Drug Cartels Raise the Game for the Mule Trackers

When Trojan cuts through the wax coating of one of the pellets, which is about 1.5 inches long and 0.75 inches in diameter, he finds additional layers of plastic wrap, transparent tape, carbon paper and other materials that suggest an attempt to evade X-ray detection. Though the ruse ultimately doesn't succeed, it reveals a working knowledge of radiology on the part of the manufacturers ... or their medical consultants.



But Trojan has his own team of medical consultants. In late 2000 he began bringing his drug-packed suspects to Bellevue Hospital, on Manhattan's East Side. Although several hospitals nearer JFK airport were more convenient for the X-rays and medical exam that Trojan's suspects required, he got little sympathy from the staff at their emergency rooms when he explained the delicacy and urgency of the situation. "They pointed me to the waiting room and the end of the line," he says. There he would sit amid the screaming, the bleeding and the retching--handcuffed to a drug courier passing narcotics into his or her pants.



The first swallower who Trojan brought to Bellevue sparked immediate interest and care. "The medical issues are fascinating," says Stephen Traub, the Bellevue toxicologist who was on call that day. "And the patients are some of the saddest I've ever seen." As a toxicologist, Traub understood the medical risks that other ER doctors tended to gloss over. Though the machined packets are less likely than tied-off condoms to leak and trigger a massive overdose, it's all too easy to leave a package behind, lodged in the intestines. Should doctors then release the patient into police custody, the pellet could degrade and begin to release its contents.



Trojan shares the doctor's sympathy for many of his suspects. "For the most part, these are not hardened criminals," he says. "Once I have them under arrest, my priority is to get them the best possible medical care." And so, over the hospital bed of their first shared charge nearly four years ago, Trojan and Traub forged a friendship and a mutually advantageous working relationship.



"They give us the red-carpet treatment, and we bring them a research opportunity like no other," says Trojan.



Last September, Trojan and Traub filled a large auditorium with a presentation on "body packer syndrome" at the annual meeting of the North American Congress of Clinical Toxicologists in Chicago. Traub and Bellevue colleagues Robert Hoffman and Lewis Nelson have also published several scientific papers on the syndrome, including a recent review article in The New England Journal of Medicine that provides the most up-to-date guidelines for diagnosis and care. It includes guidelines for recognizing telltale X-ray patterns such as the star-shaped "rosette" that signals where the knot at the end of a latex packet traps tiny air bubbles inside its folds. Similarly, air between the layers of a typical drug package can reveal its sausage-shaped outline. The repetition of these patterns on an abdominal X-ray tells the doctor that he or she is looking at manufactured goods, rather than the remains of yesterday's dinner.



The Bellevue doctors offer a compelling reason for further research into their new specialty. "If anyone is contemplating how to get a small amount of a concentrated bioterrorist agent into this country, this is it," says Hoffman. With its capacity of 10 grams, a single pellet could be used to import enough anthrax, ricin or other deadly biochemical powder to wreak havoc. "Maybe I'm just a dumb doctor," says Hoffman, "but we hear about drug money funding a lot of terrorist operations, and those people are going to think about this."



U.S. Customs Service is aware of the threat, confirms Sam Stabile, a deputy chief inspector for Kennedy Airport. "It's one of the toughest things to defend against--someone who's willing to swallow something that could kill him." While the threat is hypothetical, the drug cartels have shown they recognize the versatility of body packing: They have used swallowers to courier pellets filled with rolls of currency.



"Our most powerful screening tools are not X-rays or body scans but the instincts of our inspectors," says Stabile. "A lot of what we do involves observing behavior, recognizing discrepancies in reasons for travel, and the like. We acquired this expertise before 9/11 in our fight against narcotics, and now we are applying it to terrorism."