Body-Packing with Amphetamines – an Indication for Surgery

Smuggling of drugs by body packing: Evidence from Chinese sentencing documents

BACKGROUND

In China, body packing as a means of transporting drugs was firstly found in Yunnan province in an area that shares a border with the Golden Triangle in late 1970s. Since then, drug trafficking cases that utilize body packing as the primary mode of transportation have increased substantially. Due to a scarcity of data, however, the scope and nature of such criminal activity is not thoroughly understood. This study provides a new approach to the analysis of body packing by digitizing and analyzing court sentencing documents in China from 2006-2016.

METHODOLOGY

This study implements network analysis and descriptive statistics to identify the structures of drug trafficking routes involving body packing in China and aims to provide a comprehensive examination of body packing activity, including the pattern of geographic routes and the characteristics of captured body packers. A generalized inflated negative binomial model is also used to investigate the effects of legal and extra-legal factors on the length of sentence for captured body packers.

RESULTS

We identified three types of trafficking routes involving body packing: intra-provincial, inter-provincial, and international. Our results showed that heroin and methamphetamine are the two primary drugs trafficked by captured body packers. Network analysis revealed that among body packing routes, there are three major hubs that serve as the primary origin for the trafficking -Yunnan, Sichuan, and Myanmar- and three potential authorities- Guangdong, Xinjiang, and Sichuan-which serve as the common destinations of the drug routes. Consistent with previous studies, our research also demonstrated that heavier punishments are given in cases that involve a larger quantity of drugs and repeat offenders. Offenders who fall into special groups, such as pregnant/lactating women, the disabled, or minors, receive more lenient sentences. In addition, our analysis further revealed that the logic behind longer sentences for those offenders who confessed as opposed to those who did not, is possibly due to the concentration of imprisonment values at fifteen years, as many of the confessed body packers are sentenced to the maximum fixed term of imprisonment.

CONCLUSION

By narrowing the gap in knowledge on the topic of body packing, our analysis provides evidence-based strategies for fighting against body packing, specifically by identifying geographical patterns and the profiles of captured body packers.

Smuggling of drugs by body packing: Evidence from Chinese sentencing documents

BACKGROUND

In China, body packing as a means of transporting drugs was firstly found in Yunnan province in an area that shares a border with the Golden Triangle in late 1970s. Since then, drug trafficking cases that utilize body packing as the primary mode of transportation have increased substantially. Due to a scarcity of data, however, the scope and nature of such criminal activity is not thoroughly understood. This study provides a new approach to the analysis of body packing by digitizing and analyzing court sentencing documents in China from 2006-2016.

METHODOLOGY

This study implements network analysis and descriptive statistics to identify the structures of drug trafficking routes involving body packing in China and aims to provide a comprehensive examination of body packing activity, including the pattern of geographic routes and the characteristics of captured body packers. A generalized inflated negative binomial model is also used to investigate the effects of legal and extra-legal factors on the length of sentence for captured body packers.

RESULTS

We identified three types of trafficking routes involving body packing: intra-provincial, inter-provincial, and international. Our results showed that heroin and methamphetamine are the two primary drugs trafficked by captured body packers. Network analysis revealed that among body packing routes, there are three major hubs that serve as the primary origin for the trafficking -Yunnan, Sichuan, and Myanmar- and three potential authorities- Guangdong, Xinjiang, and Sichuan-which serve as the common destinations of the drug routes. Consistent with previous studies, our research also demonstrated that heavier punishments are given in cases that involve a larger quantity of drugs and repeat offenders. Offenders who fall into special groups, such as pregnant/lactating women, the disabled, or minors, receive more lenient sentences. In addition, our analysis further revealed that the logic behind longer sentences for those offenders who confessed as opposed to those who did not, is possibly due to the concentration of imprisonment values at fifteen years, as many of the confessed body packers are sentenced to the maximum fixed term of imprisonment.

