Body packers



Ingested Drug Pellets
Ingested Drug Pellets
Passed Drug Pellets
Passed Drug Pellets

Backgound

  • International "professional" carriers of well packed illicit drugs.
  • Usually Cocaine or Heroin, occasionally amphetamines or Ecstasy.
  • Different to body stuffers:
    • Stuffers = swallowing or inserting relatively small amounts of loosely wrapped drug because of the fear of arrest.
  • Packers usually carry 1 kg of drug (in 50 to 100 packets of 8 to 10 g).
  • Each packet holds lethal amount of drug.
  • Drug packets may be machine-made (images) - rupture is rare.
  • Layered sheath around drug surrounded by hard wax coating.
  • Plastic incorporated to alter radiodensity.
  • Constipating agents e.g. Diphenoxylate or Loperamide frequently used.

Present as

  • Drug-induced toxic effects.
  • Intestinal obstruction (rare).
  • For medical assessment after arrest (Gardaí).

Record history

  • Drug packets (incl. wrapping). Number of packets (they do know!).
  • GI symptoms.

Examination

  • Vital signs, mental status, pupil size (Heroin or Cocaine signs very ominous).
  • Bowel sounds,skin findings.
  • Packets tend to leak before rupture : beware signs.
  • Gentle PR / PV examination.

Investigations

  • In CUH do NOT do AXR but please discuss request for low dose ("Crohn's schedule") CT with on-call radiology registar. The radiation dose is equivalent to an AXR. Computer reconstruction of images may take up to an hour.
  • ± CT >90% sensitive: (Hounsfield units Cocaine=¡219, Heroin=¡520).
  • Urine toxicology not recommended (sensitivity 37%).

Treatment

Opioid

  • Opioid poisoning - treat conservatively with continuous Naloxone infusion (may need huge doses).
  • Beware pulmonary oedema which is not responsive to Naloxone (RSI plus ventilation).

Cocaine

  • Clinical Cocaine package rupture - immediate laparotomy and surgical removal.
  • Temporising benzos for fitting or hypertension (more on cocaine page)
  • No β-blockers.
  • ? hypertonic Sodium Bicarbonate / Lignocaine for ventricular dysrhythmias.
  • Phentolamine or Sodium Nitroprusside for severe hypertension.

General

  • Whole bowel irrigation with "Klean-Prep" is the mainstay of treatment (antidotes press in CUH ED).
  • 2 litre per hour until results - may need NG administration.
  • Avoid Paraffin or pro-kinetic agents.

Content by Dr Íomhar O' Sullivan 23/02/2009. Review Dr √ćOS 10/02/2011, 08/10/2012. Last review Dr IOS 15/09/14.