Imaging unveils internal secrets of drug traffickers

The proliferation of narcotics use over the past decades has been accompanied by a rise in drug smuggling. Meticulous vigilance by international customs and national authorities has led traders to adopt sophisticated and ingenious methods of drug transport. The smuggler's own body, especially the gastrointestinal tract, is now being used frequently as a vehicle for transporting narcotics. This intestinal concealment of illicit drugs, such as cocaine, marijuana, hashish, or heroin, can lead to complex health problems should the package contents leak.1-6 Modern-day emergency departments increasingly need to deal with the dangerous side effects of both the "body stuffing" of street dealers and the "body packing" of drug traffickers. Radiology can play an important role in the identification of such packages and the management of these patients. Body packers make up 80% of the professional couriers, or mules, employed by international drug organizations. These individuals generally cross international borders on airplanes in the guise of tourists. Before embarking on a flight, they will systematically fill their digestive tract with large bags containing narcotics, each bag measuring between approximately 2 cm and 8 cm in maximum diameter. Smaller packets are swallowed while larger ones are inserted into the rectum. The form and size of drug packs will depend on their production method (handmade or mechanically fabricated) and how they are brought into the body (orally or rectally). All packages will generally be compact, safely packed, and carefully wrapped in containers designed to resist gastrointestinal transit without damage.5,7,8 Body stuffers, on the other hand, tend to be drug dealers encountered on the street. They are often drug users themselves or prostitutes. When unexpectedly confronted by the police, they will simply ingest what drugs they are carrying in an attempt to conceal them. This may involve either hastily swallowing the narcotics or introducing them into the vagina or rectum. The ritual is well known to both police and drug dealers as a means of concealing illegal substances and avoiding arrest.9 Body stuffing may involve any popular drug that is sold on the street, including hallucinogens and sedatives. The drug most commonly linked to body stuffing is cocaine.6 Cocaine is extracted from Erythroxylon coca, a plant native to the South American Andes. The leaves are harvested, dried, and then converted into coca paste, which is eventually used to make white, crystalline cocaine hydrochloride. It takes about 100 kg of coca leaves to produce 800 g of cocaine.10 Cocaine powder is typically pressed into a tight ball-shaped object for transport. Crack cocaine, also linked to body stuffing, is a chemical derivate of cocaine and is much cheaper and easier to use. Generally, it is absorbed by smoking in cigarettes or special pipes, and it produces a more intense and rapid effect on the drug user than the powder, which is mostly snuffed. Drug packages ingested by body stuffers will typically be handmade and contain a single dose of the narcotic. Because the packages will have been intended for street sale, they are unlikely to be well-suited to gut transit. A packet of cocaine 8 to 10 mm in diameter, for instance, will contain approximately 1 g of cocaine powder of variable concentration (5% to 20%). The powder will most likely have been wrapped loosely in cellophane paper, condoms, and/or aluminum foil.11,12 If a package of cocaine ruptures or leaks within the intestine, the drug will immediately be absorbed by the intestinal mucosa. The resulting toxicity can affect almost any of the body's organs. Signs of cocaine intoxication can include profound stimulation to the central nervous system with psychosis and repeated grand mal convulsions, ventricular arrhythmias, respiratory dysfunction with Cheyne-Stokes breathing, respiratory paralysis, hyperthermia, and even coma. Death from cocaine intoxication can occur from doses as low as 30 mg. The minimum lethal dose from orally administered cocaine is 1.2 g.10 Body packers can ingest up to 25 cocaine-filled packets simultaneously. Sudden leakage of packages can, consequently, be fatal.6,13 Emergency room