CONCLUSION

By narrowing the gap in knowledge on the topic of body packing, our analysis provides evidence-based strategies for fighting against body packing, specifically by identifying geographical patterns and the profiles of captured body packers.

Radiological features of body packers: An experience from a regional accident and emergency department in close proximity to the Hong Kong International Airport

Background:

Body packing is a frequently used method for drug trafficking. Local information about the clinical and radiological features of body packing is lacking.

Objectives:

To evaluate the radiological features of body packers presenting to a hospital near to the Hong Kong International Airport and to compare the radiological features of solid form versus liquid cocaine.

Methods:

This was a retrospective cohort study. Medical notes of 269 suspected body packers, presenting to the Accident and Emergency Department of North Lantau Hospital under the detention by the law enforcement personnel from 1st January 2015 to 28th February 2017, were reviewed. The radiological features of body packing were retrospectively evaluated.

Results:

Sixty-nine cases were confirmed body packers radiographically. Majority of them (81%, 56/69) were cocaine packers. Powder form cocaine (67%, 49/69) was the most popular drug packed, followed by liquid cocaine (15%, 10/69). There was a trend of increasing incidence of liquid cocaine packers. The classical ‘double condom’, ‘tic tac’ and ‘halo’ signs were present in 94%, 72.5% and 42% of cases with radiologically confirmed body packing respectively. The ‘rosette’ sign was only identified in 1 case. Three new radiological signs, the ‘bag of eggs’, ‘lucent triangle’ and ‘black crescent’ sign, were suggested to aid identification of drug packets. The classical ‘tic tac’ sign was absent in all liquid cocaine packing cases (p<0.05). The liquid cocaine packets appeared irregular with indistinct border in majority of cases (p<0.05). The solid form packets were mostly opaque to faeces while liquid cocaine had variable density (p<0.05). Most solid form packets had homogeneous content which was in contrast to the heterogeneous content in liquid cocaine (p<0.05).

Conclusion:

Failure in detecting drug body packing may result in medicolegal consequences. Emergency physicians need to be aware of subtle radiological signs of liquid cocaine packets in the plain abdominal radiography.

Management of Body Packers in the Emergency Department

Body packing of illicit drugs is one of the means of drug trafficking. Asymptomatic suspects may be brought in by law-enforcement officers for body search of possible drug packing inside the body. Symptomatic body packers may present with gastrointestinal obstruction or toxicity of the leaking drugs inside the packets. Management strategies are largely determined by the modes of presentation. Asymptomatic persons must be persuaded with every effort for consent to the body cavity search as well as treatment for the safe passage of any packed drugs to avoid possible complications and medico-legal sequelae. Abdominal X-rays and computed tomography can be helpful in confirming the presence of drug packets and in identifying possible packet leakage. Gastrointestinal decontamination, whole bowel irrigation, use of specific antidote as well as operative intervention may be indicated. Emergency physicians must be conversant with the medical and legal aspects of the management of these body packers.

Case for mandatory reporting of 'body packers'

Body packing is the term used to describe the ingestion of illicit substances for transport across control lines. Where the diagnosis of body packing is made independently in the ED, the issue of reporting the case to law enforcement officials poses a difficult scenario given the legal obligations of patient confidentiality. We describe a case of a body packer brought into the ED and subsequently reported to the police. The conflicts between patient confidentiality versus statutory exceptions to confidentiality along with case law regarding this scenario are discussed.

