Substance Abuse SUBSTANCE ABUSE Substance abuse: routes,
hazards and body packing Allister Vale
Abstract Substances taken to alter the mental state may be ingested, inhaled, absorbed through mucous membranes or injected. Accidental overdose is common. Complications result either from the presence of contami- nants or from the pharmacological actions of the substance(s) involved; these include respiratory, neurological, renal and metabolic complica- tions. Body packers often swallow large numbers of packages in the hope of financial gain. Acute intestinal obstruction may result and over- dose is a hazard if a packet bursts. Immediate surgery is indicated if acute intestinal obstruction develops, or when packets can be seen radio- logically and there is clinical or analytical evidence to suggest leakage, particularly if the drug involved is a central nervous system stimulant (e.g. cocaine).
Keywords acute intestinal obstruction; body ‘packer’; body ‘pusher’; body ‘stuffer’; contaminants; ‘Parachuting’
preparations, benzodiazepines, clomethiazole, ethanol, opioid analgesics (particularly codeine and dihydrocodeine) and sympathomimetics.
Inhalation Inhalation allows more rapid absorption of cannabis, cocaine, nicotine, opiates, organic nitrites (e.g. isobutyl nitrite) and volatile substances. Volatile substances are usually ‘bagged’ (sprayed into a plastic bag and inhaled until the individual loses consciousness) or ‘huffed’ (sprayed onto a cloth held to the mouth). An abuser may attempt to enhance the intoxicant effects by placing a plastic bag over the head.
Absorption through mucous membranes Absorption through mucous membranes (‘snorting’ or ‘snuffing’) is the method most commonly used with cocaine. The drug is sniffed into the nostrils, where it is absorbed.
Injection Injection subcutaneously (‘skin-popping’, Figure 1) or intrave- nously (‘mainlining’, Figure 2) is the fastest method of delivering drugs to the brain in high concentrations. Intravenous injection is the route preferred by most abusers for the more potent opioid analgesics. Some heroin abusers inject metallic mercury after heroin in the false hope of enhancing the ‘high’ (Figure 3).
Hazards of abuse Substances
Many substances, some obtained from natural sources, are taken to alter the mental state of the user. These include amfetamines, Ecstasy, cannabis, cocaine, ethanol, ketamine, g-hydrox- ybutyrate, lysergic acid diethylamide (LSD), mushrooms, opioid analgesics, nitrites and other volatile substances. Such substances can be classified according to whether their
major effect is to alter perception, or to stimulate or depress the central nervous system (CNS), though there is some overlap between groups. Substances that predominantly depress the CNS (e.g. ethanol) may, for example, arouse and disinhibit behaviour before exerting their principal action. Other drugs that initially stimulate the brain may impair consciousness if taken in suffi- cient quantities.
Routes of abuse
Substances may be ingested, inhaled, absorbed through mucous membranes or injected.
Ingestion Ingestion is convenient, but absorption is relatively slow and the impact of the drug on the brain is correspondingly decreased, unless large quantities are taken. Drugs taken by ingestion to alter the mental state include anticholinergic drugs and plant
Allister Vale MD FRCP FRCPE FRCPG FFOM FAACT FBTS is Director of the National Poisons Information Service (Birmingham Unit) and the West Midlands Poisons Unit at City Hospital, Birmingham, UK. Competing interests: none declared.
MEDICINE 40:2 46 Africa Health 74
Accidental overdose is possible, though the degree of risk depends, to some extent, on the route of administration. Intra- venous injection carries the greatest risk, because some users are inexperienced at injection technique and because there may be unexpected increases in the potency of street drugs. Because substance abuse is usually illegal, even unconscious or seriously ill individuals may not be referred immediately for medical help, and may be simply observed by their fellow substance abusers until they improve or deteriorate so far that their condition can no longer be ignored. Irreversible brain damage may result. In addition, complications may result either from the presence
of contaminants or from the pharmacological actions of the substance(s) involved. These include respiratory,1 neurological,2
Figure 1 Erythematous skin lesions over the lower abdomen and iliac crests, resulting from ‘skin-popping’.
2011 Published by Elsevier Ltd. July 2012
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