Mr Ramirez underwent extensive plastic surgery to disguise his identity
The alleged leader of one of Colombia's most powerful drug cartels has been extradited to the US by Brazil.
Juan Carlos Ramirez Abadia was handed over to the US Drug Enforcement Agency in the city of Manaus and flown out of the country on a US government plane.
Mr Ramirez Abadia, known as Chupeta or Lollypop, was captured in Brazil last year and sentenced to 30 years in jail.
US prosecutors accuse him of smuggling more than 500 tons of cocaine into the US and of routinely killing his rivals.
Mr Ramirez Abadia is alleged to have been a key member of the Norte del Valle cartel, which is accused of sending huge amounts of cocaine to the US and Europe, and laundering the proceeds in Brazil.
Fear for life
The BBC's Jeremy McDermott says that the Brazilian government had been keen to extradite Mr Ramirez Abadia amid evidence that he was continuing to run a criminal empire from behind bars.
He was flown before dawn from a prison in central Brazil to the Amazon region jungle city of Manaus, where he was handed over to the DEA, a Brazilian Justice Ministry official told the Associated Press.
Brazil confiscated and sold many of Ramirez Abadia's properties
The spokesman added that Mr Ramirez Abadia was being flown to New York City in a US government plane.
He also said that the Brazilian government had sought assurances from US officials that they would not seek the death penalty before agreeing to extradite Mr Ramirez Abadia .
Mr Ramirez Abadia had actively sought extradition to the US, where he is wanted for drug-trafficking, money-laundering, raketeering and 15 murder charges, partly because he is said to fear for his life in Colombia.
In January, he offered to hand over millions of dollars if the extradition process went ahead quickly.
The US state department once estimated Mr Ramirez Abadia's personal wealth to be $1.8bn, and several luxury properties he owned in Brazil were put up for public auction.
Mr Ramirez Abadia has been accused of involvement in the illegal drugs trade since 1986. He surrendered to a Colombian court in 1996, but was released from prison in 2002.
He said he had moved to Brazil because he feared he might be killed by a rival cartel, and insisted he was not involved in drug-trafficking
But in April, he was convicted of money laundering, gang formation and corruption after being arrested at a luxurious hideaway in the city of Sao Paulo with more than $2m in cash.