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• Unexplored issues relating to body stuffers
  yew meng aw-yong
  Published on: 29 April 2016

• Published on: 29 April 2016

  Unexplored issues relating to body stuffers

  • yew meng aw-yong, EM Staff grade FME Met Police, med advisor SJA
  • Other Contributors:
    • yew meng Aw-Yong

  Dr Meng Aw-Yong 468 Fulham Palace Road London SW6 6Hy 11th May 2009

  Letter in response to Booker RJ, Smith JE Rodger M. Packers, pushers and stuffers- managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. EMJ Vol 26 No 5 May 2009. Pages 316-320

  Dear Sirs,

  The article in EMJ May 2009 on packers, pushers and stuffers by Booker et al is an invaluab...

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  Dr Meng Aw-Yong 468 Fulham Palace Road London SW6 6Hy 11th May 2009

  Letter in response to Booker RJ, Smith JE Rodger M. Packers, pushers and stuffers- managing patients with concealed drugs in UK emergency departments: a clinical and medicolegal review. EMJ Vol 26 No 5 May 2009. Pages 316-320

  Dear Sirs,

  The article in EMJ May 2009 on packers, pushers and stuffers by Booker et al is an invaluable and timely one especially for those involved with this particular group of patients. I must outline my conflict of interest as I am a Forensic Medical Examiner (FME) in the Metropolitan police and have examined a high caseload, probably close to 15,000 over the years. I am also in the unique position to be working as a Staff Grade in EM in the main receiving hospital for the drug packers flying in via Heathrow.

  There are several issues, which I would like to clarify and expand upon. These are the minimal reference to body stuffers, the consequences of an investigation by the Independent Police Complaints Commission (IPCC) and Coroner’s inquest arising from of any custodial death and the ethics of discharging a patient with the potential risk of sudden death. In the medical jurisprudence environment drug pushers are referred to as “stuffers”. The maximum sentence for possession with intent to supply class A drugs is life imprisonment and an unlimited fine. Henceforth many body packers or stuffers are likely to refuse to divulge any incriminatory evidence, refuse treatment and/or admission. Furthermore they face severe punishment or death from the drug dealers should they fail to deliver the goods. On the issue of conservative management of body packers, I will quote from a series of presentations at the Royal Society of Medicine in 2008 on body packer and stuffers. Mr Mohsen, consultant surgeon, presented the results of a review of 2508 suspected body packers, in a period between January 2000 and January 2005, presenting to Hillingdon Hospital. The patients were from the HM Revenue and Custom detention Unit (HMRC) at Heathrow. Those with a negative abdominal x-rays were returned to Customs in Heathrow and only symptomatic body packers (61) were kept as inpatients. Abdominal pain was the commonest presenting complaint with 4 presenting with symptoms of cocaine toxicity. There was an 8% failure rate in conservative management with 0.3% rate of surgical intervention similar to that reported in previous studies.

  We are unable to detain patients with capacity in hospital against their wishes but the ethical dilemma is whether we should allow patients to go home or return under arrest to a customs facility with no medical backup, where there may be considerable risk to their health. If admitted in hospital, they may be disruptive to the daily workings, as they require 24-hour one to one supervision, as many will swallow any emerging drugs to eliminate the evidence and the security risk posed from the dealers. Customs officials tend not to like the inconvenience and loss of officers on hospital guard.

  Police officers and FMEs fear a death in custody. Any death in custody quite rightly is rigorously examined and will ensure the closure of a custody site, the banning of police officers from any contact with the public, the possible involvement of the doctor in negligence claims, dismissal from work or a GMC referral. The costs alone are estimated at about £1 million per case.

  Drugs stuffers refer to those who swallow illicit drugs to evidence while on the verge of being arrested. This is a much more serious situation as it is unplanned with often inadequate packaging. Doses can be significantly higher than what the stuffer normally takes, together with poly-drug overdose and the unknown effect of adulterants. This is a regular occurrence presenting to FMEs and subsequently ED. Although Booker refers to scant evidence of deaths from drugs stuffers, a review of the Deaths in Custody data reveals 12 deaths from drugs in 1999 with 4 alone from airway obstruction. Havis et al found 43 drug related deaths in police custody (England and Wales) between 1997-2002. Of those 16 cases involved internal drug concealment, 8 were witnessed swallowing/concealing drugs and 5-showed airway obstruction. The Good Practice Guidelines for FMEs in the Metropolitan Police stipulate that if “A prisoner who has or is suspected of having swallowed drugs, must be treated as having taken an overdose and an ambulance should be called”. . The caveat to the ED doctor is when the police bring a “stuffer” to hospital soon after arrest. The stuffer will usually deny swallowing any drugs for the reasons outlined above. And there may little or no signs of drug intoxication. However several hours later as the wrapping becomes unwrapped or is dissolved by stomach acid dissolves there may be a sudden rush of drugs to the body potentially resulting in death. Furthermore as these cases are medicolegal in nature accurate and copious documentation is essential. Therefore the discretionary factor in Booker’s advice is that stuffers should be asymptomatic with a minimum 6 hours FROM the time of ingestion irrespective of any denial of drug swallowing. What if the detainee refuses to stay wishing to expedite the criminal process and be released? If discharged we merely displace the risk and responsibility to the hapless Custody Sergeant and FME who face serious risk? Although there is strong evidence supporting the conservative management of body packers there still remains the questions of sending them home or to custody with little or no medical facilities. I suggest that police authorities and the HMRC collaborate and built special units attached to ED thereby providing continuous and immediate medical care should the need arise. There also remains an opportunity for researching the safe parameters for stuffers and developing guidelines for Emergency Departments.

  Sentencing Guidelines. http://www.sentencing-guidelines .gov.uk/guidelines/other/courtappeal/default.asp? T=Cases&catID=6&subject=POSSESSION%20WITH%20INTENT%20TO%20SUPPL Y

  Shamir OC, Williams EW, Evans NR and Johnson P. Occupational hazard: Treating cocaine body packers in Caribbean countries International Journal of Drug Policy. Vol 20, Issue 4, July 2009, P 377-380. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VJX- 4THB4C8- 1&_user=10&_coverDate=07%2F31%2F2009&_alid=915345136&_rdoc=1&_f mt=high&_orig=search&_cdi=6106&_sort=d&_docanchor=&view=c&_ct=301 &_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=05b793 3fbd7fd30cda8309a1a9fdc1d4

  Goertemoeller H and Behrman A. The Risky Business of Body Packers and Body Stuffers.. Journal of Emergency Nursing. Vol 32, Issue 6, Dec 2006, P 541-544 http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WJ5- 4MD8SYX-P&_user=5932406&_origUdi=B8CY1-4RSHRC2- 4&_fmt=high&_coverDate=12%2F31%2F2006&_rdoc=1& Concealment of drugs by police detainees: lessons learned from adverse incidents and from routine clinical practice. S Havis, D Best and J Carter. JCFM Vol 12 No 5 p237-241

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  Conflict of Interest:
  None declared.

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