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ScienceWeek
MEDICAL BIOLOGY: BODY PACKING OF ILLICIT DRUGS
The following points are made by S.J. Traub et al (New Engl. J. Med. 2003 349:2519):
1) In 1973, two physicians from Toronto admitted a patient in whom a small-bowel obstruction developed 13 days after he had swallowed a condom filled with hashish.(1) The condom was surgically removed, and the first reported "body packer" recovered uneventfully. The transportation of illicit drugs by internal concealment has since evolved into an important means of international cocaine and heroin smuggling, with accounts of body packing reported in virtually every large city in the US and every country in the developed world.
2) Body packers may also be called "swallowers", "internal carriers", "couriers", or "mules". The term "body stuffing", occasionally and inappropriately used synonymously with body packing, refers to the swallowing of relatively small amounts of loosely wrapped drug because of the fear of arrest. This distinct clinical entity has been reviewed elsewhere.(2) In addition to transporting cocaine and heroin, body packers may smuggle amphetamines,(3) 3,4-methylenedioxymethamphetamine ("ecstasy"),(4,5) marijuana, or hashish.(1) Occasionally, they ingest more than one type of drug. Body packers usually carry about 1 kg (2.2 lb) of drug, divided into 50 to 100 packets of 8 to 10 g each (0.3 to 0.4 oz), although persons carrying more than 200 packets have been described. Each packet of cocaine, heroin, or amphetamine contains a life-threatening dose of drug.
3) Federal agencies report that body packing has increased recently, possibly because the increased border security since the events of September 11, 2001, has made conventional smuggling more difficult. Alternatively, more body packers may be detected simply as a result of increased airport security. New York's Kennedy International Airport reported 193 body-packing arrests during the seven months from October 2001 to April 2002, as compared with 202 during the entire preceding year.
4) Although early body packers were predominantly young men, the practice now crosses demographic groups. The use of children as body packers has been reported in separate incidents involving two boys, 12 and 16 years old. Each was unaccompanied, and neither raised the suspicion of US Customs Service officials. One child presented to health care providers after failing to rendezvous with his handlers; the other was discovered unconscious after a heroin packet ruptured. The use of pregnant women as body packers has also been described. Compensation may be in the form of cash (several thousand dollars per trip) or safe passage into a foreign country. In addition, family members or personal property may be held as collateral to ensure the body packer's cooperation.
5) Drug packets, which previously varied in size and construction, are now well crafted, with a precision that suggests the use of an automated process. First, the drug is densely packed into a latex sheath, such as a condom or balloon. This layer is tied at the open end, covered with several other layers of latex, and sealed with a hard wax coating. Aluminum foil, plastic food wrap, carbon paper, or other materials may be incorporated to alter the radiodensity, in an attempt to limit the risk of detection.
References (abridged):
1. Deitel M, Syed AK. Intestinal obstruction by an unusual foreign body. Can Med Assoc J 1973;109:211-212
2. June R, Aks SE, Keys N, Wahl M. Medical outcome of cocaine bodystuffers. J Emerg Med 2000;18:221-224
3. Watson CJE, Thomson HJ, Johnston PS. Body-packing with amphetamines -- an indication for surgery. J R Soc Med 1991;84:311-312
4. Krishnan A, Brown R. Plain abdominal radiography in the diagnosis of the "body packer." J Accid Emerg Med 1999;16:381-381
5. Horrocks AW. Abdominal radiography in suspected "body-packers." Clin Radiol 1992;45:322-325
New Engl. J. Med. http://www.nejm.org
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OXYCONTIN NOW A STREET NARCOTIC
The psychological effects of opium may have been known to the ancient Sumerians of 5000 years ago, but the first undisputed reference to poppy juice occurs in the writings of Theophrastus in the 3rd century BC. The word "opium" is apparently derived from the Greek word for "juice", and the drug is derived from the juice of the poppy plant, Papaver somniferam. By the 17th century AD, opium was well-established as a medicinal and narcotic.
Opium contains more than 20 distinct alkaloids, with pure morphine first isolated in 1806. Codeine was discovered in 1832, papaverine in 1848, and by the middle of the 19th century, pure alkaloids rather than crude opium were in widespread use as medicinals.
In the US, opioid abuse was common as a consequence of the unrestricted availability of opium until the early years of the 20th century, and apparently also as a consequence of the influx of opium-smoking immigrants from Asia (who had originally been introduced to opium by Europeans).
