How can I buy cocaine online in Oujda

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How can I buy cocaine online in Oujda

Border closings between Algeria and Morocco have been the norm rather than the exception. Since Algeria gained independence from France in July , the Algerian-Moroccan land border has only been open for ten years in total. Territorial and resource disputes born from decolonization and continual heightened tensions led the border to close in the Sand War , the Western Sahara War , and after the terrorist attack on the Atlas Asni Hotel in Morocco. These repeated closures divided families Moroccans and Algerians along the border have historically married and traded with each other , but they did not disrupt cross-border commercial activities. During the s and early s, trade rules and regulations—and particularly the import restrictions imposed by Algeria —made the clandestine import of Moroccan agricultural products, clothes, shoes, and alcohol highly attractive. By the late s, many Algerian food and petroleum products became subsidized, reversing the flow of goods between the two countries. The smuggling of subsidized products —especially fuel—into Morocco became a lucrative business. Intermediaries and smugglers became indispensable in connecting border communities and delivering affordable basic goods. Contraband and illegal crossings became major facets of everyday life. State officials initially tolerated this state of affairs because alternative economic options were scarce. National development efforts in border areas were crippled by insufficient budgets, inappropriate allocations, and inadequate quality. For both the Algerian and Moroccan governments, smuggling generated a level of employment that helped attenuate youth unemployment and mitigate poverty. Over decades, smuggling helped to revitalize the Algerian border towns of Zouia, Bab al Assa, and Maghnia and the Moroccan towns of Ahfir and Oujda, transforming them into significant trading centers. For example, heavily subsidized gasoline in Algeria created the incentive for outbound smuggling to Morocco. Currency devaluation in Algeria also made a wide range of commodities cheaper compared to its neighbor, contributing to a boom in illicit trade. And, as is often the case, the trade opened up routes and crossings for the trafficking of other products, including prescription drugs and cigarettes from Algeria and cannabis from Morocco. Both residents and smugglers grew savvy in using their knowledge of the border to evade security patrols and collude with border authorities. In the early s, the black market trade carried on largely unabated. The government, fearing unrest due to lingering high unemployment and poverty, continued to heavily subsidize commodities, maintaining the allure and incentives for border residents to smuggle. The contraband economy also created financial incentives for border officials, corrupt politicians, select formal businessmen, and powerful illicit smugglers to fuel trading in gasoline, food, and cigarettes. Migrant smuggling from Algeria to Morocco also increased. While the Islamist insurgency in Algeria was weakened in the s, al-Qaeda in the Islamic Maghreb AQIM , formally established in January , continued to crisscross parts of the Maghreb and adjacent Sahelian areas. In the late s, the security risks were further compounded by parts of West Africa becoming a major transit hub for cocaine smugglers out of South America and into Europe. Both Algerian and Moroccan authorities feared that drug cartels could use the cigarette and cannabis trails to expand their territories. It was ultimately the Arab uprisings and the resultant political turmoil that engulfed Libya and Tunisia that drove both Algeria and Morocco to tighten border control. The overthrow of Libyan strongman Muammar Gaddafi triggered a far-reaching chain of events, resulting in a wave of refugees and arms proliferation. Algerian and Moroccan officials feared that transnational weapons smugglers, human traffickers, and terrorist groups would exploit the contraband trade and the corruption of some border officials to expand their routes. As a result, both governments began reinforcing their architecture for border management , increasing the number of observation posts, regular mobile patrols, and surveillance systems. This required investment in new technologies and man power, which, in turn, necessitated substantial financial capital, especially for the Algerian government, which was facing mounting security threats along its borders with Libya, Tunisia, Mali, and Niger, as well as rising social discontent. In the summer of , the Algerian regime started cracking down on smuggled fuel , hoping that regaining lost state revenues would help pay for its investments in border management and the substantial increase in social transfers, food subsidies, and state salaries intended to weaken popular opposition and shore up regime stability. With an upcoming presidential election in April , the Algerian