FYI: How Much Cocaine Can You Fit In Your, Ahem, Body?

The first thing you learn, when investigating drug muling, is that muling is a very common and efficient way of transporting contraband. The second thing you learn is that you have no idea how elastic the gastrointestinal tract is.

There are two kinds of mules. The first is long-term; these are the ones that fly from another country and need to keep whatever they're smuggling inside their bodies for a day or so. Dr. Rama Rao, an emergency room physician at New York Presbyterian Hospital, calls this "body packing," though terms vary. The other type is short-term, the ones who need to smuggle something into jail or just to conceal something for a few minutes or hours. Dr. Rao calls this "stuffing" or "booty bumping," though as with packing, there are dozens of slang terms for it. Whatever it's called, the ER sees plenty of it.

These two methods primarily differ based on which end the contraband enters: packers swallow, stuffers insert (...into the butthole).

When we talk about mules caught with hundreds of bags of cocaine or heroin, we're talking about packers. "Almost always these people will swallow," says Dr. Rao. "The [gastrointestinal] tract is very long; it's the best way to store a lot." It makes sense to follow the body's natural inclinations here; when you swallow something, the gastrointestinal tract will naturally keep materials within the body while it digests (or attempts to digest), and then pass it. Your entire body is designed to help take things from your mouth and pass them out your anus, with some time in between. When smuggling, that's exactly what you want.

There have been no conclusive studies done on the body's capacity for packing via the mouth. "It's really just up to what the patient can tolerate," says Dr. Rao. Cocaine and heroin are the most common items to smuggle via packing, as they have an extremely high ratio of value to physical size. Stephen Traub led a study in 2003, published in the New England Journal of Medicine, that focused on this sort of muling. The study found that the packets are highly sophisticated and efficient. Muling, despite seeming sort of primitive, is just about the best and safest way to get illicit materials across a border. If you're picturing a poor sap swallowing a condom filled with coke, forget it. "Drug packets, which previously varied in size and construction, are now well crafted, with a precision that suggests the use of an automated process," notes Straub's paper.

These drug packets typically consist of the drug--usually cocaine, heroin, or methamphetamine--compressed to be as dense as possible, and placed into some kind of latex. That latex might be a condom or balloon, yes, but that's not the end of the preparation. That balloon is then sealed with a coating, typically of wax or some kind of industrial sealant. The packet might also include aluminum foil or some other item to throw off any machine that might be able to detect it. The packets are uniform, tapered at both ends, with the appearance of being machined--this isn't a guy smooshing balloons with his hands, this is a concerted, professional operation.

As for capacity, well, nobody knows, really. Typically a packer or mule will carry about 50-100 of these packets, but folks have been caught carrying in excess of 200--as much as five pounds, concealed in the gastrointestinal tract. Sometimes packers will take some kind of anti-diarrheal medicine to halt the body's impulse to expel the packets, and choose not to eat during the flight. As Mary Roach notes in her excellent new book Gulp: Adventures on the Alimentary Canal, some flight attendants on long international flights make a note of any passenger who refuses to eat, to be given to security when the plane lands. So a packer will be wildly uncomfortable, paranoid, committing several illegal acts, and on top of it all, probably hungry.

Once on the ground, that packer will have to keep as calm as possible; customs officials keep an eye out for people who look like they've shoved literally pounds of hard materials inside themselves and are shaking, perspiring, or walking like their legs are made of glass. That's just due to the basic discomfort of having a bunch of alien objects in your gastrointestinal tract, and it doesn't mean it's dangerous, necessarily, but it's still difficult to act normal when you're dealing with a couple hundred wax cylinders in your gut. And so some people get caught.

When suspected, an in-depth x-ray, more time-consuming than the one given to regular passengers, is administered on possible packers. If packets are found, these packers will have to wait around to defecate, which doesn't sound like much fun. At New York's JFK Airport, that's done at the "drug loo," a toilet that automatically washes packets after they've been passed.

Dr. Rao was a little bit reluctant to talk about this--I only got through to her after promising the hospital's press relations person that I'd talk about safety, which I will later--but there isn't actually that much serious long-term risk in packing. "If all the packets are passed," she says, "then, medically speaking, that person is likely to do fine." The muscles of the rectum and anus won't get stretched out permanently or anything like that.

When swallowing packets of drugs, the length of time they stay within the body is mostly up to the literal intestinal fortitude of the packer. Generally it'll take about a day or two to pass through the system, but if the packer is desperate, times of as long as five days (five agonizing days) have been reported.

There is a risk of obstruction or perforation of various internal bits, but that's up to a combination of bad luck (your body tries to pass several packets at once, say) or shoddy worksmanship on the packets. "The number of packets ingested does not appear to correlate with the risk of these complications," according to Traub's paper. If everything goes as planned, you're probably fine. Of course, this is drug smuggling; not everything always goes as planned.

