Stuffers = swallowing or inserting relatively small amounts of loosely wrapped drug because of the fear of arrest.
Packers usually carry 1 kg of drug (in 50 to 100 packets of 8 to 10 g).
Each packet holds lethal amount of drug.
Drug packets may be machine-made (images) - rupture is rare.
Layered sheath around drug surrounded by hard wax coating.
Plastic incorporated to alter radiodensity.
Constipating agents e.g. Diphenoxylate or Loperamide frequently used.
Drug-induced toxic effects.
Intestinal obstruction (rare).
For medical assessment after arrest (Gardaí).
Drug packets (incl. wrapping). Number of packets (they do know!).
Vital signs, mental status, pupil size (Heroin or Cocaine signs very ominous).
Bowel sounds,skin findings.
Packets tend to leak before rupture : beware signs.
Gentle PR / PV examination.
In CUH do NOT do AXR but please discuss request for low dose ("Crohn's schedule") CT with on-call radiology registar. The radiation dose is equivalent to an AXR. Computer reconstruction of images may take up to an hour.
± CT >90% sensitive: (Hounsfield units Cocaine=¡219, Heroin=¡520).
Urine toxicology not recommended (sensitivity 37%).
Opioid poisoning - treat conservatively with continuous Naloxone infusion (may need huge doses).
Beware pulmonary oedema which is not responsive to Naloxone (RSI plus ventilation).
Clinical Cocaine package rupture - immediate laparotomy and surgical removal.
Temporising benzos for fitting or hypertension (more on cocaine page)
? hypertonic Sodium Bicarbonate / Lignocaine for ventricular dysrhythmias.