policy, and the political coalitions needed to make change sustainable.

Cocalero women and peace policies in Colombia.

BACKGROUND: Illicit crop economies are shaped by gender arrangements that can play an important role in the experiences of illicit crop workers. In Colombia, the coca production -considered a war economy- granted peasant women a source of access to productive resources (land, credit and seeds) and paid work, conditions that are difficult to find in other legal agrarian economies. For this reason, policies pursuing a transition from war to peace, such as the ones that emerged from the 2016 Peace Agreement between the Colombian government and the FARC guerrilla, must incorporate a gender perspective in order to acknowledge the social progress that women can achieve in war scenarios. METHODS: The empirical evidence comes from thirty-one in-depth and semi-structured interviews with cocalero peasants, social leaders and public officials; ethnographic fieldwork in two municipalities with the highest levels of illicit crop production (Puerto Asís and Tumaco); official documents of anti-drug and Alternative Development policies in Colombia, and other official information from the agencies in charge of implementing these policies; and data from the survey of participants of the National Comprehensive Program for the Substitution of Illicit Crops (PNIS) (National University of Colombia, 2019), and one dataset from the Colombian National Administrative Department of Statistics (the Quality of Life Survey of 2018). For the analysis of the data we used an open-codification method and conducted hypothesis tests with Welch's correction. RESULTS: In Colombia, women involved in the coca economy experience a degree of empowerment that leads to increased income, time control and decision-making power. When we compared the lived experience of cocalero women with what the National Crop Substitution Programme -PNIS- offers, we found that the programme falls short from offering viable gender-sensitive alternatives, producing a setback in women's empowerment. CONCLUSION: Illicit crop economies in war contexts can be a source of social advancement for marginalized populations, particularly women. Thus, peace policies that do not recognise these advances, i.e. that do not incorporate a gender perspective in their design, deepen gender-based inequalities.

Criminal entrepreneurs as pioneers, intermediaries, and arbitrageurs in borderland economies.

Many discussions of mafia and criminal entrepreneurs typically focus on violence and illegality, and less on their possible roles in rural transformation, even when they are located in borderland economies linking the subsistence cultivators of illicit crops to regional and global markets. This paper assesses the life stories of drug lords, the Castaño brothers of Colombia and Roberto Suárez Gomez of Bolivia, to draw inferences into how such rural elites in the illicit drugs trade are not only specialists in crime but are also actors who regulate and manipulate, often coercively, access to land and resources, mobilise labour and shape its divisions, and promote certain forms of capital accumulation. This paper contends that a better understanding of the roles of these rural elites as pioneers for capital, intermediaries in commodity chains, and arbitrageurs between state and borderlands may provide ways of unpacking key challenges to peacebuilding and economic transformation in borderlands where illicit economies thrive.

Clinical and Histological Manifestations of Chronic Coca Leaf Chewing in a Peruvian Population: A Cross-sectional Study.

AIMS: This study aimed to determine the possible clinical and histological periodontal effects of long-term coca leaf chewing habit in habitants of the highland region of Peru. MATERIALS AND METHODS: A total of 100 residents, were recruited for the study. Fifty individuals were habitual coca leaf chewers and 50 were non-users. Eligibility criteria were: 60-80 years old, ≥20 teeth present (excluding third molars), systemically healthy (controlled systemic disease), not using medication affecting the gingiva. Chronic tobacco smokers were excluded. All participants completed questionnaires, received clinical periodontal examination, and had gingival biopsies harvested for histopathological assessment. RESULTS: Most coca leaf chewers reported several oral changes resulting from the habit, such as bitterness, numbness and mouth dryness, while none of the non-chewers reported experiencing such changes. Within the clinical periodontal parameters, it was found that there was a significant difference in terms of clinical attachment level loss, with a p value of 0.014 in those who chewed coca leaves, who appeared to have less clinical attachment loss. CONCLUSIONS: Chewing coca leaf produce bitterness, numbness and mouth dryness, and clinical attachment loss. Histologically higher number of inflammatory cells in the stratum spinosum, with more acanthosis, clear cell, and higher number of blood vessels.

