The current recommended treatment for cocaine "body packers" is surgical removal of the drug packages to prevent death due to cocaine poisoning. We describe 47 patients treated successfully with purgation and one patient who required surgery to remove packages obstructing the small bowel. Treatment decisions depend on the physical findings, the location of the cocaine packages in the gastrointestinal (GI) tract, and the type of package. Twelve patients (25%) had packages highly susceptible to breakage or leaching cocaine; in two cases, pieces of wrapping sloughed in the GI tract, and in another, a bag broke as it was being passed. In 36 cases (75%), the packages were more resistant to breakage or leaching cocaine, and no complications occurred. The types of packages can often be distinguished roentgenographically; however, 12 patients who passed cocaine packages had abdominal roentgenograms that did not show these foreign bodies.