Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Acute ingestion of illicit drugs (body stuffing)

Steven E Aks, DO, FACMT, FACEP
Sean M Bryant, MD
Section Editor
Stephen J Traub, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


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) [2], 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: Acute 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].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 08, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. McCarron MM, Wood JD. The cocaine 'body packer' syndrome. Diagnosis and treatment. JAMA 1983; 250:1417.
  2. Traub SJ, Hoffman RS, Nelson LS. Body packing--the internal concealment of illicit drugs. N Engl J Med 2003; 349:2519.
  3. Simson LR Jr. Sudden death while attempting to conceal illegal drugs: laryngeal obstruction by a package of heroin. J Forensic Sci 1976; 21:378.
  4. Roberts JR, Price D, Goldfrank L, Hartnett L. The bodystuffer syndrome: a clandestine form of drug overdose. Am J Emerg Med 1986; 4:24.
  5. June R, Aks SE, Keys N, Wahl M. Medical outcome of cocaine bodystuffers. J Emerg Med 2000; 18:221.
  6. Hendrickson RG, Horowitz BZ, Norton RL, Notenboom H. "Parachuting" meth: a novel delivery method for methamphetamine and delayed-onset toxicity from "body stuffing". Clin Toxicol (Phila) 2006; 44:379.
  7. Püschel K, Stein S, Stobbe S, Heinemann A. Analysis of 683 drug packages seized from "body stuffers". Forensic Sci Int 2004; 140:109.
  8. Fineschi V, Centini F, Monciotti F, Turillazzi E. The cocaine "body stuffer" syndrome: a fatal case. Forensic Sci Int 2002; 126:7.
  9. Jordan MT, Bryant SM, Aks SE, Wahl M. A five-year review of the medical outcome of heroin body stuffers. J Emerg Med 2009; 36:250.
  10. West PL, McKeown NJ, Hendrickson RG. Methamphetamine body stuffers: an observational case series. Ann Emerg Med 2010; 55:190.
  11. Aks SE, Vander Hoek TL, Hryhorczuk DO, et al. Cocaine liberation from body packets in an in vitro model. Ann Emerg Med 1992; 21:1321.
  12. Sporer KA, Firestone J. Clinical course of crack cocaine body stuffers. Ann Emerg Med 1997; 29:596.
  13. Cumpston KL, Laeben L, Crandall C. Life-threatening toxicity in a cocaine ‘‘stuffer’’ greater than fourteen hours from ingestion [abstract]. Clin Toxicol 2005; 43: 670.
  14. Booker RJ, Smith JE, Rodger MP. Packers, pushers and stuffers--managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. Emerg Med J 2009; 26:316.
  15. Havis S, Best D, Carter J. Concealment of drugs by police detainees: lessons learned from adverse incidents and from 'routine' clinical practice. J Clin Forensic Med 2005; 12:237.
  16. Norfolk GA. The fatal case of a cocaine body-stuffer and a literature review - towards evidence based management. J Forensic Leg Med 2007; 14:49.
  17. Eng JG, Aks SE, Waldron R, et al. False-negative abdominal CT scan in a cocaine body stuffer. Am J Emerg Med 1999; 17:702.
  18. Merigian KS, Park LJ, Leeper KV, et al. Adrenergic crisis from crack cocaine ingestion: report of five cases. J Emerg Med 1994; 12:485.
  19. Chang C, Grush A, McClintock DE, et al. Unusual finding on bronchoscopy: trauma patient identified as a body stuffer. J Clin Anesth 2006; 18:628.
  20. Kashani J, Ruha AM. Methamphetamine toxicity secondary to intravaginal body stuffing. J Toxicol Clin Toxicol 2004; 42:987.
  21. Beerman R, Nunez D Jr, Wetli CV. Radiographic evaluation of the cocaine smuggler. Gastrointest Radiol 1986; 11:351.
  22. Hoffman RS, Chiang WK, Weisman RS, Goldfrank LR. Prospective evaluation of "crack-vial" ingestions. Vet Hum Toxicol 1990; 32:164.
  23. Marc B, Baud FJ, Aelion MJ, et al. The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel. J Forensic Sci 1990; 35:345.
  24. Harchelroad F. Identification of orally ingested cocaine by CT scan. Vet Hum Toxicol 1992; 34:350.
  25. Cranston PE, Pollack CV Jr, Harrison RB. CT of crack cocaine ingestion. J Comput Assist Tomogr 1992; 16:560.
  26. Pollack CV Jr, Biggers DW, Carlton FB Jr, et al. Two crack cocaine body stuffers. Ann Emerg Med 1992; 21:1370.
  27. Schmidt S, Hugli O, Rizzo E, et al. Detection of ingested cocaine-filled packets--diagnostic value of unenhanced CT. Eur J Radiol 2008; 67:133.
  28. Hibbard R, Wahl M, Kirshenbaum M, et al. Spiral CT Imaging of Ingested Foreign Bodies Wrapped in Plastic: A Pilot Study Designed to Mimic Cocaine Bodystuffers. J Toxicol Clin Toxicol 1999; 37:644.(ABS) Presented at the North American Congress of Clinical Toxicology Meeting, La Jolla, CA, 1999
  29. Tomaszewski C, Voorhees S, Wathen J, et al. Cocaine adsorption to activated charcoal in vitro. J Emerg Med 1992; 10:59.
  30. Kirshenbaum LA, Sitar DS, Tenenbein M. Interaction between whole-bowel irrigation solution and activated charcoal: implications for the treatment of toxic ingestions. Ann Emerg Med 1990; 19:1129.
  31. Hoffman RS, Smilkstein MJ, Goldfrank LR. Whole bowel irrigation and the cocaine body-packer: a new approach to a common problem. Am J Emerg Med 1990; 8:523.
  32. 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.
  33. 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.
  34. 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.
  35. Moreira M, Buchanan J, Heard K. Validation of a 6-hour observation period for cocaine body stuffers. Am J Emerg Med 2011; 29:299.