Cocaine by internal mail

Abstract

I welcome the comments of Mr Bycroft (June 2003 JRSM1) on the odious use of children as surgical mules, but take issue with his statement about the occasional radiolucency of intracorporal drug packages. Our statement that ingested narcotic containing packages are invariably radio-opaque2 was based on empirical experience from the Hillingdon Hospital (which takes the majority of symptomatic surgical mules apprehended at Heathrow Airport). In the past three years we have not seen a single patient whose concealed packages were not radio-opaque. The evidence cited by Mr Bycroft is well over a decade old. International drug trafficking has evolved considerably since then. The surgical mule is recruited by highly organized cartels that target vulnerable populations in some of the world's most impoverished regions. The packages usually contain cocaine (approximately 10 g) and are invariably factory processed: the narcotic powder is highly compressed and then encased in a protective cellophane coat. Their characteristic shape and density makes them readily visible radiologically—even with a faecally loaded colon. Our experience is supported by that of Bulstrode and colleagues, who reported a series of 180 surgical mules, all identified by a plain abdominal radiograph.3 Jones and Shorey presented 51 mules who were similarly diagnosed.4 A Dutch group concluded that, of 40 consecutive 'body-packers' admitted over a five-year period, all had identifiable packages on plain abdominal X-ray.5 With a lack of contemporaneous evidence to the contrary, we agree with Krishnan and Brown, that plain abdominal radiography is a key diagnostic tool in this patient group.6 If recreational drug users knew the enteric history of much of the cocaine available on British streets, would they be so keen to use it?