Body packer: cocaine intoxication, causing death, masked by concomitant administration of major tranquilizers

Methamphetamine poisoning due to body packer swallowing in a prisoner

Individuals who introduce illicit substances such as opioids and amphetamines into the gastrointestinal tract by swallowing or inserting them into the rectum are known as body packers. We describe a prisoner who developed severe poisoning symptoms after swallowing amphetamine packets and was promptly removed by laparotomy.

In body packers and body stuffers, if these packages are opened in the gastrointestinal tract, it can be associated with severe poisoning and high mortality, which requires surgical intervention.

Fatality in a body packer: the first reported case in Saudi Arabia

Background

Body packers use different methods and materials to pack drugs inside their bodies. These could be simple or sophisticated to ensure a successful transfer or concealment of the drug with minimal risk to the packer. Different drugs were reported with cocaine and heroin being the most common. The packer presents to health facilities whenever they develop complications like drug leakage or intestinal obstruction, or they can be detected after a fatal event as an incidental finding in autopsy.

Case presentation

A body packer who was in detention suffered pain and died shortly after that. The autopsy not only revealed severe coronary atherosclerosis but also unveiled 10 rubber packages filled with methamphetamine and cannabis, and one package was found ruptured in the mouth. Toxicological analysis showed a blood level of methamphetamine 3.66 mg/L which was considered a cause of death. While methamphetamine was reported in cases of body packers, cannabis is rarely concealed by body packers for several reasons including its cost compared to the risk of packing.

Conclusions

This is the first reported case of fatality in body packers in Saudi Arabia and Arab countries. This should put into consideration the need for screening suspicious cases who are involved or suspected to be involved with drugs. Effective screening in specific facilities is needed to reduce fatalities and at the same time lowering drug smuggling.

[Party and designer drugs : From ecstasy and crystal meth to angel's trumpet]

BACKGROUND

The growing abuse of party and designer drugs increases the number of emergency cases related to drug consumption.

OBJECTIVES

Presentation of the scenario as well as the diagnostic and therapeutic principles of emergency management and characterization of the most frequently abused drugs and its effects.

MATERIALS AND METHODS

Evaluation of drug statistics, and work-up and discussion of expert publications and recommendations.

RESULTS

In 2014, there were 1032 drug-related deaths, which is 3 % more incidents than in 2013. However, there is a drastically and steadily increasing consumption of newer enhancing drugs such as crystal meth. Throughout Europe, there are about 1500 designer drugs that are disguised as so-called spice mixtures or bath salts. In addition to stimulating substances, hallucinogenic and sedative drugs are also consumed. Common nonspecific symptoms of emergency drug overdose are psychosis, impaired consciousness, seizures, and disorders of various internal organs. Based on the clinical presentation, different neurotransmitter syndromes can be distinguished and the drug etiology can be diagnosed and proven by laboratory assays. Therapy includes symptom-oriented measures.

CONCLUSIONS

Knowledge of different party and designer drugs and their complications enables prompt emergency management.

A systematic review of evidence on the association between cocaine use and seizures

BACKGROUND

Institutional monographs/medical textbooks mention seizures as a neurological complication of cocaine, but no systematic reviews (SRs) have been published on this issue. We aimed to conduct a SR of the literature on the relationship between cocaine use and seizures and to summarize the biological plausibility of that relationship.

METHODS

The pathophysiological mechanisms that may underlie an association between cocaine and seizures were summarized; a SR was then performed using three databases (EMBASE, Medline, PsycINFO) and the Cochrane-library to search for published papers (1980-2012) aimed at quantifying the associations between cocaine use and seizures. The inclusion criteria for selection were: articles based on clinical trials, cohort, case-control (CC) or cross-sectional (CS) studies, participants ≥ 14 years old and not pregnant, and use of cocaine in the last 72 h. Information was extracted, evaluated and cross-checked independently by two researchers.

RESULTS

Of the 1243 potentially relevant articles initially identified; one CC and 22 CS studies were finally selected. The CC study did not find cocaine use to be a risk-factor for seizures. In addition to the limitations of the CS design, these studies had important methodological weaknesses and biases.

CONCLUSIONS

Despite its biological plausibility, no rigorous scientific evidence supports a causal relationship between cocaine use and seizures. The misinterpretation of the role of cocaine may have important implications in medical services. Well-conducted studies are urgently needed.