regime had a strong incentive to combat the smuggling. The Moroccan government also took unilateral initiatives to clamp down on the inflow of undocumented migrants, tobacco, and medicines. In addition to enhanced electronic surveillance at the border, the authorities invested in strengthening national-level security coordination among the different agencies in charge of border security. Previously, young intermediaries would buy gasoline in Tlemcen, using ordinary passenger cars that have a double gas tank or trucks with extra large tanks. They would then transport it to warehouses, where they put it in storage tanks. Once the gasoline was put into jerry cans, smugglers used four-wheel-drive vehicles or motorcycles to transport the cans across the border to the Moroccan town Oujda. Smugglers of cigarettes, psychotropic drugs, and cannabis also used these animals. To stem the flow of human smuggling and prevent the possible infiltration of terrorists, Morocco began building a security fence begun in and ongoing with electronic sensors. Moroccan authorities also began identifying the donkeys in the region and branding them with ear tags for traceability, while Algeria started to purportedly shoot at any animals crossing the border unaccompanied. These enhanced border control measures appear to have succeeded in curbing the cross-border smuggling of Algerian fuel and other consumer goods such as dates , milk, and Turkish-made clothes. The impact is noticeable on the Moroccan side of the border, where the number of roadside stalls selling fuel has dwindled. Tightened border security, supplemented by government regulations and price changes, has also reduced cigarette smuggling. The 38 percent increase in the price of Algerian cigarettes between and and the emergence of low-priced brands in Morocco in led to a 49 percent decline in the inflows of counterfeit and contraband cigarettes from Algeria to Morocco in However, the allure of contraband cigarettes has not disappeared completely, as Algerian products are still about 43 percent cheaper than those available in Morocco. This helps explain why one in eight cigarettes consumed in Morocco come from contraband. Algerian illicit cigarettes are also prized in the European market, especially in France where, in , Algeria supplied more than 31 percent of contraband cigarettes. Advocates of border defenses point to this relative success in disrupting illicit cross-border trade. Yet, ramped-up enforcement and surveillance have not stemmed the illicit flow of all products between Algeria and Morocco. The most organized and well-resourced trafficking networks have shifted from trafficking highly lucrative fuel to smuggling migrants, cannabis, psychotropic tablets and other medicines, and narcotics. The Algerian border town of Maghnia continues to be a strategic transit point for sub-Saharan migrants intent on crossing into Morocco and eventually Spain. Since Moroccan King Mohammed VI ordered the regularization of over 25, undocumented sub-Saharans in , Morocco has seen the number of migrants increase significantly. Most migrants enter Algeria from Niger, where they travel south through the cities of Tamanrasset and Ghardaia to reach Tlemcen, near the Moroccan border. Assisted by Algerian smugglers, they cross Maghnia into Oujda. Some attempt to get into the Spanish autonomous city of Melilla by jumping over the fence, swimming around the harbor, or hiding under a truck. Others seek smugglers who can help them procure false documents to enter Melilla or Ceuta or attempt the sea crossing to Spain. Since , cannabis seizures have also increased significantly in Algeria. The enhanced border security between Spain and Morocco has driven more cannabis trafficking east. The cannabis shipments to Oran and Algiers are smuggled onto ferries traveling to France, Italy, and Spain. Moroccan authorities are alarmed by the staggering rise in the smuggling of psychotropic drugs. Local media have reported numerous incidents of violent crime being committed by an increasing number of young men under the influence of amphetamine pills Rivotril or Qarqobi in Moroccan colloquial Arabic. Media stories also abound about the dangers of black market medications. In Morocco, these medicines are among the leading causes of poisoning , with 4, cases in compared to 4, in , an increase of almost 30 percent. Yet the smuggling of prescription drugs into the Moroccan black market continues to boom. According to the Secretary General of the Federation of Pharmaceutical Unions, Abdelhamid Nacer, Algerian medicines for asthma, diabetes, and hypertension are prevalent in the Moroccan border town of Oujda. In his estimation, the black market for pharmaceuticals account for at least 10 percent of medicine consumption in the region of Oujda-Nador-Tetouan. Moroccan authorities have tried without success to dismantle this market. Every year, the number of seizures of large quantities of smuggled medicines goes up, but the cross-border trade in prescription medication