Cannabis body packing in Greenland

Description

Internal concealment of illegal drugs through body packing, pushing or stuffing, after crossing international borders is commonly encountered in Greenland, similar to many other emergency departments around the world.^{1 2} In Greenland, body packing primarily involves cannabis.

Here we report about a woman who was taken directly from the airport to our hospital by police officers due to high suspicion of drug trafficking. The patient was rather silent and made little eye contact during most of the consultation. The patient was gently asked to present any drugs, which she refused. She also refused a clinical examination but agreed to let us obtain an abdominal X-ray (AXR). The AXR showed a package in the rectum (figure 1). After explaining the AXR findings to her, she calmly removed a package containing cannabis from her rectum (figure 2). Then she confessed drug trafficking and was taken to custody by the local police officers. Six months later, I talked with the patient about the incident during a regular visit to the hospital. She told me that she was ashamed of what she had done and regretted her actions.

Figure 1.

Abdominal X-ray showing a cannabis package in the rectum.

Figure 2.

Cannabis package wrapped in a condom.

Body packers often represent a combination of medical, legal, ethical and social aspects, which put the doctor in the dilemma of both caring for the patient and at the same time awareness of the justice system.³ There is no golden standard for image detection. AXR is a valuable diagnostic tool in detection of foreign bodies. The AXR is diagnostic if positive, though it is not sensitive (47%–95%) enough to completely rule out abdominal body packing. CT scanning, ultrasound scanning and MR scanning may have a role in detection of body packing, though false negative abdominal CT scans have been reported.^{2 3} A thoroughly intimate body search includes mouth, nostrils, ears, umbilicus, foreskin, rectum and vagina.²

Body packers can be women, men and children who present themselves in a number of ways. The majority of patients are asymptomatic. Symptomatic patients can present with abdominal obstruction or with the ‘body packer syndrome’ caused by poisoning after a packet rupture. Patients may need acute surgery to remove the packages for both these reasons.^{1 2} Poisoning is mostly caused by cocaine or heroin.² Cocaine intoxication presents itself with agitation, sweating, dilated pupils, hyperthermia, tachycardia and hypertension, or in case of more severe seizures, myocardial infarction and arrhythmias. Heroin can lead to fall in consciousness, respiratory depression, pinpoint pupils, decreased bowel sounds.²

Asymptomatic patients can be treated conservatively with low risk of complications.^{1 2} Mild oral laxatives can be used.²

It is worth to mention that low-quality packages (condoms, toy balloons) filled with loose powder and tied with bad knots (type 1 in McCarron and Wood classification system for drug packets) are rare (prevalence 9%), but low-quality packages are strongly associated with complications (prevalence 62.5%). Therefore, it is important to get information about content, quality and number of packages (up to 200 packages have been seen). Mild oral laxatives may be given if constipated. It is important to remember that international travellers who suddenly become ill shall be suspected for internal drug carriage.^{1 2}

Learning points.

• ‘Body packing syndrome’ should be suspected in international travellers who become ill.

• Cannabis is the most common drug seen in body packers in Greenland, while cocaine and heroin are the most common drugs seen in body packers worldwide.

• Asymptomatic patients have little risk for complications. Symptomatic patients may require intensive care treatment and surgery.