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Internal concealment of illicit xenobiotics is a significant concern for local and international police efforts as well as medical, social, 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 drugs in a body cavity or ingest the drugs in an attempt to hide evidence from law enforcement officers. The xenobiotics are ingested 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 drugs 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 in order to transport it into Canada after a trip to Lebanon.13 Internal drug smuggling has become a worldwide problem as increased surveillance at international borders has made conventional transportation of illegal drugs more difficult. Improved detection of smugglers has increased the number of patients brought to the attention of healthcare providers. Pregnant women and children as young as 6 years of age have been used as body packers.2,6,9

Airline and airport personnel are trained to identify people who may be drug couriers. Suspicious behavior includes not eating or drinking on the airplane, abnormal behavior while going through customs, and overt signs of drug toxicity.76,87

Composition of Packages

Body packers typically swallow large numbers of well prepared packages, each filled with substantial amounts of drug. Packets may also be concealed by insertion into the vagina and rectum.14,92 The most frequently smuggled cargo is either heroin or cocaine, but other drugs have been reported (Table SC4–1). Body packers often swallow 50 to 100 packages and ingestion of as many as 500 has been reported.93 Each package typically contains from 0.5 to 10 g of drug. Therefore, one person may carry as much as 1.5 kg of drug.84 Lethal doses of cocaine and heroin are difficult to determine based in part on sparse data and on widely variable purity. For reference, death from cocaine toxicity is reported after ingestion of as little as 2 to 3 g.71 As such, each packet should be considered to contain a potentially lethal dose.

Table SC4-1. Xenobiotics Associated with Internal Concealment

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