endures. More worrisome, there has been a steady increase in the distribution of counterfeit medicines , further impacting public health and safety. The trade in fraudulent medicines tends to be linked to organized crime groups, who are attracted to the huge profits. The concern for Morocco is that the logistical infrastructure established for the trafficking and sale of counterfeit medicine may also be utilized by drug trafficking organizations. Both Algeria and Morocco fear becoming a transit route for cocaine originating from South America. Moroccan authorities regularly report interceptions of cocaine air couriers of mostly West African origin on the Rio de Janeiro—Casablanca flight. In , the BCIJ announced the seizure of kilograms of cocaine at the port of Casablanca in a container transported by a cargo ship coming from Brazil. The drug busts provide a window into the drug-related corruption of law enforcement officials. They also signal that narcotic traffickers might be shifting their routes to the Maghreb. Another cocaine scandal underscores the growing importance of the region to transnational drug-trafficking organizations. It also reaffirms the central role that corruption plays. The major bust in the western Algerian port of Oran not only netted kilograms of cocaine but also revealed the involvement of influential real estate moguls, judges, prosecutors, mayors, and the children of prominent politicians. The ringleader, Kamel Chikhi , was a well-connected real estate mogul. His contacts and reach reportedly ran deep, from government circles to the military, intelligence, and police sectors. Due to drugs coming in from multiple origins and pervasive corruption, Algeria and Morocco are struggling to fight against the rising volume of cannabis, cocaine, and pharmaceuticals. In the case of Algeria and Morocco, the vast array of border control measures have had serious side effects. For example, they have crippled the economies of borderland communities. There seems to be little or no limit to these disruptive absurdities. The same applies to agricultural commodities that Algeria imports in mass from outside of the Maghreb— many of the commodities are produced by Morocco. This importing practice has been prohibitively costly. The failure of the Algerian and Moroccan governments to provide formal employment opportunities has exacerbated the problem. The disruption of illicit trade has caused regional distress and popular anger along both sides of the Algerian-Moroccan border. The crackdown on fuel smuggling has set off intermittent protests. According to Driss Houat, former president of the Chamber of Commerce, Industry and Services of Oujda, this situation pushed 30, families living on profits from contraband fuel to organize many sit-ins in —in one instance, blocking the national road linking Oujda to Saidia. The months-long protests over the deaths of three young men extracting coal from abandoned mines in the impoverished eastern town of Jerada in January demonstrated this rising tension. Algerian border towns have also been gripped by intermittent protests. In February , angry protests broke out in the impoverished border towns of Souani and Labtime , where residents demanded alternative economic options to mitigate the impact of border fortifications on their livelihood. The situation bodes ill for other countries considering the use of fortified walls to help control access to their territory. In Maghreb countries that have even less resources and man power than Algeria and Morocco—such as Libya, Mauritania, and Tunisia—the impact on border populations is likely to be even worse. As long as Algeria and Morocco are taking a narrow approach to border security, enhancing law enforcement, erecting barriers, and increasing surveillance will not be wholly effective. Barriers and technology need to be accompanied by fully integrated border control strategies that account for the geographical, political, and socioeconomic contexts. Border enforcement measures that ignore smuggling as a core development issue and disregard win-win neighborly endeavors are likely to fail. The stifling of illicit cross-border trade in subsidized commodities such as fuel and food has merely resulted in new markets and routes. Smugglers still elude border control or bribe their way across the border. Others have simply set up new supply lines. Moreover, as long as Algeria and Morocco continue to work unilaterally, traffickers will continue to bore holes into the border strategies, aided and abetted by the corruption of security officials. Police and judicial reforms are necessary, but so is the political will to address corruption, the greatest enabler of drug trafficking and organized crime. In recent years, Algeria and Morocco have begun to reform and modernize their customs administrations. But more needs to be done to enhance both countries border management systems, including professionalizing the training, recruitment, and promotion of their customs officials and security managers.