The bigger risk is that one of the packets will break open. Any single one of these packets--and remember, packers are swallowing literally hundreds of them--"generally contains several times more than a lethal dose," says Dr. Rao. Overdosing is common; there is an antidote for a heroin overdose, but for cocaine, the only solution is a specific type of beta blocker which can treat hypertension. And besides that, mules are often unwilling to cooperate with authorities, seeing as how they're engaged in highly illegal activity on behalf of a criminal organization.

Packing is more widely practiced than I realized; after 9/11, it's proved one of the most failsafe ways to smuggle reasonably large quantities of hard drugs into the US. It's basically impossible to spot for standard airport security, and it's not very expensive for the exporter (packers are paid a few thousand dollars or sometimes just with the plane ticket to the States).

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Stuffing, the insertion of something directly into the rectum, is comparatively primitive. Stuffing is a short-term solution; you stuff things into your rectum to get past one quick check, not to travel across international borders and go through customs. The two most common stuffing situations are prison smuggling and quick concealment (for example, you're surprised by police, and have to get rid of some contraband object immediately). That means it's just as likely that the materials will be objects, tobacco, or other non-drug--stuffing is not done by professional drug smugglers, so such professional packaging is rarely seen. It's much more likely that a stuffer will simply wrap the item in a lubricated balloon or condom and go to town.

"You're always working against the natural movement of the GI tract," says Dr. Rao. There's very simply a limit to how far you can push something into the rectum; after a few inches, you run into the colon and then the large intestine, which is much more delicate and prone to perforation or tearing, especially when you're forcing it to do the opposite of what it's designed to do. The muscles of the body are fighting you the entire way.

That said, the rectum is designed to be a storage container. It's used to store a certain amount of feces, until the stretching of the walls of the rectum send a message to the nervous system that you have to expel what's in there. If you ignore the message, the feces can sometimes be drawn back into the colon, where more water is extracted from it until the feces becomes hard and bumpy and awful, which makes for a more painful bowel movement later.

The key to stuffing, as in so many things, is practice. Accomplished rectal stuffers, many of whom can be found in our prison system, work both to expand their rectal capacity and, at least as importantly, to train their bodies to suppress the urge to defecate. I spoke to Dr. William Whitehead of the University of North Carolina, an expert on the movements of the gastrointestinal system, who says, "There are a lot of circumstances in which people develop a much larger rectum, or a megarectum." A megarectum is just a large rectum, generally defined as having a capacity of more than 1,500 mL, and Dr. Whitehead is used to seeing it from those with severe constipation. "Through repeated retention of stool the rectum becomes enlarged," he says, but when I asked if manual effort--practice, basically--could also enlarge the capacity, he said "I think it could."

The maximum capacity of a normal rectum--meaning, before the patient is overcome by the urge to defecate--is about 350 to 500 mL, or about a pint in volume. That's a lot; the first urge to defecate comes at about 100 mL, so if you're storing five times that amount, you're probably pretty uncomfortable. But repeated stretching of the rectum can increase that size markedly. "We do know that it's not rare for people to have larger capacities," says Dr. Whitehead. "We have certainly tested people for whom it's 800 mL. With practice the capacity becomes larger."

The rectum is a fantastically powerful, stretchable part of the body. The problem I kept running into in trying to figure out how much cocaine you could fit in your butthole is that, well, there isn't really an upper limit. It's all about conditioning and practice. That said, let's take that 800 mL as an example upper limit. Given the density of cocaine hydrochloride, that converts to about 0.97 kilograms of cocaine, or very nearly the size of one of those big bricks you see confiscated on the news. And that 800 mL isn't unheard-of; it's probably on the low end for someone who performs a lot of rectal stretching activities.

A more firm upper limit can be found by looking not at volume but at pressure. At a certain amount of pressure, the walls of the rectum will begin to perforate, which is exactly as horrifying as it sounds. "There's no evidence of perforation before 150 mm of mercury," says Dr. Whitehead, mm of mercury being a measure of pressure similar to pounds per square inch or pascals. But that doesn't really get us anywhere, since calculating that pressure depends on the capacity, which is basically impossible to nail down.

Can repeatedly stretching out the rectum in order to carry huge amounts of cocaine cause permanent injury? Dr. Whitehead thinks probably not. "It would almost certainly lead to a weaker sense of urgency to defecate, weaker warning signs," he says, and in cases of constipation, which can have a similar rectum-stretching effect as stuffing, "the act of defecation becomes less efficient." But that's not life-threatening, really. The danger is more from sharp objects tearing the walls of the rectum, or from drug packets bursting and causing overdoses--much more likely in stuffers than packers. That's because stuffing is a last-minute, often hastily prepared activity, just to get something through a quick security check.

So, how much cocaine can you fit in your butthole? With practice, the sky's the limit, though if you're aiming for pure storage capacity, you'd be better off swallowing--you can nearly double your storage space by entering through the mouth rather than the anus. Right now, at most, assuming you haven't been practicing by stretching your rectal capacity and that your rectal capacity is on the high end of the normal spectrum, you could fit about 0.61 kilos of cocaine in there. The more you know!