Drug Searches

Persons unlawfully in possession of illicit drugs for personal use or involved in drug supply or trafficking may ingest drugs or pack them into certain body cavities ("body packers" or "mules"). Third parties may be employed to act as mules, and a case of body packing using children, two boys aged 6 and 12 years, who had concealed heroin has been reported (31). A person who is about to be arrested by the police may swallow drugs ("body swallower" or "stuffer").

Doctors may then be called by the police to conduct intimate searches of those arrested (see Chapter 2) (32). Any health care professional who agrees to perform an intimate search should have the required skills and a comprehensive understanding of the risks involved and their management. The doctor should discuss the possible implications of the ingestion of certain drugs and obtain fully informed consent from the detainee before conducting any search that may involve examination of the mouth, nostrils, ears, umbilicus, foreskin, rectum, or vagina.

Variable quantities of drugs, such as heroin, cocaine, cannabis, and amphetamine, may be packaged in layers of cellophane or in condoms. All searches for such drugs should be carried out in premises where there are full facilities for resuscitation (32a) in case significant quantities of the drugs leak into the bloodstream, resulting in acute intoxication and death from overdose (33). Other medical problems such as bowel obstruction may also occur.

The aim of medical management is to prevent these complications, but for ethical reasons, the retrieval of packages for legal purposes alone is no indication for intervention without the patient's permission. Therefore, without such permission, the doctor can do nothing except advise the police authorities that the detainee should be observed. In most patients who are asymptomatic, a trial of conservative treatment, provided bowel obstruction or package perforation is not suspected, will result in the uncomplicated elimination of all ingested packages (34,35).

In a genuine emergency when there is no possibility of obtaining consent, the doctor has a duty to perform treatment to safeguard the life and health of a patient in accordance with what would be accepted as appropriate treatment in the patient's best interests (36).

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