The Pathology of the Unlucky Coke Mule

The new Netflix drug war drama Narcos features a particularly grim scene in which a young, pregnant "coke mule" dies in a Miami emergency room having accidentally ingested 12 grams of cocaine. At the behest of a hipster Colombian drug smuggler operating within the nascent Pablo Escobar empire, she'd ingested several supposedly sealed packets of the drug—a practice known as "body packing"—some of which had ruptured in transit, which is not especially uncommon, even now.

With that much cocaine already in her (and her baby's) system, there was really no chance for survival.

The scene reminded me of a post I wrote a few years ago examining the actual physiology of a cocaine mega-overdose, which I've rewritten here because it's pretty interesting.

In 2011, a young Irish coke mule was busted at an airport in Brazil with 72 thumb-size packets of cocaine hanging out within his digestive system. It was about 830 grams in all. Details are sketchy as to how exactly the suspect went from being detained for "nervous" behavior to being in a medical imaging machine, which produced the damning picture above, but, nonetheless, the mule was reportedly alive and well after having had the packets removed. He faced 15 years for international drug smuggling, but that's a lot better than dying, arguably.

The removal mechanism liberating those 72 packets wasn't specified at the time. Smugglers with low risk factors and no symptoms of blockage can be sent to special facilities where cops literally wait until the suspect takes a crap, and then inspect said crap courtesy of a special sort of toilet with built in glove ports. The Irish mule had a couple of big risk factors just based on the amount of the drug in his system and the number of total packets. Surgery's not preferred for this sort of thing, but given just how all over the place they are, it might have been the only option.

He got lucky. A study published in the Journal of the American Medical Association in 1983 looked at 47 body packers, as these sorts of smugglers are commonly known, and of those 47, one patient had a bag tear as it was being pooped, while 12 had packages in their guts on the verge of breakage. That's bad news.

How bad? I'm finding that there's an assumption that if a lone bag of coke busts in your stomach or intestines, you're toast. Guaranteed overdose/toxicity, guaranteed fatal. The assumption makes sense. Each one of the guy's 72 packets held about 11 grams of cocaine, three eight-balls, or 220 average lines for snorttage. That's a lot of coke—and coke, contrary to popular belief, achieves the same blood concentrations either through your nose or through your gut. The latter takes longer to get there, which probably makes it feel a whole lot weaker. But it does get there.

So, say one packet broke pretty much anywhere in our body packing champ's body. That is 220 lines released all at once. It'll take about 30 minutes for it to be absorbed, according to most of the literature I've found. The generally accepted fatal dose for cocaine in humans is around 1.5 grams. One of these packets had 11.

But people can and do all the time put way more than that up their nose, at least they say they do. Just Google "the most cocaine you've done" and you'll find a combination of bashful boasts about doing an eight-ball (or more) in one binge, and heavily tweaking kids thinking they're about to die after killing a gram.

Notably, in either case, the user/writer is still alive. In fact, the vast majority of coke overdoses come from shooting it, not snorting it. And, in considering our unlucky coke mule, we're looking at snorting because it's most comparable to absorbing it in your guts. But still, 11 grams. There has to be some kind of point past which you're just plain fucked. No ambiguity, you're just dead.

Turns out researchers aren't huge on testing lethal doses of coke on humans; they are on animals, however. For what it's worth—which is not much at all—the LD100 coke dose, how much it takes to kill 100-percent of test subjects, for a human-size (150 pound) dog is about an eight-ball. For the same size rat, that goes all the way up to 13.5 grams. Rats love cocaine.

So, if our body packer was a giant rat, he might, possibly be able to weather absorbing a single 11 gram packet of orally ingested cocaine without dying courtesy of a stroke, a number of heart attack variations, hemorrhage, hyperthermia, or delirium. The medical term for what we're talking about, by the by, is "body packing syndrome." Coke mule syndrome, OK. Apparently, a ruptured packet is survivable with immediate medical help—specifically, benzos delivered via IV quickly, counteracting the stimulant effects on the central nervous system, and possibly cooling measures like ice etc. to keep the patient from dying from overheating. But, yeah, a lot of people actually do die because it's very often too late.

I couldn't find a death total from body packing, but a couple of stats might give it perspective: between 1990 and 2001, for example, 50 people in New York City died as a result of body-packing related overdoses. Sup, drug war.