What is the classification of drug mules and body packers according to the Royal College of Emergency Medicine (RCEM)?

From the Guidelines

Drug mules and body packers are classified as a specific subset of patients who conceal drugs as retained anorectal foreign bodies (AFBs), requiring modified management with great caution.

Classification and Management

• According to the guidelines, body packers require a careful approach to avoid disrupting the drug package, which can lead to life-threatening complications of drug overdose 1.
• The management of body packers involves avoiding any maneuver that can disrupt the drug package, including endoscopic retrieval, which is contraindicated by different authors and specialist societies 1.
• A complete survey of the GI tract is required when drug packages are detected in the anorectal region, as many of these are swallowed rather than inserted retrograde 1.

Key Considerations

• The Royal College of Emergency Medicine (RCEM) guidelines are not directly mentioned in the provided evidence, but the World Journal of Emergency Surgery guidelines provide valuable insights into the management of retained anorectal foreign bodies, including body packers 1.
• The evidence suggests that body packers require a tailored approach, taking into account the risk of drug overdose and the need to avoid disrupting the drug package 1.

From the Research

Classification of Drug Mules and Body Packers

The Royal College of Emergency Medicine (RCEM) classifies individuals who transport drugs within their bodies as "body packers" or "mules" and "body stuffers".

• Body packers or mules are individuals who swallow or insert drug-filled packets into their body cavities to smuggle them across secure borders 2, 3, 4, 5, 6.
• Body stuffers, on the other hand, are individuals who emergently place the contraband in a body orifice when they sense apprehension is imminent 6.

Characteristics of Body Packers

Body packers typically carry drugs such as heroin and cocaine, packed in rubber or plastic, in their body in order to smuggle them 2, 3, 4, 5.

• The drugs are usually swallowed or inserted into the body cavity, and can cause symptoms ranging from mild abdominal complaints to respiratory insufficiency and even death 3, 4, 5.
• Body packers can present in the emergency department as a result of ruptured drug packets, bowel obstruction, or for medicolegal purposes 2.

Diagnosis and Treatment

Suspected cases of body packers are diagnosed with X-ray and computed tomography scan of the abdomen 2, 3, 4.

• Symptomatic patients require urgent removal of packets, which can be done conservatively with fluids and mild laxatives, or surgically in cases of obstruction or rupture 2, 3, 4, 6.