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In this paper, we compare the findings of a new assessment of the harms of cocaine trafficking in Belgium with those of a prior assessment of harms in the early 2000s (Paoli et al., 2013), using the same “Harm Assessment Framework” to systematically and empirically examine conditions in each period and the changes between them. Our prior application of the framework found few examples of substantial harms of cocaine trafficking in Belgium, but since then the crime has become more pervasive and violent, leading some to ask if it is jeopardizing Belgium’s social fabric or if Belgium is on the verge of becoming a narco-state. These developments motivated us to update our assessment and presented an opportunity to take our framework into a new, analytical domain, i.e., an inter-temporal one. The update, starting with a revised script analysis, yields a compelling story about changes in the modus operandi of cocaine trafficking in Belgium over the past two decades and the consequences for harms, especially those of escalating violence to individuals, institutions, and the environment. We discuss the implications of our findings for drug policy and for applications of our framework in the future.