Stability of cocaine in formalin solution and fixed tissues

Embalming and formalin fixation are common, and yet they can create problems for the forensic scientist if a drug has been the cause of death and if the only available specimens to be analyzed are formalin-fixed tissues. Previous studies have demonstrated that during fixation xenobiotics are extracted into formalin according to tissue and fixing solution characteristics. In some cases formalin can react with the analyte resulting in the production of new chemical entities. Regarding cocaine and its metabolites, Cingolani et al. have reported that formalin-fixation extracts benzoylecgonine (BE) from tissues and that BE is stable in the fixing solution. However, the stability and kinetic properties of cocaine remain so far unexplored. Our data show that in buffered formalin (pH 7.4) cocaine is hydrolyzed to BE in agreement with a pseudo first-order reaction kinetic (half-life time approximately 7 days), whereas in unbuffered formalin (pH approximately 3.5) it is relatively stable over a period of 30 days. The analysis of brain and liver samples at different fixation times indicates that during fixation an extraction process occurs for both analytes and that the extraction is more efficient in the liver than in the brain, probably because of a greater lipophilicity of the brain tissue. In conclusion, our study demonstrates that formalin-fixed tissues and their fixing solutions can be used for cocaine analysis only if a short time period has passed since the fixation beginning. The rapid extraction process of cocaine into formalin and the concomitant hydrolysis to BE occurring in buffered formalin may prevent the identification of cocaine in both tissues and formalin solution already at 15-30 days after fixation. Moreover, the unpredictable extraction rate of both analytes, along with the hydrolysis of cocaine into BE significantly affects tissue concentrations, thus complicating the interpretation of quantitative results.

[Body packer: review and experience in a referral hospital]

Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management -usually conservative management- of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients.

Cocaine-related deaths: an enigma still under investigation

In recent years there has been an increase interest in cocaine-related death reflecting the rising trend in cocaine use in Europe. Nevertheless it is still now very difficult to attribute a death to cocaine. We can affirm that cocaine can be responsible for the cause of death only when there is a reasonably complete understanding of the circumstances or facts surrounding the death. Isolated blood cocaine levels are not enough to assess lethality, and should be always considered and evaluated in relation to concentrations of cocaine and benzoylecgonine concentrations in body tissue compartments, especially in brain and blood. We have reanalyzed all of our cocaine-related cases from 1990 to 2005, applying the methodology used by Spielher and Reed over 30 years ago. Our aim was to try to validate this model and verify its applicability and effectiveness after 20 years.

The risk of body packing: a case of a fatal cocaine overdose

The process of swallowing or inserting illegal packets of drugs for the purpose of evading law enforcement officers carries risks other than criminal charges. It can be fatal. Individuals engaged in such activities are called "Body Packers" or "Mules". The most frequent cause of the death among body packers is acute drug intoxication due to rupture of the package(s) within the gastrointestinal tract. We present the first documented case of a body packer that died from cocaine intoxication following the rupture of packets of cocaine in Western Pennsylvania.

One-step liquid-liquid extraction of cocaine from urine samples for gas chromatographic analysis

An improved technique for cocaine extraction from urine samples for gas chromatographic (GC) analysis is described. Employing a simple liquid-liquid extraction (LLE) of cocaine with a mixture of ethyl ether:isopropanol (9:1) the method presents a mean recovery of 74.49%. Limit of detection (LOD) and limit of quantification (LOQ) were 5 and 20 ng/ml, respectively. The method is highly precise (coefficient of variation (CV) <8%) and linear from 20 to 2000 ng/ml. It can he applied to detect the presence of cocaine in urine as a marker of its recent use in drug abuse treatment protocols.

Reversible myocardial dysfunction in critically ill, noncardiac patients: a review

OBJECTIVE

To review reversible myocardial dysfunction affecting critically ill patients without cardiac pathology.

DATA SOURCES

The bibliography for the study was compiled through a search of different databases for the period 1966-2001. References cited in the selected articles also were reviewed.

STUDY SELECTION

The selection criteria included all articles published on reversible myocardial dysfunction in critically ill patients.

CONCLUSIONS

Reversible myocardial dysfunction may develop in a situation of critical pathology, but the etiology of reversible myocardial dysfunction is not fully understood. This dysfunction may be accompanied by increases in enzyme concentrations and electrocardiographic changes. Reversible myocardial dysfunction probably is underdiagnosed, although its presence is associated with a worsening of the prognosis and with more specific therapeutic options. Further studies are necessary to define its true incidence and clinical implications.