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
