Internal concealment of drugs of abuse (body packing)
- Robert S Hoffman, MD
Robert S Hoffman, MD
- Professor of Emergency Medicine
- Director, Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine
- New York University School of Medicine
- Lewis Nelson, MD
Lewis Nelson, MD
- Professor and Chair of Emergency Medicine
- Rutgers New Jersey Medical School
- New Jersey Poison Information & Education System
- Section Editor
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Body packers are persons who, voluntarily or through coercion, swallow, or insert drug-filled packets into a body cavity, generally in an attempt to smuggle them across secure borders. Body packing was first described in the medical literature in 1973 [1-3]; however, anecdotal reports suggest the practice was utilized by drug traffickers at least a decade prior to recognition. Body stuffing, which involves ingestion of drugs to avoid imminent apprehension by authorities, is a separate but related practice that can lead to acute massive toxicity [4-6].
When body packers present to health care providers, it may be for one (or more) of the following reasons :
●The body packer is asymptomatic but may be in the custody of authorities. There is a need for medical evaluation and monitoring.
●The body packer has signs of systemic drug toxicity from a ruptured packet.
●The body packer has developed symptoms of gastrointestinal obstruction or perforation.
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- METHODS OF BODY PACKING
- History and physical examination
- - Physical evidence of body packing
- - Drug toxicity
- - Intestinal obstruction or perforation
- Diagnostic imaging
- - Indications and approach to radiographic evaluation
- - Plain abdominal radiograph
- - Ultrasound
- - Advanced abdominal imaging
- Urine drug testing
- Asymptomatic patients
- Opioid toxicity
- Sympathomimetic (cocaine or amphetamine) toxicity
- Obstruction or perforation
- Endoscopic removal of packets
- Documentation of packet clearance
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS