Body Packing - The Internal Concealment of Illicit Drugs

New England Journal of Medicine

Volumn 349, Issue 26, 2003, Pages 2519-2526

  Traub, Stephen J ^a,b,c,d   Hoffman, Robert S ^a,b   Nelson, Lewis S ^a,b  

^a BELLEVUE HOSPITAL CENTER   (United States)

^b NEW YORK CITY POISON CONTROL CENTER   (United States)

^c HARVARD MEDICAL SCHOOL   (United States)

^d BETH ISRAEL DEACONESS MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

3,4 METHYLENEDIOXYMETHAMPHETAMINE; ACTIVATED CARBON; AMPHETAMINE; BENZODIAZEPINE; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; BICARBONATE; CANNABIS; COCAINE; DIAMORPHINE; DIAZEPAM; DIPHENOXYLATE; ENEMA; ERYTHROMYCIN; GLYCERYL TRINITRATE; ILLICIT DRUG; LABETALOL; LAXATIVE; LIDOCAINE; LOPERAMIDE; LORAZEPAM; METOCLOPRAMIDE; NALOXONE; NITROPRUSSIDE SODIUM; PHENTOLAMINE; VECURONIUM;

ABDOMINAL RADIOGRAPHY; AIRPORT; ANAMNESIS; AUTOMATION; BALLOON; BODY PACKING; CANADA; COMPUTER ASSISTED TOMOGRAPHY; CONDOM; DEMOGRAPHY; DETENTION; DIGESTIVE SYSTEM PERFORATION; DRUG INTOXICATION; DRUG OVERDOSE; DRUG PACKAGING; ECHOGRAPHY; GASTROINTESTINAL ENDOSCOPY; GOVERNMENT; HEALTH CARE PERSONNEL; HEART VENTRICLE ARRHYTHMIA; HUMAN; HYPERTENSION; IMAGE ANALYSIS; INTESTINE LAVAGE; LAW ENFORCEMENT; LUNG INJURY; MONEY; NEUROMUSCULAR BLOCKING; PHYSICAL EXAMINATION; PREGNANCY; PRIORITY JOURNAL; RECTUM; RESPIRATION DEPRESSION; REVIEW; SEIZURE; SMALL INTESTINE OBSTRUCTION; SWALLOWING; TECHNIQUE; TREATMENT INDICATION; UNITED STATES; URINALYSIS; VAGINA;

ALGORITHMS; CRIME; DIGESTIVE SYSTEM; ETHICS; FOREIGN BODIES; HUMANS; INTESTINAL OBSTRUCTION; INTESTINAL PERFORATION; STREET DRUGS;

EID: 0346734309     PISSN: 00284793     EISSN: None     Source Type: Journal    
DOI: 10.1056/NEJMra022719     Document Type: Review

References (50)

