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Following exploratory fieldwork in the rural coca growing fields of Colombia , GDPO followed the cocaine supply chain to Panama. Most recently, time spent on the Northern Caribbean coast soon revealed the permeation of drug trafficking into the already complex socioeconomic context that many perceive as paradise. With sympathetic afternoon light, the final leg of the 1-hour flight from Panama City reveals aqua marine water lapping at golden sands backed by lush green forests. Once established in the area, other widely talked about attractions of Bocas quickly emerge. There is a wealth of outdoor activities. Many international tourists, largely backpackers, and domestic visitors come to enjoy the Caribbean Sea: to scuba dive and snorkel, surf the notorious waves of Playa Bluff, or to take things a little easier with sunbathing and guided tours to spot the charismatic wildlife. Another attraction of Bocas del Toro for many, and particularly backpackers, is undoubtedly the opportunity to mix Salsa and Reggaeton music, with low cost national beers and regional rum cocktails, as they enjoy the party life offer on Isla Colon primarily in BocasTown and the surround islands. In this hedonistic environment, it is seemingly easy to forget the volumes of boat traffic and not think about the dubious quality of the sea water while enjoying a midnight swim. Another undercurrent in the town is the availability cocaine and cannabis. Sellers freely mix in the nightlife with various degrees of subtly in communicating their offerings. Part of the reason for the level of supply is the demand of international tourists and more permanent life style migrants willing to pay higher prices than local consumers. However, Bocas del Toro is also well supplied with drugs as one of the recognized points of refuge for traffickers making the journey up the EasternCoast from Colombia to North America. Originally founded as a settlement of concentrated population by foreign banana producers, the region remained disconnected from administration in Panama City due to a lack of a reliable road connection: and therefore, the centralized government administration has lacked a presence in many respects. The archipelago is also composed of some highly remote islands that fall well beyond almost all government services and authority: and as in many cases across the world, the lack of state institutions supports the trafficking of drugs. View of coastal geography from the air Author Despite limited resources, local law enforcement officers in Bocas confirm that they have been involved in interdiction operations in partnership with central authorities and the US Coast Guard: furthermore, these operations have yielded high powerboats used by the traffickers that are then repurposed for local counter narcotics operations. Discussions with the local police support existing knowledge that traffickers use the inland water ways of the Panamanian coast to evade the authorities during the day, and then make their staged journeys under the cover of night UNODC In some cases it is believed that small shipments of drugs are consolidated in Panama before being moved on UNODC Local testimony also identified that during chases, traffickers will jettison quantities of drugs in attempts to bribe the police. It is through a combination of these mechanisms that trafficked drugs enter the Bocas economy. The availability of drugs then provides relatively easy returns for those willing to become involved. This option is especially attractive so some due to the poor quality of education, high levels of poverty and general limitations on livelihood opportunities in the Bocas region. Many of these people live on subsistence agriculture and fishing on outer islands. There is therefore a potentially strong pull incentive to become involved in the distribution of drugs. In this case, as was found in Colombia , rural development will likely be as important an anti-trafficing policy as strengthening governance capacity for interdiction operations. Again, genuine investment in enhancing the life opportunities of those currently motivated to support drugs distribution will likely contribute to a reduction in the global trade in narcotic drugs. UNODC Cocaine from South America to the United States. Paradise of Bocas del Toro MandingA

Life threatening abdominal complications following cocaine abuse

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Official websites use. Share sensitive information only on official, secure websites. Cocaine an alkaloid extracted from the Erythroxylon coca plant is used orally, intranasally, intravenously or smoked as crack the free-base form of cocaine. A recent survey from the Department of Health in the UK shows that the use of cocaine has increased considerably over the last 10 years. The common pathologies associated with cocaine and crack abuse include nasal septal perforation and necrosis, cardiovascular and respiratory problems and complications which arise as a result of intravenous injection of the drug including cellulitis, abscesses, arterial and venous thrombosis and infections such as hepatitis and human immunodeficiency virus. Cerebral events in patients following drug abuse include seizures, intra-cranial haemorrhage and strokes secondary to vasospasm. In this editorial