Ecologies of drug war and more-than-human health: The case of a chemical at war with a plant.

Drawing on an ecological approach, we trace how the political-economy of drug wars are locally materialised in relation to health. We take the case of coca cultivation and eradication as our example. To make our analysis, we trace the different ways that the chemical glyphosate is materialised in a war with the coca plant in Colombia. Glyphosate has been used for decades in aerial fumigation campaigns to eradicate illicit coca cultivation. Our analysis traces the more-than-human effects of glyphosate in relation to health. This leads us to outline a more-than-human approach to harm reduction; a harm reduction which positions health as a matter of ecology, paying attention not only to the nonhuman actors affecting human health but also to the health of environments which are themselves always in-the-making. We envisage harm reduction as a collaboration in which humans 'become-with' their environments.

'Whatever we have, we owe it to coca'. Insights on armed conflict and the coca economy from Argelia, Colombia.

Since the formal declaration of the War on Drugs in the 1980s, illicit drugs and crops have been regarded primarily as a security problem. However, without a comprehensive development strategy and deep transformative reform addressing structural issues (land, resources, market access, etc.), it is a war bound to be lost despite enormous human suffering. In Colombia, agrarian development came as the first topic in the agenda between the FARC-EP and the government during the latest peace negotiations (2012-2016), recognising its intimate link to illicit drugs. This recognition went against the grain of dominant discourses. However, the agreement fell short of much needed transformative reform. Moreover, it also failed to engage with the governance mechanisms -enforced and sustained by the rebels- which were key to social order in many drug-producing regions. By exploring the case of Argelia, in South-Western Colombia, I will argue that a transformative approach to peace-building was needed, as rural development and engagement with local governance mechanisms in drug-producing regions are paramount to address effectively the problem of illicit crops.

Efecto de la masticación de Erythroxylum coca Lamarck (Coca) sobre los niveles de colesterol y triglicérido sérico en personas altoandinas / Effect of chewing of Erythroxylum coca Lamarck (Coca) on cholesterol and serum triglyceride levels in high andean people

La investigación tuvo como objetivo, determinar el efecto de la masticación de Erythroxylum coca Lamarck (Coca) sobre los niveles de colesterol y triglicéridos séricos en personas altoandinas, la población fue de 100 personas altoandinas, 50 mujeres y 50 varones como masticadores, conformando grupos control con personas no masticadoras. Previa entrevista y los exámenes de laboratorio se obtuvieron los siguientes resultados, para el grupo control: los niveles de colesterol (201.75 mg% varones y 193.50 mg% mujeres) y niveles de triglicéridos (174 mg% varones y 134 mg% mujeres). En comparación con el grupo de problema o masticadores: cuyos niveles de colesterol (155 mg % varones y 150 mg % mujeres) y niveles de triglicéridos (84 mg % varones y 55 mg % mujeres) siendo estadísticamente significativos con la prueba de ANVA y el coeficiente de correlación simple es positiva y directa. Por lo que se concluye: que las personas que realizan la masticación de hojas de coca no son obesas. Además, el extracto de hojas de coca no facilita la digestión de alimentos grasos como el colesterol y triglicéridos al inhibir la actividad enzimática.

The objective of the research was to determine the effect of chewing Erythroxylum coca. Lamarck (Coca) on serum cholesterol and triglyceride levels in high Andean people, the population was 100 high Andean people, 50 women and 50 men as chewers, forming control groups with non-chewers. After an interview and laboratory tests, the following results were obtained for the control group: cholesterol levels (201.75 mg % men and 193.50 mg % women) and triglyceride levels (174 mg % men and 134 mg % women). Compared with the problem group or chewers: whose cholesterol levels (155 mg % men and 150 mg % women) and triglyceride levels (84 mg % men and 55 mg % women) being statistically significant with the ANVA test, and the simple correlation coefficient is positive and direct. Therefore, it is concluded: that people who chew coca leaves are not obese. In addition, the extract of coca leaves does not facilitate the digestion of fatty foods such as cholesterol and triglyc-erides by inhibiting the enzymatic activity.