benzoylecgonine and Foreign-Bodies

The case of a 50-year old female body-stuffer who collapsed and died more than 10h after swallowing a plastic wrap of cocaine is reported. The case is discussed together with a review of the literature in order that guidelines on managing body-stuffers in police custody can be evidence based.

Topics: Cocaine; Crime; Dopamine Uptake Inhibitors; Evidence-Based Medicine; Female; Foreign Bodies; Forensic Medicine; Humans; Intestinal Mucosa; Intestine, Small; Middle Aged; Prisoners

To quantitatively assess cocaine liberation from various body packet materials.. 100-milligram cocaine packets (plastic bags with various wrapping techniques, paper, and condoms) were placed in a simulated gastric medium. Samples were also tested in an alkalinized gastric medium, with determination of both cocaine and benzoylecogonine concentrations using high-performance liquid chromatography with ultraviolet detection.. Cocaine liberation was greatest in acid medium, with increasing liberation from condom packets to cellophane bags (three wrapping techniques used) to paper packets. The same trend was noted in alkaline medium but with a far lower maximum cocaine concentration accompanied by rapid hydrolysis to its inactive metabolite, benzoylecgonine.. Cocaine liberation of a known quantity of drug is dependent on the wrapping method and material used; thus, a good history from the "body-stuffer" is essential to predict potential cocaine liberation and toxicity. Rapid hydrolysis of cocaine to its inactive metabolite in an alkaline medium implies a role for gastric alkalinization in the acute management of these patients.

Topics: Aluminum Hydroxide; Antacids; Cellophane; Chromatography, High Pressure Liquid; Cocaine; Condoms; Digestive System; Drug Combinations; Electrolytes; Foreign Bodies; Gastric Juice; Humans; In Vitro Techniques; Magnesium Hydroxide; Paper; Polyethylene Glycols

Drug packets are usually detected by ordinary abdominal radiographs, which is of major importance in the apprehension and prosecution of drug body packers, but false negatives may occur. We report the case of a cocaine body packer who had used the prograde route and in whom the initial abdominal plain films were normal. The diagnosis of cocaine body packing was assessed by seldom-described complementary methods of detection, including drug detection in the urine and contrast study of the bowel.

Topics: Adult; Cocaine; Contrast Media; Crime; Female; Foreign Bodies; Humans; Intestines; Male; Predictive Value of Tests; Radiography

The presence of opiates and benzoylecgonine, the major metabolite of cocaine, in the urine was detected by means of enzyme immunoassay in a series of 120 smugglers who had either ingested or inserted into their rectum cocaine or heroin packaged for transportation. There was a striking relation between the presence of drugs in the urine and swallowing of drug-filled bundles (cocaine 49 of 50 cases, heroin 9 of 10). The proportion of positive results was also high in cases of rectal insertion (cocaine 2 of 2, heroin 35 of 58). In 30 cases of cocaine-packet ingestion, serial measurements showed that the accuracy of the test progressively decreased with respect to the detection of residual packets in the body. Drug detection in the urine of suspected body-packers seems to be a useful test, positive results justifying subsequent radiological investigations.

Topics: Cocaine; Crime; Evaluation Studies as Topic; Foreign Bodies; Foreign-Body Migration; Heroin; Humans; Immunoenzyme Techniques; Morphine; Radiography; Rectum