Acute ingestion of illicit drugs (body stuffing)
- Steven E Aks, DO, FACMT, FACEP
Steven E Aks, DO, FACMT, FACEP
- Associate Professor of Emergency Medicine
- Rush Medical College
- Director, The Toxikon Consortium, Division of Toxicology; Department of Emergency Medicine
- Cook County Hospital
- Sean M Bryant, MD
Sean M Bryant, MD
- Associate Professor of Emergency Medicine
- Cook County Hospital (Stroger)
Oral ingestion of drugs of abuse to evade detection occurs in two distinct patterns. "Body packing" is the planned and relatively well-coordinated ingestion for the purposes of smuggling [1,2]. It is reviewed separately. (See "Internal concealment of drugs of abuse (body packing)".)
"Body stuffing," the hasty ingestion of drugs in order to evade law enforcement, is a distinct syndrome from body packing [3,4]. The body stuffer is often at risk for acute toxicity because the drugs are usually unwrapped or poorly wrapped, and not designed for ingestion and transport.
Body packers tend to ingest packets that contain a large quantity of drug (approximately 1 kg) , whereas body stuffers usually ingest smaller amounts (grams) intended for individual sale. If a packet ingested by a "body packer" ruptures, severe toxicity is likely, whereas a much larger number of body stuffing packets must be ingested for comparable toxicity to develop.
The diagnosis and management of body stuffing is reviewed here. The toxicities of specific agents commonly abused or ingested are discussed separately. (See "Cocaine: Acute intoxication" and "Acute opioid intoxication in adults" and "Methamphetamine intoxication" and "Initial management of the critically ill adult with an unknown overdose".)
Little data are available to provide insight into the scope of the body stuffing problem. However, cases are frequently seen in urban centers where the use of illegal drugs is common. Packaging methods for body stuffers vary widely among different regions [5-8]. Knowledge of local packaging techniques is essential to assess the potential risk of rupture and drug toxicity. Many drugs of abuse are "stuffed" with cocaine, heroin, and methamphetamine among the most common [5,9,10].
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- Cumpston KL, Aks SE, Sigg T, Pallasch E. Whole bowel irrigation and the hemodynamically unstable calcium channel blocker overdose: primum non nocere. J Emerg Med 2010; 38:171.
- Bryant SM, Weiselberg R, Metz J, et al. Treating body stuffers with whole bowel irrigation; should we flush the procedure? NACCT Annual Meeting, Toronto, Canada, September 2008.
- Wills B, Aks S, Mazor S, et al. Delayed Passage of Heroin Packets by a Body Stuffer. J Toxicol Clin Toxicol 2004;42;758. Presented at the North American Congress of Clinical Toxicology Meeting, Seattle, WA, 2004.
- Moreira M, Buchanan J, Heard K. Validation of a 6-hour observation period for cocaine body stuffers. Am J Emerg Med 2011; 29:299.
- PHYSICAL EXAMINATION
- Approach to imaging
- Plain abdominal radiography
- Computerized tomography
- LABORATORY TESTING
- Urine toxicology screening
- Symptomatic patients
- - Cocaine and other sympathomimetic toxicity
- - Opioid toxicity
- OBSERVATION AND DISPOSITION
- Symptomatic patients
- Asymptomatic patients
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS