Case ReportDrug-related deaths with evidences of body packing: Two case reports and medico-legal issues
Graphical abstract
Introduction
Body packing is a general term used to indicate the internal transportation of drug packages within the gastrointestinal tract; the most common drugs involved are cocaine and heroin [1]. It is noteworthy that these drugs may be frequently and deliberately adulterated with various cutting agents such as piracetam and levamisole, respectively in the heroin and cocaine body packer cases presented in the paper.
The drugs concealed are wrapped in the form of capsules, made by cellophane, layers of latex, condoms, plastic bags, rubber cots, plastic foil, aluminum foil, wax, carbon paper or self adhesive tape [2], [3]. Body packers usually carry about one kg of drug, divided into 50–100 packets of 8–10 g each, although drug smugglers carrying up to 500 packets have been reported [4], [5], [6].
Despite the increase in quality of the packaging procedures, and the consequent decrease in mortality among body packers, the rupture of the packets and the consequent toxicity remain the most important life-threatening complications [7]. Nevertheless, packet failure may still cause poisoning in the country of origin, during the journey, or at their destination, as in the cases presented. However, clinicians and forensic pathologists sometimes may discover the concealed drug packages through medical examination or autopsy of cases with an unknown cause of death [8], [9].
The aim of this paper is to describe the forensic examination and the toxicological analysis carried out on both drug packages and biological samples, as well as to highlight the main medico-legal issues that commonly arise in cases of suspected or ascertained body packers.
Section snippets
Case 1
An adult male with false ID card coming from a country of Western Europe by cruise ship was found dead in his cabin at the Rome harbor. The man was 173 cm in height and 90 kg in weight. The examination of clothes and personal effects, carried out by police officers, didn’t shown any important elements. The external examination did not reveal any evidence of trauma.
A supine plain X-ray of the chest and abdomen was carried out. No pneumothorax, rib fractures or other significant elements were
Discussion
In both cases the cause of death was due to acute drug intoxication. According to Meissner et al. [13], morphine blood levels in victims of lethal heroin intoxication vary from 0.03 to 5 mg/L; in body packers, because of the possibility of a package failure, these values may be higher. The blood morphine values obtained in the first case (0.8 mg/L) led us to confirm that the death was due to acute heroin intoxication. Furthermore, the absence of damaged packages and the presence of trace amounts
Conclusion
Two lethal cases of body packing has been described. The forensic examination of the drug packages highlighted important differences in their type and composition. These differences, due to the mechanical procedures adopted by drug smuggling organizations, allow body packer to reduce the risk of rupture and decrease the rate of drug couriers discovered by police officers. The two cases presented, even if occurred in a relatively small time frame, represent only a small amount of the real number
Conflicts of interest
The authors report no conflicts of interest.
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