By Eulalee Thompson, Staff Reporter 
Surgeons removing cocaine packets from a drug mule's abdomen. - Contributed
Each drug mule may carry, in their gastrointestinal tract, 350 to 700 times the minimal lethal dose of cocaine -
Dr. Trevor McCartney, senior medical officer, Kingston Public Hospital, 29th Annual Dr. Ena Thomas Memorial Symposium.
THIN RESOURCES at the Kingston Public Hospital (KPH), already stretched caring for victims of rampant acts of crime and violence, are now under further strain as a result of the recent phenomenon of the drug mule.
"For the past three years we have seen a new addition to the medical care, cocaine body packers. The medical management of these patients has had a significant impact on the practice of medicine and have presented the patients who have other diseases with some difficulty in accessing the quality of care they deserve," said Dr. Trevor McCartney, KPH's senior medical officer.
In 2000, the hospital had only seen 17 cases of drug mules gradually increasing to 54 cases last year and within the first nine months of this year, 523 cases were seen, 250 of them admitted to the hospital. In fact, these cases have become so common over the past few years that the hospital has develop a cadre of clinical staff extremely skilled at detecting drug carriers.
Drug mules undertake tremendous personal risk in the transportation of the illegal drug in their bodies. Dr. McCartney explained that the average minimal lethal dose of cocaine is 500mg and may be as small as 25 mg in acute gastrointestinal tract exposures in cases where packages rupture inside the carrier. Each package may contain one to 12 grams of cocaine and in KPH's experience they are seeing body packers who ingest up to 175 packets. These large numbers of packets, Dr. McCartney said, means that each drug mule may be carrying 350 to 700 times the minimal lethal dose of the illegal drug.
The body stuffers, those who might hastily ingest drugs to avoid detection by lawmen on their heels, Dr. McCartney pointed out are at greater risk of toxicity because although they generally ingest smaller amounts of cocaine, it is usually poorly wrapped.
Stuffers are not to be confused with body packers. These are the 'pros', who go through "training exercises" before their planned ingestion of numerous packets of cocaine for the purpose of entering the huge and lucrative drug smuggling market.
"Significantly, there was early mortality associated with this practice as the methods were often insecure...but more recently they have become much more sophisticated, using pig intestines, wrapping it up, doubling it up, and making several knots. This has decreased the risk of rupture but it has also increased the ability of the packers to avoid radiological detection," Dr. McCartney said.
Radiological detection usually a plain abdominal X-ray is the usually investigative tool used by KPH when suspected body packers are brought in by the security forces. Dr. McCartney indicates however, that this procedure has a wide range of false negatives 1.2 to 33 per cent false negatives. CT Scan would be useful but is not available at KPH and the ultrasound produces disappointing results.
However, in addition to the IONSCAN machines located at the country's airports, which has been weeding out suspected smugglers, the senior medical officer has been strongly recommending the use of urine analysis at the airports.
"Urine analysis...(has) a 97 per cent sensitivity for cocaine metabolites in the first 24 hours after ingestion and can produce a positive result even when the packets are unruptured," he said.
