This is an account of the experience of the radiological department in identifying heroin smugglers coming from the African continent in transit through Malta. The method of preparation and ways of concealment of drugs in the alimentary tract are described and their radiological appearances illustrated. Conventional and alternative methods of investigation are discussed.peer-reviewe

Zammit, Anthony

English

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Maltese Medical Journal 45 Volume IV Issue 11992 APPREHENDING NARCOTIC SMUGGLERS IN MALTA DR. A. ZAMMIT MD., D.MR.D., FR.C.R., SENIOR CONSUL7ANT RADIOLOGiST, AND lECTURER iN RADIOLOGY, THE DEPARTMENT OF RADIOLOGY, ST. LUKE'S HOSPITAl., G'MANGIA, MALTA ABSTRACT This is an account of the experience of the radiological department in identi­fying heroin smugglers coming from the African continent in transit through Malta. The method of preparation and ways of concealment of drugs in the alimentary tract are described and their radiological appearances illustrated. Conventional and alternative methods of investigation are discussed. INTRODUCTION Among the many techniques of trans­port and contraband of narcotics, one of the latest fashions is concealment within the alimentary tract, 1.2.3. This method is adopted because: 1. The alimentary tract is voluminous and can take quite a large volume of drugs. 2. It is relatively inaceessable to cus­toms officials and police officers who need to involve hospital personnel to prove the presence of the smuggled drug. 3. Initially. it might have been quite an ingenious way of eluding anti-narcotic authorities. Nowadays, our customs officers and vice squad personnel arc alert to the situation and refer sus­pected travellers to our main hospital for assessment. METHOD The drug carriers ingest multi pie doses of the drug enclosed in rubberised cap­sules of about 2 to 3 centimeters by 4 to 5 centimeters. These must obvi­ously be hennatically sealed as acci­dental absorption ofthe chemical within the bowel would result in a fatal over­dose. Maltese Medical Journal 46 Volume IV Issue I 1992 These multiple units are usually visible on plain radiography of the abdomen because the rubberised capsule is ra­dio-opaque . The number of capsules varies from 50 to 100 depending on the weight of narcotic to be transported. they are usually situated within the large bowel but can lie inside small bowel also (fig. I) . Some carriers have a few capsules (two orthree) oflargerthan usual size, some as large as 5 by 7 cm., which are all within the rectum (fig. 2). In these cases , the method of insertion is be­lieved to have been by the anal route. In the latest effort to elude the law­enforcing Officers thc drug smugglers now pack smaller units of the drugs in plastic polyethylene sheath capsules of about 1.5 by 3 cm (fig. 3). Having put an amount of heroin in the capsule, the end is then tied securely. As the plastic is radiolucent it cannot be readily seen on a plain X-ray of the abdomen. The smaller size of capsule also renders it less visible within the bowel and also more easily ingested. However, during the process offilling the capsule, some air is left uninten­tionally within these units and there­fore an oval-shaped pattern results in the radiograph by the contrast created between the drug, the trapped air and the soft tissues (fig. 4) . Sometimes during the packing proc­ess, radio opaque contaminants are unintentionally sealed into the radiolucent capsules. Figures 3 and 4 are apt examples of this. Close inspec­tion of these photographs discloses the presence of a "U" shaped metallic ob­ject or clip, which also establishes a connection between the capsules in Figure 3 and the person radiographed in figure4, as this same object is visible in both these figures. Our experience is of seven cases of narcotics concealed inside the alimen­tary tract. In two of these cases the drugs were introduced via the anus while in the other five cases thc drugs were swallowed. Only one of the latter cases utilised non opaque plastic cap­sules . DISCUSSION Our Vice Squad Officers are on the alertfordrug smuggling by thesc meth­ods. Suspected travellers, particularly those coming from the African Conti­nent, are referred to hospital for medi­cal examination and for plain abdomi­nal radiography. If the test is positive, these suspects are then admitted and followed up until a search oftheir bowel motions confinns the suspicions and reveals the exact number and weight of capsules containing narcotics. This information will then give the officers the evidence they need for prosecuting the individual. t FIG. 2 Radiograph depicts two large capsules located in rectum . t FIG. J Plain Abdominal X-Ray shows multi­ple oval/cylindrical packets with ra­dio-opaq ue sheath containing narcotic within large bowel. • FIG . 