Serotonin Syndrome Precipitated by the Use of Cocaine and Fentanyl

How can I buy cocaine online in Oujda

Official websites use. Share sensitive information only on official, secure websites. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Serotonin syndrome SS is a condition that occurs following the administration of serotonergic drugs. The syndrome is classically associated with the simultaneous administration of two serotonergic agents. The patient was brought to the hospital with chief complaints of altered mental status, abdominal pain, nausea, and vomiting. The patient used her friend's fentanyl patch, and her urine drug screen was positive for cocaine. She was intubated and admitted to the intensive care unit for a low Glasgow Coma Scale score of 6 and autonomic instability. All the inciting agents were stopped, supportive treatment was given, and the patient was sedated with benzodiazepines and propofol. She received cyproheptadine, and the patient was extubated and clinically improved over the next 24 hours. Cocaine and fentanyl are not classically associated with SS. We did not encounter any cases where SS was precipitated by the combined use of cocaine and fentanyl in patients taking psychotropic medications during our literature review. This case report underlines the association of SS with cocaine and fentanyl. SS should be suspected in patients using cocaine and fentanyl or any other substance of abuse along with psychotropic agents. Keywords: serotonin syndrome and cyproheptadine, serotonin syndrome prognosis, serotonin syndrome in drug users, serotonin syndrome and fentanyl patch, serotonin syndrome and autonomic instability, serotonin syndrome management, serotonin syndrome diagnosis, serotonin syndrome precipitated by the use of cocaine and fentanyl, serotonin syndrome. Serotonin syndrome SS corresponds to a set of more or less severe, potentially fatal symptoms associated with an excess of serotonin in the central and peripheral nervous system, occurring after using serotonergic agents. It can be caused by drug use, drug overdose, or drug interactions \[ 1 \]. This condition is classically manifested by a triad of cognitive-behavioral and neuromuscular disorders and damage to the autonomic nervous system. It has a variable prognosis, ranging from mild to severe to fatal forms \[ 1 , 2 \]. The diagnosis of SS is clinical. The medication history must be meticulously collected. The first step is to stop taking the medication in question. Most cases usually resolve within 48 to 72 hours of stopping the causative agent. In more severe cases, hospitalization may be required to provide intensive treatment \[ 3 \]. A year-old female with a past medical history of bipolar disorder was presented to the hospital by the Emergency Medical Services EMS with chief complaints of confusion, generalized abdominal pain, nausea, and vomiting. The last known well time was 9 pm the night before the presentation. On EMS arrival, the patient's pupils were less than 2 mm. The patient was given 0. The patient was given 5 mg of intravenous midazolam for seizure and was brought to the emergency room. The patient was extremely agitated and was placed in a four-point restraint. On physical examination, the patient's pupils were dilated and nonreactive to light, with extreme total body rigidity, ocular clonus, and inducible and spontaneous myoclonus of the lower extremities with hyperreflexia grade 4. The urine drug screen was positive for cocaine metabolites, opiates, cannabinoids, and benzodiazepine. Electrocardiogram revealed sinus tachycardia and was otherwise unremarkable. CT of the head without contrast was unremarkable for any acute intracranial pathology. The patient was given multiple doses of intravenous lorazepam because of agitation and autonomic instability hyperthermia, tachypnea, tachycardia, diaphoresis, or mydriasis. The patient was started on propofol for sedation and agitation. The patient was diagnosed with SS clinically with the help of Hunter's criteria. The patient was given cyproheptadine 12 mg through a nasogastric NG tube. The poison control team was contacted, and they agreed with the diagnosis of SS and management. The patient was admitted to the medical intensive care unit MICU and was maintained on 4 mg cyproheptadine every four hours through an NG tube. The patient was extubated the next day, and over the next few days, the patient was safely discharged home with education about drug-drug interaction. SS is a set of symptoms resulting from increased serotonergic activity. Indeed, this toxic syndrome can be triggered by the introduction or escalation of a serotonergic treatment or, most commonly, by the combination of multiple treatments with serotonergic effects \[ 1 \]. An excess of serotonin in the central nervous system is associated with SS. Different types of serotonergic receptors are likely to bind to serotonin. It is known that some drugs interfere with serotonin metabolism and increase the level of serotonin in the synaptic cleft, leading to receptor saturation \[ 5 \]. In our case, the patient had applied a patch of fentanyl before going to sleep. Before her presentation to the emergency room, she was at her baseline, which raised suspicion of an association with SS. Fentanyl is a synthetic opioid commonly used to relieve moderate to severe chronic pain. This molecule binds to the mu receptor at the spinal, supraspinal, and peripheral levels, producing, in particular, an analgesic effect as well as a sedative effect. The common routes of administration are intravenous, transdermal, and transmucosal \[ 6 \]. Fentanyl is widely utilized as an induction agent in anesthesia. It is