Cough It Up, Punk!

If a criminal swallows the evidence, how do police get it out of him?

Swallowing. Click image to expand.
Can police force suspects to throw up evidence they’ve swallowed?

A thief who stole a diamond pendant from a British traveler in Spain last week swallowed the jewel when confronted by police, authorities said on Wednesday. A week earlier, the city of Chicago settled a lawsuit with the mother of a man who died after ingesting packets of heroin during his arrest. When criminals swallow the evidence, how do police get it out of them?

They wait. Police are allowed to use medicines and medical procedures to retrieve evidence from the bodies of unwilling criminal suspects only if the procedure is reliable and routine, and there’s no gentler way to get the goods. Under most circumstances, this rule prevents authorities from forcing a vomit-inducing agent or an endoscopy on a suspect who isn’t in immediate medical danger. Ethical standards also forbid physicians from administering treatments solely for the purpose of collecting evidence, rather than to aid the patient. So police have to wait. They lock the suspect in a “dry cell” without running water, where he defecates in a bucket or a toilet lined with a plastic bag. An unlucky junior guard has to search through the waste. The “transit time” depends on the patient’s individual biology and diet, but most jails and prisons limit these vigils to a week or a prescribed number of bowel movements.

Drug packets—usually one or two ounces of narcotics sealed in a condom, latex glove, or balloon—present a special problem. If they remain sealed, as they do in most cases, they can pass harmlessly through the digestive tract. On the other hand, if the knot comes undone or sharp objects in the stomach such as nuts cut the bag, the leakage can quickly cause cardiac arrest. Several states and criminal defendants have litigated the question of whether a recently swallowed bag of drugs represents a medical emergency and justifies immediate intervention, but most courts seem to have found against police who order involuntary emetics in these cases. In fact, the Supreme Court’s famous phrase “shocks the conscience” was first written in reference to police forcing emetics down the throat of a suspect.

Most so-called body packers are flagged by border and airport security agents who don’t actually see the smuggler pop the goods into his mouth. If questioning reveals a potential body packer, agents look for drug metabolites in the suspect’s urine. When well-sealed packets foil that tactic, they order an abdominal X-ray. Spotting a bag of cocaine on an X-ray is no easy task, though. In the digestive tract, ordinary stool or pockets of gas can look very much like drug pouches. Radiologists look for certain tell-tale patterns: 1) a column of oblong objects, known as the “tic-tac sign”; 2) a flowerlike pattern of air formed in the knot that holds the packet shut, known as the “rosette sign”; or 3) a circular ring of air trapped between layers of latex, known as the “double condom sign.”

When they spot drugs, emergency physicians can help them along with laxatives and bowel irrigation if the patient consents. If there are any signs that the bag has leaked or stopped its progress—pain, vomiting, or failure to defecate for days on end—surgeons go in after the contraband.

Involuntary use of emetics can be extremely risky. German authorities forced an emetic into a suspect’s stomach in 2004. The man clenched his teeth tightly, which forced the vomit into his lungs. He fell into a coma and died days later. The European Court of Human Rights has since banned (PDF) the tactic.

Got a question about today’s news? Ask the Explainer.

Explainer thanks Paula Hancock and Donald Kern of the Society of Correctional Physicians, Edward Harrison of the National Commission on Correctional Health Care, and Thomas Lincoln of Baystate Medical Center and Tufts University School of Medicine. Thanks also to reader Andy Heiting-Doane for asking the question.