3 This X-ray illustratcs the mode of pack­age of these sixty one capsules each containing about 5.5. grams of 50S{ Heroin. Metallic "U" clip is arrowed. .. FJG.4 This Radiograph with multiple packets containing narcotics, rendered visible due to air content. Note metallic "U" clip over the left neuro-exit foramen at S 1/2 (arrowed). Maltese Medical Journal 47 Volume IV Issue I 1992 Our radiological and medical staff are also quite alert to the magnitude of the problem and they have successfully identified drugs in the alimentary tract enclosed in non opaque plastic bal­loons. The co-operation between the law en­forcement agencies and the hospital staff ensures that Malta makes a valid contribution to the control of drug smuggling. CONCLUSION It is important to point out that there are other methods of investigation besides plain abdominal radiography. Ultra­sonic scanning may be utilised as a first line of investigation or as a confirma­toryexamination. An ultrasound scan is a less invasive technique since one avoids a radiation dose and it is a more cost-effective approach to screening suspects 4 . The ultrasonic examination could visu­alise individual capsules or it could detect scalloping of adjacent capsules with acoustic shadowing from the en­trapped air (fig. 5). In conclusion therefore, one would rec­ommend that cases of suspected nar­cotic smuggling should be initially re­ferred for an ultrasound scan for screen­ing. The positive cases could then be referred for a plain abdominal radio­graph to confirm or refute the suspi­cious findings. REFERENCES 1. Caruana D.S., Winbach B., George D. et al. Cocaine-packet ingestion Ann. Intern. Med. 1984; 100: 73­74 FIG. 5 Ultrasound Image shows convex up­wards echogenic surface with acous­tic shadow beneath arising from a cap­sule with trapped air. 2. Pamilo M., Suoranta H., Suramo 1. Narcotic Smuggling and Radiogra­phy of the Gastro-intestinal tract. Acta. Radiol. 1986; 27: 213-216 3. Beerman R., Nunez D. Jr., Wetli C.V. Radiographic evaluation of the Co­caine Smuggler G.!. Radiol. 1986; 11: 351-354 4. Nicolletti R., Mina A., Campanoni V., Balzaretti G. Abdominal foreign bodies in nar­cotic smugglers. Radiography and Sonography Radiol. Medica 1990; 80: 562-564 GeneralElectric CGR Leading the world in diagnostic imaging technology. Innovative Products for Better Heclthcare: * Computed Tomography * 'RFX' 90°/90° Radiographic & Fluoroscopic'Starcam' Nuclear medicine facilities Screening Room Systems * RT range of Ultrasound Sytems * 'Stenoscope' Mobile C-Arm XRay Systemswith fully electronic probes AMX 4Mobile X-Ray Systems * 'Senographe' Mammography Systems 'Saturne' range of linear Accelerators ,. denotes already in operation in the Maltese Islands) distributors 121 Marina Street. PietaJOSEPH F. SPITERI &CO. (1927) LTD. Telephone: 246670 Hospital & Medical Supplies Division The copyright of this article belongs to the Editorial Board of the Malta Medical Journal. The Malta Medical Journal’s rights in respect of this work are as defined by the Copyright Act (Chapter 415) of the Laws of Malta or as modified by any successive legislation. Users may access this full-text article and can make use of the information contained in accordance with the Copyright Act provided that the author must be properly acknowledged.  Further distribution or reproduction in any format is prohibited without the prior permission of the copyright holder. This article has been reproduced with the authorization of the editor of the Malta Medical Journal (Ref. No 000001)  

100: 73 2. Pamilo M., Suoranta H., Suramo 1. Narcotic Smuggling and Radiogra phy of the Gastro-intestinal tract.

Abdominal foreign bodies in nar cotic smugglers. Radiography and Sonography Radiol. Medica

Apprehending narcotic smugglers in Malta

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Apprehending narcotic smugglers in Malta

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