DRUG FACILITATED SEXUAL ASSAULT

1. DRUG FACILITATED SEXUAL ASSAULT (Content areas reflective of current practice 7/16/09 – revise as appropriate to reflect current standards of care.)

2. Drug Facilitated Sexual Assault • “Sexual assault facilitated by the offender’s use of an “anesthesia-type” drug which, when administered to the victim, (stealthily or not) rendered the victim “physically incapacitated or helpless” and thus incapable of giving or not giving consent.” American Prosecutor’s Research Institute - 1999

3. What is Drug Facilitated Rape? • Classic ‘slipping a mickey’ • Recreational drug use by victim • Victim mixing Rx or OTC meds with ETOH or Recreational drugs

4. MOST Common “Date Rape” Drugs • GHB • Ketamine • Ecstasy • Alcohol

5. Challenges Surrounding Reporting • Is it even reported ? • Time elapsed since drugging • Convincing law enforcement • Is the victim being truthful?

6. Challenges With Evidence Collection • Proper specimens • Enough specimens • Preservation of specimens • Testing facilities

7. Signs of Date Rape Drugging • Victim REPORTS: • Recalls having a drink but doesn’t remember what happened afterward • Feeling very drunk after one or two drinks • Suddenly feeling very nauseated after one or two drinks or no ETOH • Wake up feeling like someone had sex with them, but doesn’t remember who, where or when.

8. Scenario • Female aged 15-25, at a bar, club or private party • Given a beverage she didn’t see poured, or left her drink unattended • Sudden onset nausea; goes to the bathroom • Male waiting outside bathroom, expresses concern, offers to accompany female outside for air or a ride home.

9. Scenario (cont.) • Female wakes up 1 – 12 hours later in her car in her home next to a stranger in unfamiliar surroundings in an isolated location • Complains of confusion, HA, genital soreness • Clothing messed up, some articles missing

10. Scenario (cont.) • Victim has no memory or only flashes • May recall being awake but unable to move extremities • Perpetrator may tell her that she consented • Victim often too confused or embarrassed to tell anyone or report to police because she can’t remember

11. Ethanol (ETOH) What makes ethanol a good DFSA drug? • Easy to obtain • Most commonly associated with rape • Victims commonly consume voluntarily • May cause decreases inhibitions, impaired perceptions, loss of consciousness, amnesia • Prosecution doubtful • CNS depressant, enhancing effect of other drugs • Associated with risk behaviors

12. Pharmacology of Ethanol Pharmacokinetics • Rapidly absorbed into bloodstream • Distribution to entire body including CNS • Rapidly eliminated Detection periods: • Blood 5 – 15 hrs. • Urine 5- 24 hrs.

13. Gammahydroxybuterol GHB Liquid E Grievous Bodily Harm Soap Georgia Home Boy Easy Lay Scoop Salty Water Blue Verve Goop G Gamma - oh

14. GHB • Naturally occurring metabolite of GABA • Strong CNS depressant • Abuse / Misuse bodybuilders recreational DFSA • Detectable less than 8 hrs. in blood; less than 12 hrs. in urine

15. GHB • Made in clandestine labs • Ingredients include industrial degreaser and lye • End product a tasteless – colorless liquid • Street Cost: $10 per dose • Greatly enhanced with ETOH

16. What Makes GHB A Good DFSA Drug? • Easy to obtain • Fast acting sedative properties • Mimics ethanol • Amnesiac • Rapidly eliminated • Majority of labs do not have assays • Naturally occurring

17. Ketamine Special K Vitamin K Jet Super Acid Bump Kit Kat Cat Valium

18. Ketamine • Since 1972, anesthetic induction agent • Vets - Watch robberies • Structurally similar to PCP • Increasingly popular hallucinogen • Described as superior to PCP and LSD • $40 - $50 / ½ gram

19. Ketamine • “K Hole” Businessman’s LSD mind body separation near death experience extremely short half life go into “K Hole” then get back to work • Able to follow instructions and obey commands

20. What Makes Ketamine A Good DFSA Drug? • Dissociative, analgesic and mild sedative effects • Popular drug of abuse • Readily available • Often victim voluntarily ingests

21. Ecstacy X XTC Candy Love Drug Light Show Hug Drug Smurfs Love Drug

22. Ecstacy • Chemical Name MDMA methelenedioxymethamphetamine • Central nervous system stimulant • Increases BP and HR • Often highly elevated core body temps of over 105 • Rapid dehydration – H2O intoxication • Street Cost: $8 - $20 per pill • Holiday stamps on tablets

23. What Makes Ecstasy A Good DFSA Drug? • The “love drug” or “hug drug” • The “perfect high” • Becoming very popular “club drug” • Often voluntarily ingested • Intense thirst and need to suck, grind teeth and clench jaws • Increased perception of sensory stimuli: lights brighter with trails skin surfaces more sensitive

24. Recommendations for Victims of DFSA • Collect first urine in a clean container • Ask trusted people for help • Call police • Get to a SANE team • Be truthful about any ethanol or recreational drugs on board • Save the glass, can or bottle

25. Recommendations for Medical Professionals • Get 100 cc of urine if reported within first 96 hrs. • Get blood if within 24 hrs. 10cc in grey top tube Big red tube • Hair samples in research – longer window • Immediately refrigerate up to 7 d and frozen if over 7 days (make LE aware!) • Follow local procedure for analyzing specimens • Discuss local protocol / forms / lab venues

26. Conclusions • DFSA cases are increasing, esp. on campus • Many different drugs, not just ones in media • Many challenges to be overcome: education of kids, esp. teen girls education of medical personnel education of law enforcement/judicial thorough investigation a MUST teamwork is vital SART approach