Body Stuffers
Stuart Swadron, MD and Sean Nordt, MD
- Body stuffers ingest packets of drugs spontaneously, often as they are confronted with law enforcement.
- Body packers are classic drug “mules” who ingest large quantities of professionally wrapped and secured drugs. Body pushers are people who insert drugs into their rectum or vagina.
- The amount of drugs ingested is variable.
- The packets that they are contained in are also variable in terms of the security of the drug contents.
- Patients who are body stuffers fall into 2 categories: symptomatic and asymptomatic.
- All patients should be offered activated charcoal at a dose of 1g/kg (minimum of 50g) as long as the patient is awake and cooperative.
- Symptomatic patients should be treated for the toxidrome that is clinically present and the patient should be admitted.
PEARLS
-
- Asymptomatic patients will need to be observed to see if they become symptomatic.
- The minimum amount of observation time is 6 hours, but some would argue that it should be a minimum of 12 hours if there is any suspicion regarding ingestion of new, synthetic fentanyl products.
- In general, there is no role for diagnostic imaging.
- Endoscopy and/or surgery are not indicated.
- If a patient is in custody, has capacity, and refuses treatment or requests to be discharged, the treating provider should comply with that request.
Related Content:
Crunch Time EM - Drug Packers & Stuffers
CorePendium Chapter: Overdose
Jesse H. - September 10, 2021 11:23 AM
If I was to observe a symptomatic patient, how long after symptoms resolve would you recommend observation?
Sean N. - September 12, 2021 12:34 PM
Hi Jesse,
Thank you for the comment about how long to watch a symptomatic patient where symptoms resolve
As we discussed there is much variability in the “body stuffer” regarding not only the substance ingested but the quantity and what was substance wrapped in making generalization more difficult
Below is for “body stuffers” not “body packers” which we have in an upcoming episode and treated differently. There are different approaches by toxicologists and poison centers based on local practice patterns and individual patient presentation
I generally recommend all symptomatic patients following “body stuffing” are admitted to a monitored setting. This would include the patient who was symptomatic then resolved as could be symptomatic earlier in ingestion and unclear if maybe package opened a little and had absorption and then stopped leaking but still in GI tract ie, patient could again get symptomatic
We would also need to determine how symptomatic the patient was. If the patient was moderately to severely symptomatic and then resolved I would still recommend admission. One could consider at minimum prolonged ED observation on continuous monitoring eg, 24 hours to observe for any continued absorption and toxicity
Often there is confusion if the patient is a sympathomimetic toxidrome as they are tachycardiac and may have increased blood pressure readings, anxious, and diaphoretic and or if this increase in sympathetic activity as this could be from being in custody rather than true toxicity. These patients having signs and symptoms more from being in custody not toxicity generally resolve symptoms relatively quickly with either no treatment or one dose of a benzodiazepine and after a 6-12 hour observation period if truly asymptomatic probably can be discharged. If there was any question whether or not from ingestion safest to admit or prolonged ED observation
As these symptomatic “body stuffers” can be unpredictable as we discussed, if symptomatic at any time, I will recommend admission. Many of the “body stuffer” patients will present asymptomatic and remain asymptomatic and generally can be discharged after generally a 6-hour observation period and if concerned can be extended to 12 hours