Should an individual who inserts drugs into their body in a corrections setting be sent to the emergency room (ER) immediately?

Emergency Medical Evaluation for Body-Packed Drugs in Correctional Settings

Individuals who have inserted drugs into their body in a correctional setting should be immediately sent to the emergency room for evaluation and treatment due to the high risk of potentially fatal drug toxicity from package rupture or leakage.

Rationale for Emergency Evaluation

Body packing or "shoving" drugs presents significant health risks that require prompt medical attention:

1. Risk of severe toxicity: If drug packages rupture or leak, inmates can experience life-threatening overdose symptoms, including:

   • Central nervous system depression (94% of cases) 1
   • Bradycardia (61% of cases) 1
   • Agitation (33% of cases) 1
   • Seizures (22% of cases) 1

2. Potential fatal outcomes: Recent evidence documents mortality from hypoxic ischemic encephalopathy following drug exposure from concealed substances in correctional facilities 1.

Assessment Protocol

When an inmate is suspected of body packing drugs:

1. Initial evaluation:

   • Assess for altered mental status, respiratory depression, abnormal vital signs
   • Document time of suspected insertion if known
   • Determine type of substance if possible (opioids, synthetic cannabinoids, etc.)

2. High-risk indicators requiring immediate transfer:

   • Any signs of intoxication or overdose
   • Altered mental status
   • Abnormal vital signs, especially bradycardia
   • History of inserting multiple packages
   • Unknown substance type

Management Considerations

In the Correctional Facility

While arranging emergency transport:

• Have naloxone readily available for suspected opioid involvement 2
• For severe agitation, appropriate chemical restraint may be necessary for safe transport 3
• Document all observations and interventions

Emergency Department Management

The ED will typically provide:

• Diagnostic imaging to locate packages
• Monitoring for signs of toxicity
• Specialized extraction procedures if needed
• Treatment of any overdose symptoms

Special Considerations

1. Synthetic substances: Modern body-packed drugs often contain potent synthetic cannabinoids and benzimidazole opioids that can cause unpredictable and severe clinical effects 1.

2. Variable presentations: The clinical manifestations can vary widely based on the substance, making medical evaluation crucial even in seemingly stable patients 1.

3. Institutional protocols: Correctional facilities should have clear protocols for recognizing and responding to suspected body packing, similar to protocols for other medical emergencies 4.

Documentation Requirements

Proper documentation should include:

• Time of discovery/report
• Observed symptoms
• Interventions performed
• Time of transfer to emergency services

Conclusion

The high risk of severe toxicity and potential fatal outcomes from body-packed drugs necessitates immediate emergency department evaluation. While correctional facilities may have medical staff on site, the specialized imaging, monitoring, and interventions required for safe management of body-packed drugs are typically only available in hospital settings.