also used in intensive care units and for procedural sedation with benzodiazepines. In a prospective observational study of patients, 7. The authors report that the diagnosis is not infrequent in intensive care and that the diagnosis may go unnoticed, particularly in the setting of increased use of serotonergic agents \[ 7 \]. Furthermore, it is known that the incidence of SS is significantly higher in patients receiving fentanyl and a serotonergic agent \[ 8 \]. However, there was a case report where the use of fentanyl was the sole causative agent in the absence of other drugs known to induce SS \[ 8 \]. The amount of blood flow through the skin to which the patch is placed can also affect the rate at which the drug is absorbed. Any rise in skin temperature caused by fever, external application of heat, muscle activity, or local inflammation can gradually increase blood flow to the skin. Higher perfusion leads to increased systemic absorption and higher fentanyl serum concentrations \[ 9 \]. It is also possible to inject fentanyl from a matrix patch. Cocaine inhibits serotonin uptake, and its combination with serotonergic drugs such as fentanyl may have a synergistic effect \[ 2 \], as was the case in this patient. It is also worth noting that illicit fentanyl is occasionally mixed with other drugs, such as cocaine. DiSalvo et al. The symptoms of SS are best described with a triad that includes mental status changes confusion, delirium, convulsions, anxiety, and coma , neuromuscular changes tremors, clonus, and hyperreflexia , and autonomic nervous system instability tachycardia, tachypnea, hypertension, hypotension, hyperthermia, and diarrhea \[ 2 \]. The typical triad is not present in all cases. However, the toxidrome must be included if several symptoms suggest it and there is a possibility of taking drugs or toxins that have serotonergic effects. Because of the vast diversity and non-specificity of the symptoms, this condition can easily go unrecognized or misdiagnosed, delaying treatment \[ 1 \]. The clinical manifestations of NMS and SS are remarkably similar, making it difficult to distinguish between the two clinical entities. Patients can fit the criteria for both syndromes. NMS is characterized by 'lead-pipe' rigidity, while SS is characterized by hyperreflexia and clonus \[ 12 \]. In some cases, the start and progression of symptoms can be a diagnostic clue. Unlike SS, which has a quick onset and progression of symptoms, NMS usually progresses slowly \[ 12 \]. Similarly, while SS resolves typically within a few days after ceasing the causative medicines and initiating therapy, NMS typically takes days to resolve \[ 2 \]. The diagnosis of SS should only be confirmed after an infectious, neurological or metabolic pathology has been eliminated. Treatment initially consists of stopping the offending agent and excellent supportive care \[ 5 , 12 \]. Hospitalization with close monitoring of vital signs, renal function, electrolyte, and fluid balance is recommended \[ 5 , 12 , 13 \]. Benzodiazepines are indicated to alleviate agitation and seizures and their consequences, such as hyperthermia \[ 13 \]. However, resistance to this treatment or symptomatic severity, sedation, and paralysis under intubation is required, as was the case in this patient \[ 5 , 13 \]. If the patient has hyperthermia, starting with active external cooling is essential \[ 5 , 12 - 13 \]. Antipyretics are ineffective since the temperature rise is muscular \[ 5 \]. Because hemodynamic instability can quickly develop into hypotension and shock, arterial hypertension should be treated with short-acting drugs. Finally, cyproheptadine, a serotonin antagonist, has been suggested for the treatment of SS if supportive treatment and benzodiazepines fail to improve agitation and correct vital signs \[ 12 , 13 \]. The treatment regimen is, to begin with, a loading dose of 12 mg orally or crushed via the nasogastric tube followed by 2 mg every two hours until the patient is clinically stabilized \[ 2 - 5 \]. In any case, restraint by physical restraint should be avoided, as this increases isometric contraction of the muscles, leading to an increase in hyperthermia and lactic acidosis \[ 2 \]. SS has a fairly good prognosis, and most illnesses are resolved within 24 hours \[ 5 \]. However, symptoms last longer than 24 hours in some cases, necessitating more stringent treatment \[ 2 \]. SS is a potentially life-threatening adverse drug reaction resulting from ingesting substances with serotonergic effects, including psychostimulants such as cocaine. Our case was unique as in our patient; the use of cocaine and fentanyl precipitated SS. It implicates that SS should be suspected, especially in drug abusers treated with psychotropic agents. The clinical presentation is variable and often non-specific, making diagnosis difficult, mainly because it is unfamiliar to practitioners. Training healthcare professionals to recognize the manifestations of SS is undoubtedly a challenge. However, it is imperative to intervene quickly and early in patients to avoid fatal outcomes. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus. As a library, NLM provides access to scientific literature. Find articles by Arshan Khan. Find articles by Abdelilah Lahmar. Find articles by Haris Asif. Find articles by Muhammad Haseeb. Find articles by Kelash Rai. Accepted Mar 3; Collection date Mar. The authors have declared that no competing interests exist. Consent was obtained or waived by all participants in this study. Similar articles. Add to Collections. Create a new collection. 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How can I buy cocaine online in Oujda