A case report of opium body packer; review of the treatment protocols and mechanisms of poisoning

ABSTRACT Body packers are people who illegally carry drugs, mostly cocaine as well as opium and/or heroin, concealed within their bodies. The packets are inserted in the mouth, rectum, or vagina in order to get across borders without being detected. In this presentation we report a case of an opium body packer and review the available scientific literature by focusing on mechanisms of toxicity and treatment approach. The patient was a 35-year-old man who had lethargy, respiratory depression, tachycardia, normal blood pressure, hyperthermia, and pinpoint pupils on presentation. No past medical history was obtained and the only positive history was his travel from Afghanistan 2 days earlier, which he had given to emergency personnel before arriving at our hospital. Complete blood cells and kidney and liver tests were all in normal range. In the emergency department, the patient was treated with oxygen, naloxone, and hypertonic glucose. One dose of activated charcoal (1 g/kg) was administered orally. After intravenous injection of naloxone (4 mg), the lethargy, respiratory depression, and miosis were resolved. The patient was admitted to the intensive care unit and 90 min after admission, the patient redeveloped respiratory distress and lost consciousness. He was intubated and mechanically ventilated due to the suspicious of body packing. Plain abdominal x-ray showed multiple packets throughout the gastrointestinal tract; 81 packets were removed by surgery and three of them were left due to leaking. After removing the packets, the patient was treated conservatively. He suffered a pulmonary infection (aspiration pneumonia) and he regained consciousness after 4 days. Upon recovery the patient was seen by a psychiatrist prior to going to prison. Surgery is recommended for body packers who have significant signs or symptoms.

“Body Packing” and its Implications in Qatar

The internal concealment of highly profitable illicit drugs such as cocaine and heroin, by means of body packing is an important means of international drug trafficking. This phenomenon is apparently uncommon in Qatar, with only one reported case thus far. Here, we present a case of body packer who was transiting Doha and was found to be carrying 90 internalized packets of heroin. Regardless of whether this is another isolated case or an emerging phenomenon in Qatar, awareness of medical and surgical complication that can arise in these individuals is of importance to practicing physicians.

[Surgical and forensic problems of body-packing]

Body-packing has increased as a means of illicit drug transportation, particularly since the intensification of customs control and luggage inspection which followed the terrorist attacks of September 11, 2001. This mode of drug transport may result in intestinal obstruction or systemic intoxication; diagnostic measures are discussed; management may require specific precautions and occasionally surgical intervention. The problem of how to handle and dispose of large quantities of drugs removed from or passed by a patient who may not be under arrest presents specific medicolegal considerations.

Methamphetamine body packer: acute poisoning death due to massive leaking of methamphetamine

We encountered three methamphetamine (MA) body packers presenting simultaneously, one of whom died. Three Nigerian men (39, 35, and 37 years old) who attempted to smuggle were found to contain 35 (498 g), 21 (292 g), and 5 packages (73 g) of methamphetamine hydrochloride (MA-HCl) in their stomachs, respectively. Packages were wrapped with plastic film and Scotch tape. The 39-year-old man died with acute poisoning from c. 20 g of MA-HCl that had leaked from the packages into the stomach. His plasma MA concentration was 8.6 microg/mL when he was hospitalized (17 h before his death). Autopsy findings showed extreme pulmonary congestion and edema as well as moderate hepatic edema and several petechiae. Quantitative analysis was performed by gas chromatography/mass spectrometry. Extremely high concentrations of MA and its metabolite amphetamine (AP) were found in cardiac blood (63.5 microg/mL and 1.2 microg/mL), urine (4,518 microg/mL and 72.4 microg/mL), gastric contents (8,490 microg/mL and 16.9 microg/mL), and in all other autopsy samples. These high concentrations confirmed that the cause of death was acute MA poisoning. Furthermore, impurity-profiling analysis of the seized MA revealed that the MA smuggled by the three suspects originated from the same batch.

Surgical issues in the poisoned patient

Some toxicologic emergencies require immediate or urgent surgical intervention in addition to routine medical care. The EP must be familiar with the indications for operative care, even though many of these poisonings and exposures are relatively rare. The EP must also be knowledgeable regarding the various means of surgical decontamination that are available, including temporary cardiopulmonary bypass. Finally, a high level of vigilance must be maintained for patients who have delayed presentation and fulminant organ failure necessitating early involvement of the transplantation team.