REVIEW
Packers, pushers and stuffers—managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review
1 Emergency Department, Derriford Hospital, Plymouth, UK
2 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
3 Orthopaedic Department, Torbay Hospital Torquay, UK
Correspondence to:
Captain R J Booker, Wardroom HMS Drake, Plymouth PL2 2BG, UK; rjbooker{at}doctors.org.uk
Body packing, pushing and stuffing are methods by which illicit drugs may be carried within the human body. Patients involved in these practices may present UK emergency departments with complex medical, legal and ethical considerations. This review article examines not only the evidence behind the clinical management of these patients, but also the legal powers afforded to the authorities to authorise the use of intimate searches and diagnostic imaging for forensic purposes. Serious complications from concealed drug packets are now rare, and most asymptomatic patients may be safely discharged from hospital after assessment. Emergency surgery is indicated for body packers with cocaine poisoning and for some cases of heroin poisoning. Urgent surgery is indicated for obstruction, perforation, the passage of packet fragments and failure of conservative treatment. Guidance is given for doctors who are faced with requests from the authorities to perform intimate searches and diagnostic imaging for forensic purposes.
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