Basuco, with its name derived from the Spanish for “dirty trash of cocaine”, is a psychoactive by product of cocaine production, a residual paste left at the bottom of the barrel after the pure drug has been produced.

Speaking to The Lancet, Julian Quintero, director of Colombian non-governmental organisation Technical Social Action (ATS), calls basuco “the diabolical son of narcotrafficking”, adding that “much like Colombian coffee, the best product leaves and the worst stays”.

More potent than the crack cocaine found across European and American cities, basuco is typically smoked through a pipe, although it is sometimes rolled in cigarette papers with tobacco or cannabis. Basuco is highly addictive; families tell of relatives who become dependent after just 15 days of repeated consumption. Given the fleeting 2-minute high it provides, users often retake the drug chronically, resulting in binges that leave little time for eating or sleeping.

To attempt to manage the high and the paranoia that the drug induces, users sometimes take a cocktail of industrial alcohol, fruit juice, and another psychoactive agent such as MDMA. Alongside the tooth decay caused by the abandonment of hygiene, this near-sleepless existence takes its toll on users’ skin, giving it a sunken, hanging appearance that makes age difficult to determine.          

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