we discuss some of the common complications of cocaine abuse that are well known by physicians but concentrate on the relatively uncommon, but life threatening, gastrointestinal complications which present to surgeons. One of the most common symptoms in patients taking cocaine is chest pain. Patients also present with symptoms and signs of cardiomyopathy, myocarditis, endocarditis and cardiogenic pulmonary oedema. Myocardial infarction in patients can be difficult to diagnose because of abnormal electrocardiograms in a high proportion of patients without chest pain who regularly take cocaine. This is further confounded by raised cardiac enzymes in such patients, when they may not necessarily have had a myocardial infarction. The treatment of myocardial infarction in this group of patients is similar to standard treatment protocols but also employs other drugs such as benzodiazepines and avoidance of certain drugs especially beta-blockers and possibly calcium channel blockers. Thrombolysis is not of proven benefit. Respiratory problems include cough, haemoptysis which may be due to pulmonary heamorrhage, mild dyspnoea and severe acute problems such as pneumothorax, pneumomediastinum, non-cardiogenic pulmonary oedema, i. Pneumothorax in patients who continue to abuse crack may be recurrent and these patients eventually end up needing a thoracotomy. Smoking of crack also leads to deterioration of underlying chest conditions such as asthma and bronchitis. The treatment of non-cardiogenic pulmonary oedema is diuretics, oxygen and mechanical ventilation as needed. Gastrointestinal complications of cocaine abuse are uncommon compared to the complication discussed above. They are relatively well documented in the American literature, due to the higher incidence of drug abuse in the USA. However, experience with this drug in the UK is limited; therefore heightened awareness of its complication is paramount, in the light of the increasing abuse of cocaine. The actual incidence of gastrointestinal complication is not known worldwide but in one series from the USA, 50 patients with juxtapyloric perforation were treated in a hospital over a period of 4 years. The number of cases reported from the UK is very limited, although the authors have recently encountered two cases of gastrointestinal perforation secondary to cocaine abuse within a few weeks. It is likely to increase as the number of cocaine abusers goes up. Following intake of the drug, abusers develop abdominal pain and tenderness. There may also be associated nausea, vomiting and bloody diarrhoea. The onset of symptoms may be within an hour following drug abuse but the presentation may be delayed by up to 48 hours. The diagnosis of an acute abdomen may be difficult and requires a high index of clinical suspicion, especially as there may be no abnormal findings on imaging investigation such as free intraperitoneal air. Cocaine abuse can cause mesenteric ischaemia and gangrene, which result in small and large bowel perforation as well as intra-peritoneal haemorrhage. The common underlying pathophysiological mechanism is cocaine-induced arterial vasospasm or vasoconstriction leading to intestinal ischaemia with mucosal and transmural necrosis. This is a chronic process afflicting young patients who present with abdominal pain aggravated by food and weight loss—the classical symptoms of mesenteric angina. In these patients the diagnosis can be made pre-operatively by angiography. The usual management of small or large bowel gangrene or perforation is by resection and primary anastomosis. Patients with mesenteric angina are treated with standard two-vessel bypass typically from the supra-coeliac aorta to the coeliac and superior mesenteric arteries, respectively. The Inferior mesenteric artery may be reimplanted at the same time if occluded at its origin. Following crack abuse, the usual cause of an acute abdomen is a pre-pyloric or a duodenal perforation. Crack abuse also causes ischaemic colitis, which presents with abdominal pain and bloody diarrhoea. It is not clear why crack abuse preferentially causes upper gastrointestinal perforation rather than bowel gangrene or perforation. One possible explanation is the documented effects on gastric motility and increased intragastric pressure associated with the smoking of crack, which may in part be due to increased air swallowing and breath holding. The management of gastroduodenal perforation is by standard closure of the perforation, which is usually mm in diameter. Patients should be tested for Helecobacter pylori either by per-operative biopsy or, subsequently, because of the high incidence of the infection in these patients. In view of the increasing abuse of cocaine and crack in this country, it is important that doctors should be aware of their abdominal complications especially mesenteric ischaemia and gastroduodenal perforation, which primarily affects younger age groups. These conditions should always be considered in patients with a history of cocaine abuse who present with abdominal pain in order to avoid delay in diagnosis and treatment. As a library, NLM provides access to scientific literature. Find articles by Alok Tiwari. Find articles by Mohammed Moghal. Find articles by Luke Meleagros. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. 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