Since the beginning of the 21st century, the use of cocaine has doubled in certain European countries. Street dealers sell cocaine in small cellophane-wrapped packets each containing one gram, and that are stored in their mouth or rectum. In case of arrest, they swallow the packets that each contains enough cocaine to cause a fatal overdose. The packets cannot be detected by conventional radiology, and only an unenhanced abdominal CT allows for their detection. We present here our algorithm that integrates the diagnostic, therapeutic and medico-legal aspects of these cases. We also briefly review the treatment of acute cocaine intoxication, and present pitfalls that need to be avoided in the management of these difficult cases.