Body Packing
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Spain is an important European entry point for illicit drugs from South America and other countries, and as a consequence, the Spanish experience with body packers has increased in recent years.1,2 In their review of the subject, Traub et al. (Dec. 25 issue)3 do not mention one medical complication that we have observed — namely, upper gastrointestinal hemorrhage caused by prolonged pressure of a packet on the gastric mucosa, with the large size of the packet impeding transit through the pylorus. Many patients do not provide accurate information on the contents of the packets ingested, so it is important to carry out urinary toxicologic tests immediately. In our experience,4 the results in up to 78 percent of patients are positive for the drug, thereby facilitating implementation of the best therapeutic strategy. Although we agree that body packers with signs of opioid poisoning should be treated with naloxone, some patients have severe complications that are resolved only by surgery.5
Antonio Due?as-Laita, M.D., Ph.D.
Hospital Universitario Río Hortega
47010 Valladolid, Spain
Santiago Nogué, M.D., Ph.D.
Hospital Clínic
08036 Barcelona, Spain
Guillermo Burillo-Putze, M.D.
Hospital Universitario de Canarias
38320 Tenerife, Spain
References
Nogué S, Luca Quaglio G. El estómago y el intestino: unos órganos con pluriempleo. Med Clin (Barc) 1998;111:338-340.
Due?as-Laita A, Burillo-Putze G. Nuevas tendencias en emergencias toxicológicas. In: Perales y Rodríguez de Viguri N, ed. Avances en emergencias y resucitación. Vol. 5. Barcelona, Spain: Edika Med, 2002:109-22.
Traub SJ, Hoffman RS, Nelson LS. Body packing -- the internal concealment of illicit drugs. N Engl J Med 2003;349:2519-2526.
Luburich P, Santamaría G, Tomás X, et al. Ocultación gastrointestinal de drogas ilegales. Rev Esp Enferm Dig 1991;79:190-195.
Utecht MJ, Stone AF, McCarron MM. Heroin body packers. J Emerg Med 1993;11:33-40.
The authors reply: We appreciate the comments of Due?as-Laita and colleagues, since we were unaware of gastrointestinal hemorrhage as a complication of body packing. We reiterate that urinary toxicologic testing is an insufficiently sensitive method of screening for body packing, but we agree that it may help identify the contents of packets in known cases. Although law-enforcement testing is our preferred method of identifying packet contents, we realize that it may not always be available. Urinary toxicologic testing may detect a drug that was either present on the packets after processing (and ingested when the packets were swallowed) or that slowly leaked from the packets in the gastrointestinal tract. The results of urinary toxicologic tests should be interpreted with caution, however, since cocaine body packers with positive urinary tests for opiates have been reported1; one of these body packers also had a negative urinary test for cocaine.
Finally, we agree wholeheartedly that some complications of body packing (such as symptomatic toxic effects of cocaine, gastrointestinal obstruction or perforation, and perhaps massive gastrointestinal hemorrhage) are indications for surgical intervention.
Stephen J. Traub, M.D.
Beth Israel Deaconess Medical Center
Boston, MA 02215
Robert S. Hoffman, M.D.
Lewis S. Nelson, M.D.
New York University School of Medicine
New York, NY 10016
References
Nihira M, Hayashida M, Ohno Y, Inuzuka S, Yokota H, Yamamoto Y. Urinalysis of body packers in Japan. J Anal Toxicol 1998;22:61-65.
Antonio Due?as-Laita, M.D., Ph.D.
Hospital Universitario Río Hortega
47010 Valladolid, Spain
Santiago Nogué, M.D., Ph.D.
Hospital Clínic
08036 Barcelona, Spain
Guillermo Burillo-Putze, M.D.
Hospital Universitario de Canarias
38320 Tenerife, Spain
References
Nogué S, Luca Quaglio G. El estómago y el intestino: unos órganos con pluriempleo. Med Clin (Barc) 1998;111:338-340.
Due?as-Laita A, Burillo-Putze G. Nuevas tendencias en emergencias toxicológicas. In: Perales y Rodríguez de Viguri N, ed. Avances en emergencias y resucitación. Vol. 5. Barcelona, Spain: Edika Med, 2002:109-22.
Traub SJ, Hoffman RS, Nelson LS. Body packing -- the internal concealment of illicit drugs. N Engl J Med 2003;349:2519-2526.
Luburich P, Santamaría G, Tomás X, et al. Ocultación gastrointestinal de drogas ilegales. Rev Esp Enferm Dig 1991;79:190-195.
Utecht MJ, Stone AF, McCarron MM. Heroin body packers. J Emerg Med 1993;11:33-40.
The authors reply: We appreciate the comments of Due?as-Laita and colleagues, since we were unaware of gastrointestinal hemorrhage as a complication of body packing. We reiterate that urinary toxicologic testing is an insufficiently sensitive method of screening for body packing, but we agree that it may help identify the contents of packets in known cases. Although law-enforcement testing is our preferred method of identifying packet contents, we realize that it may not always be available. Urinary toxicologic testing may detect a drug that was either present on the packets after processing (and ingested when the packets were swallowed) or that slowly leaked from the packets in the gastrointestinal tract. The results of urinary toxicologic tests should be interpreted with caution, however, since cocaine body packers with positive urinary tests for opiates have been reported1; one of these body packers also had a negative urinary test for cocaine.
Finally, we agree wholeheartedly that some complications of body packing (such as symptomatic toxic effects of cocaine, gastrointestinal obstruction or perforation, and perhaps massive gastrointestinal hemorrhage) are indications for surgical intervention.
Stephen J. Traub, M.D.
Beth Israel Deaconess Medical Center
Boston, MA 02215
Robert S. Hoffman, M.D.
Lewis S. Nelson, M.D.
New York University School of Medicine
New York, NY 10016
References
Nihira M, Hayashida M, Ohno Y, Inuzuka S, Yokota H, Yamamoto Y. Urinalysis of body packers in Japan. J Anal Toxicol 1998;22:61-65.