Internal concealment of illicit xenobiotics is a significant concern for local and international police efforts as well as medical and public health practitioners. There are two distinct categories of concealment colloquially known as “body stuffers” and “body packers.” The term body stuffer refers to individuals who hide xenobiotics in a body cavity or ingest them in an attempt to avoid discovery. The xenobiotics are concealed in an unplanned manner and are often poorly wrapped. The term body packer refers to individuals who conceal xenobiotics, typically in large quantities, in a premeditated fashion almost exclusively for the purposes of international smuggling.
Internal concealment of xenobiotics for the purpose of smuggling was first reported in Canada in 1973. A 21-year-old man presented with a small bowel obstruction as a result of swallowing a condom filled with hashish. He had swallowed the condom to transport it into Canada after a trip to Lebanon.21 Internal xenobiotic smuggling subsequently became a worldwide problem as increased surveillance at international borders made conventional transportation of illegal xenobiotics more difficult. Improved detection of smugglers also increased the number of patients brought to the attention of health care providers. Unfortunately, in attempts to evade enhanced detection, pregnant women and children as young as 6 years of age have been used as body packers.7,13,16
Airline and airport personnel are trained to identify people who may be body packers. Suspicious behavior includes not eating or drinking on the airplane, abnormal behavior while going through customs, and overt signs of xenobiotic toxicity.82,94
Body packers typically swallow large numbers of well-prepared packages, each filled with substantial amounts of xenobiotic. Although ingestion is common, packets are also sometimes concealed by insertion into the vagina and rectum.22,99 The most frequently smuggled cargo is either heroin or cocaine, but other xenobiotics are also reported (Table SC5–1). Body packers often swallow 50 to 100 packages, and ingestion of as many as 500 is reported.100 Each package typically contains from 0.5 to 10 g of xenobiotic. Therefore, one person may carry as much as 1.5 kg of xenobiotic.89 Lethal doses of cocaine and heroin are not well characterized. For reference, death from cocaine toxicity is reported after ingestion of as little as 2 to 3 g,77 and the lethal dose of oral heroin in an opioid-naïve person is above 300 mg.30 As such, each packet should be considered to contain a potentially lethal dose.
TABLE SC5–1Xenobiotics Associated With Internal Concealment