Cocaine mules: what to do with body packers

February 28, 2010, 8:49 pm


Clinical management of cocaine body packers: the Hillingdon experience. Beckley I et al.  Can J Surg 2009;52:417-421.

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This retrospective observational study looked at 5-years of experience with patients suspected of being cocaine body packers referred to Hilldingdon Hospital in Uxbridge, England.  Since that hospital is located just outside of Heathrow Airport in London, the study population is considerable:  590 suspected body packers referred to hospital, 351 with packets visible on abdominal x-ray, 61 admitted to Hillingdon Hospital.  Fifty-six of these patients were managed conservatively, with laxatives or whole-bowel irrigation (WBI).  Six patients developed signs and symptoms of cocaine intoxication (hypertension, tachycardia, agitation, seizure) and 5 required surgery for persisting signs and symptoms, or evidence of intestinal obstruction.  The authors propose a protocol for managing suspected cocaine body packers, and conclude that their results confirm the safety of a conservative approach to these patients — that is, observation and surgery only if specifically indicated.

Although I think their conclusion is most likely correct, unfortunately the data is so confusing and incomplete  that I find it impossible to take anything definite from the paper.  For instance, the authors state that:

“A total of 351 (59.5%) of those referred to hospital had visible cocaine packets on plain abdominal radiographs obtained in the accident and emergency department. Most (75.8%) of these confirmed body packers then returned to Heathrow, as they were judged to be suitable for observation and conservative management at the airport detention centre.”

Say what? I find it difficult to believe that they sent confirmed body packers out of the hospital. What were the observation facilities at Heathrow? Could they administer  laxatives and WBI there? What were the indications for keeping a confirmed body packer in hospital? Abdominal pain? Signs and symptoms of cocaine toxicity?  What happened to those who were not admitted? Were there any complications from the different means of gastrointestinal emptying: cathartics, WBI, enemas and suppositories, or some combination of these?  The questions go on and on, and the paper becomes more frustrating the more one reads it.

Speaking of body packers, the following is an excerpt from the 2003 film Maria Full of Grace, vividly depicting the preparation and ingestion of packets full of drugs:


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