1. Deitel M, Syed AK. Intestinal obstruction by an unusual foreign body. Can Med Assoc J 1973;109:211-2.
2. June R, Aks SE, Keys N, Wahl M. Medical outcome of cocaine bodystuffers. J Emerg Med 2000;18:221-4.
3. Watson CJE, Thomson HJ, Johnston PS. Body-packing with amphetamines - an indication for surgery. J R Soc Med 1991;84:311-2.
4. Krishnan A, Brown R. Plain abdominal radiography in the diagnosis of the "body packer." J Accid Emerg Med 1999;16:381.
5. Horrocks AW. Abdominal radiography in suspected 'body-packers.' Clin Radiol 1992;45:322-5.
6. Dassel PM, Punjabi E. Ingested marihuana-filled balloons. Gastroenterology 1979;76:166-9.
7. Gill JR, Graham SM. Ten years of "body-packers" in New York City: 50 deaths. J Forensic Sci 2002;47:843-6.
8. Gherardi RK, Baud FJ, Leporc P, Marc B, Dupeyron JP, Diamant-Berger O. Detection of drugs in the urine of body-packers. Lancet 1988;1:1076-8.
9. Bulstrode N, Banks F, Shrotria S. The outcome of drug smuggling by 'body-packers' - the British experience. Ann R Coll Surg Engl 2002;84:35-8.
10. Claffey M. Stampede of drug mules at Kennedy: after 9/11 lull, heroin & ecstasy busts soar. New York Daily News. May 5, 2002:5.
11. Traub SJ, Kohn GL, Hoffman RS, Nelson LS. Pediatric " body-packing." Arch Pediatr Adolesc Med 2003;157:174-7.
12. Greenberg MI, Shrethra M. Management of the pregnant body packer. J Toxicol Clin Toxicol 2000;38;176-7. abstract.
13. The Chicago swallowers - today is a good day to die. Washington, D.C.: U.S. Customs News, June 1997. (Accessed December 1, 2003, at http://www.customs.gov/hot-new/pressrel/1997/0612-01.htm.)
14. McCarron MM, Wood JD. The cocaine 'body-packer' syndrome: diagnosis and treatment. JAMA 1983;250:1417-20.
15. Pidoto RR, Agliata AM, Bertoline R, Nainini A, Rossi G, Giani G. A new method of packaging cocaine for international traffic and implications for the management of cocaine body-packers. J Emerg Med 2002;23:149-53.
16. Aldrighetti L, Paganelli M, Giacomelli M, Villa G, Ferla G. Conservative management of cocaine-packet ingestion: experience in Milan, the main Italian smuggling center of South American cocaine. Panminerva Med 1996;38:111-6.
17. Wetli CV, Mittleman RE. The "body-packer syndrome" - toxicity following ingestion of illicit drugs packaged for transportation. J Forensic Sci 1981;26:492-500.
18. Utecht MJ, Stone AF, McCarron MM. Heroin body packers. J Emerg Med 1993;11:33-40.
19. Beerman R, Nunez D Jr, Wetli CV. Radiographic evaluation of the cocaine smuggler. Gastrointest Radiol 1986;11:351-4.
20. Marc B, Baud FJ, Aelion MJ, et al. The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel. J Forensic Sci 1990;35:345-55.
21. Jones OM, Shorey BA. Body-packers: grading of risk as a guide to management and intervention. Ann R Coll Surg Engl 2002;84:131-2.
22. Personal Search Review Commission. Report on personal searches by the United States Customs Service and independent advisor's report. Washington, D.C.: U.S. Customs Service, 2000.
23. Caruana DS, Weinbach B, Goerg D, Gardner LB. Cocaine-packet ingestion: diagnosis, management, and natural history. Ann Intern Med 1984;100:73-4.
24. Hartoko TJ, Demey HE, De Schepper AMA, Beaucourt LE, Bossaert LL. The body packer syndrome - cocaine smuggling in the gastro-intestinal tract. Klin Wochenschr 1988;66:1116-20.
25. Hahn IH, Hoffman RS, Nelson LS. Contrast CT scan fails to detect the last heroin packet. J Toxicol Clin Toxicol 1999;37:644-5. abstract.
26. Hierholzer J, Cordes M, Tantow H, Keske U, Maurer J, Felix R. Drug smuggling by ingested cocaine-filled packages: conventional x-ray and ultrasound. Abdom Imaging 1995;20:333-8.