The term "opiates" refers to drugs derived from opium, and includes morphine, codeine, and a wide variety of semisynthetic congeners derived from these substances and from thebaine, another component of opium. The term "opioid" is more inclusive, referring to all drugs with morphine-like activity, as well as to naturally occurring and synthetic opioid peptides. The term "endorphin" is a generic term referring to the three families of endogenous opioid peptides: the enkephalins, the dynorphins, and the beta-endorphins.
The term "narcotic" is derived from the Greek word for "stupor", and at one time referred to any drug that induced sleep. The word gradually came to be used for strong opiate analgesics, and now the term "narcotic" is used in a legal context to refer to a wide variety of abused substances, many of which are not opioids. This report concerns the marketed drug OxyContin, the brand name (sold by Purdue Pharma) of a form of oxycodone hydrochloride (dihydrohydroxycodeinone), which is most definitely an opioid. Oxycodone is also widely used in combination with aspirin in the form of Percodan or in combination with acetaminophen in the form of Percocet. Another form is Roxicodone. Purdue Pharma's OxyContin is therefore not the only marketed drug containing oxycodone.
Various opioids are widely used in the US for the treatment of moderate to severe pain, and although all such drugs are considered to be "controlled substances", the degree of "control" apparently varies according to who is writing prescriptions.
The central nervous system actions of oxycodone are qualitatively similar to those of morphine, with the most prominent actions involving the central nervous system and organs composed of smooth muscles. Oxycodone is similar to codeine and methadone in that it retains at least half of its analgesic activity when administered orally. Oral potency of oxycodone is high: 50 milligrams of oxycodone administered orally is equivalent to 10 milligrams of intramuscularly administered morphine. Oxycodone tablets come in 20, 40, and 80 milligram forms. Oxycodone is known to have the capacity to produce morphine-type drug dependence: repeated use characteristically produces tolerance for the drug, physical dependence, and strong craving for higher concentrations. An addiction to oxycodone, in fact, is not much different than a heroin addiction. "Heroin", which is the opium derivative diacetylmorphine, is manufactured outside the US and smuggled into the US for sale and distribution. Oxycodone, which is another opium derivative, is manufactured, sold, and distributed inside the US with no smuggling necessary.
The following points are made by Paul Tough (New York Times 2001 29 July):
1) These days the only street narcotic for sale in many small US towns is OxyContin, the tablets of which users crush to disable its patented time-release mechanism, the powder then snorted or injected for a powerful and immediate opiate high. Legally, OxyContin is sold only by prescription for the treatment of chronic pain, but in practice the drug is immediately available everywhere for cash in small towns in the US.
2) The going rate for OxyContin is apparently one dollar a milligram, or $40 for a 40-milligram pill. Oxycodone is the only active ingredient of OxyContin, and the "oxy buzz", as it is called, is produced by the opiate composition.
3) Until very recently, OxyContin abuse was considered a regional problem, labeled "hillbilly heroin", and confined to areas far from US population centers. However, this year abuse of OxyContin has apparently started to move away from its backwoods origins and into metropolitan areas on the East Coast, into the Deep South and parts of the Southwest, and into suburban communities throughout the Eastern US.
4) In Miami-Dade county, there have been 11 overdose deaths so far this year in which oxycodone was the probable cause, according to the county medical examiner. There have been 11 more overdose deaths in Philadelphia, according to the medical examiner there. Police in the Connecticut city of Bridgeport recently arrested a local doctor for prescribing tens of thousands of OxyContin tablets to patients, apparently often without any medical examination at all. Police in Boston say that more than a dozen suburban pharmacies have been held up by a gang of young men looking for OxyContin.
5) Purdue Pharma has recently announced plans to modify the time-release mechanism in OxyContin tablets to make the mechanism secure even with tablet-crushing, but the modification is expected not to be in place for at least 3 years. Meanwhile, government statistics indicate that as of 1999, 221,000 people in the US have abused OxyContin, which apparently is currently prescribed to 1 million patients, with revenues in the year 2000 to Purdue Pharma from this drug at $1.14 billion. In the year 2000, physicians in the US wrote more than 6.5 million prescriptions for OxyContin, making the drug the 18th best-selling prescription drug in the US (as measured by retail sales) and the No. 1 opioid painkiller.
New York Times http://www.nytimes.com
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