Epidemiology and medical management of body‐packers in French Guiana between 2010 and 2015

Abstract

Background French Guiana is used as a drug trafficking pipeline of cocaine to Europe. The number of arrests for transporting cocaine in corpore has increased exponentially in recent years. Since 2010, Cayenne Hospital's emergency care unit has applied a medical management protocol system for body‐packers. Our objective was to describe the epidemiology of body‐packers and to evaluate medical management. Method A retrospective descriptive study was performed among patients hospitalized in Cayenne Hospital for transporting cocaine in corpore between January 2010 and November 2015. In addition, a qualitative study including interviews of body‐packers imprisoned in Rémire‐Montjoly prison was conducted in April 2016. Result A total of 282 patients were included in the study. The median age was 24 years and the sex ratio M/W was to 4/1. Among them, 3.5% showed signs of severity (9 with pre‐existing condition and 1 with severe form). No surgery or deaths were reported. Ten endoscopies were performed because of the delay in evacuation without complications. Approximately 28% of patients had urinary screening, of which 60.7% were positive. The median length of stay was 1.8 days. Prolonged length of stay was significantly associated with the presence of gastrointestinal symptoms, hypoglycemia, or having swallowed a minimum of 10 pellets. Conclusion This study led to a change in the management of body‐packers in the hospital setting in Guiana. A computed tomography scan at discharge became more prevalent. Endoscopy has emerged as an effective and safe alternative to surgery. Despite the increase in the number of patients treated, it should be noted that there were few complications and no deaths in our cohort.

International Smuggling of Illicit Drugs by Body Concealment at a Tertiary Hospital in Istanbul

“…Improvements in packaging quality and complications from surgery are responsible for the increasing tendency to treat these cases conservatively. 5,6,21 Two large retrospective studies confirmed the safety of conservative management for the treatment of body packers. These studies analyzed 1181 and 1250 subjects, who required surgery in only 2% and 1.6% of cases, respectively.…”

“…Currently, a conservative approach to these patients is recommended. Improvements in packaging quality and complications from surgery are responsible for the increasing tendency to treat these cases conservatively 5,6,21 . Two large retrospective studies confirmed the safety of conservative management for the treatment of body packers.…”

Emergency medicine management of patients transporting cocaine by body-packing

“…Mechanical complications related to the ingestion of foreign body ingestion such as bowel obstruction and or perforation are less frequently described but can have lethal consequences [6,8]. Overall, these complications are scarce, and French studies observed a rate of severe complications from 1.4 to 3.5% [3,4].…”

“…A symptomatic patient should be admitted to an ICU. The surgical removal of drug packets in patients with cocaine toxicity or bowel obstruction remains the standard of care but endoscopy can also be considered as an alternative to surgery in some cases [4]. Benzodiazepines are recommended in case of neuropsychiatric symptoms or seizures.…”

“…In Europe, cocaine is the second most commonly abused drug, and cocaine customs seizures are increasing every year [2]. Consistently, the number of patients transporting cocaine through body-packing admitted to French forensic medicine departments after their arrest has increased in the last few years [3,4].…”