27. Pinsky MF, Ducas J, Ruggere MD. Narcotic smuggling: the double condom sign. J Can Assoc Radiol 1978;29:79-81.
28. McCleave NR. Drug smuggling by body-packers: detection and removal of internally concealed drugs. Med J Aust 1993;159:750-4.
29. Karhunen PJ, Suoranta H, Penttila A, Pitkaranta P. Pitfalls in the diagnosis of drug smuggler's abdomen. J Forensic Sci 1991;36:397-402.
30. Bogusz MJ, Althoff H, Erkens M, Maier R-D, Hofmann R. Internally concealed cocaine: analytical and diagnostic aspects. J Forensic Sci 1995;40:811-5.
31. Wilgoren J. Misdiagnosis led to man's handcuffing, suit claims. New York Times. December 6, 1998:62.
32. Traub SJ, Hoffman RS, Nelson LS. False-positive abdominal radiography in a body packer resulting from intraabdominal calcifications. Am J Emerg Med 2003;21:607-8.
33. Alzen G, Banning S, Gunther R. Sonographische Nachweisbarkeit von Betäubungsmitt elbehältnissen im gastrointestinaltrakt: Experimentelle Untersuchung beim hund. ROFO Fortschr Geb Rontgenstr Nuklearmed 1987;146:544-7.
34. Kersschot EAJ, Beaucourt LEA, Degryse HRM, De Schepper AMAP. Roentgenographical detection of cocaine smuggling in the alimentary tract. ROFO Fortschr Geb Rontgenstr Nuklearmed 1985;142:295-8.
35. Wackerle B, Rupp N, von Clarmann M, Kahn T, Heller H, Feuerbach S. Nachweis von Rauschgiftpäckchen beim "body-packers" durch bildgebende Verfahren: Untersuchungen in vitro und in vivo. ROFO Fortschr Geb Rontgenstr Nuklearmed 1986; 145:274-7.
36. Albertson TE, Dawson A, de Latorre F, et al. TOX-ACLS: toxicologic-oriented advanced cardiac life support. Ann Emerg Med 2001;37:Suppl:S78-S90.
37. Hollander JE, Hoffman RS. Cocaine. In: Goldfrank LR, Flomenbaum NE, Lewin NA, Howland MA, Hoffman RS, Nelson LS, eds. Goldfrank's toxicologic emergencies. 7th ed. New York: McGraw-Hill, 2002:1004-19.
38. Robinson T, Birrer R, Mandava N, Pizzi WF. Body smuggling of illicit drugs: two cases requiring surgical intervention. Surgery 1993;113:709-11.
39. Hutchins KD, Pierre-Louis PJB, Zaretski L, Williams AW, Lin RL, Natarajan GA. Heroin body-packing: three fatal cases of intestinal perforation. J Forensic Sci 2000;45:42-7.
40. Johnson JA, Landreneau RJ. Esophageal obstruction and mediastinitis: a hard pill to swallow for drug smugglers. Am Surg 1991;57:723-6.
41. Dunne JW. Drug smuggling by internal bodily concealment. Med J Aust 1983;2:436-9.
42. Suarez CA, Arango A, Lester JL III. Cocaine-condom ingestion: surgical treatment. JAMA 1977;238:1391-2.
43. Marc B, Baud FJ, Maison-Blanche P, Leporc P, Garnier M, Gherardi R. Cardiac monitoring during medical management of cocaine body packers. J Toxicol Clin Toxicol 1992;30:387-97.
44. Tomaszewski C, McKinney P, Phillips S, Brent J, Kulig K. Prevention of toxicity from oral cocaine by activated charcoal in mice. Ann Emerg Med 1993;22:1804-6.
45. Hoffman RS, Smilkstein MJ, Goldfrank LR. Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem. Am J Emerg Med 1990;8:523-7.
46. White N, Taylor K, Lyszkowski A, Tullett J, Morris C. Dangers of lubricants used with condoms. Nature 1988;335:19.
47. Visser L, Sticker B, Hoogendoorn M, Vinks A. Do not give paraffin to packers. Lancet 1998;352:1352.
48. Traub SJ, Su M, Hoffman RS, Nelson LS. Use of pharmaceutical promotility agents in the treatment of body packers. Am J Emerg Med 2003;21:511-2.
49. Beck NE, Hale JE. Cocaine 'body-packers.' Br J Surg 1993;80:1513-6.
50. Olmedo R, Nelson L, Chu J, Hoffman RS. Is surgical decontamination definitive treatment of "body-packers"? Am J Emerg Med 2001;19:593-6.