We treated 50 patients who ingested packets of cocaine and developed a protocol for conservative medical management. Of the 50 patients, only 3 required emergency surgery. Surgery was precipitated by signs and symptoms of bowel obstruction in all cases. Six patients chose elective surgery. The rest of the patients passed the packets without signs of cocaine toxicity or other complications. This finding is in contrast to that of previous reports. Asymptomatic patients who have ingested packets of cocaine can be safely observed and managed conservatively.