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Appendix 20 Drug-Facilitated Rape National Judicial Education Program Drug-Facilitated Sexual Assault US Department of Justice Federal Bureau of Investigation FBI Laboratory Chemistry Unit Washington, DC 20535 (202) 324-4329 Agenda • • • • What is DFR? Challenges Surrounding the Investigations Drugs Used to Commit DFR Recommendations to Overcome the Challenges 3 What is Drug-Facilitated Rape? • Slipping a “Mickey” • Recreational Drug Use by Victim • Victim Mixing Prescription or OTC Medications with Ethanol or Recreational Drugs 4 Challenges Surrounding the Investigation • • • • Drugs Used Reporting the Crime Collection of Evidence Laboratory Methodologies 5 Challenges with Drugs that are Used • Dosages • Number of Candidates 6 Drugs Reportedly Used to Commit DFR • Ethanol • Benzodiazepines – – – – – – – – Flunitrazepam Clonazepam Lorazepam Alprazolam Triazolam Chlordiazepoxide Diazepam Temazepam • Zolpidem • Barbiturates • • • • • • • • • • GHB Ketamine Opiates Antihistamines Hallucinogens Antidepressants Chloral Hydrate Muscle Relaxants Clonidine Yohimbine 7 Challenges with Drugs that are Used • • • • Dosages Number of Candidates Pharmacokinetics Pharmacodynamics 8 Fate of Drugs in Body Distribution Absorption Excretion Biotransformation (Metabolism) 9 Where is the Drug ??? The Toxicological Problems Absorption and Distribution Metabolism and Excretion Conc Plasma Urine Time 10 Challenges Surrounding Reporting of the Crime • Is it Even Reported? • Time Elapsed Since Drugging 11 El Sohley Study: 80 Time of Collection vs % Positives 70 60 50 % 40 30 20 10 0 0-12 13-24 25-36 37-48 49-60 61-72 73-84 >84 Hours Since Drugging M.A. ElSohly, S.J. Salamone. Journal of Analytical Toxicology, May/June 1999, pages 141-146 12 Challenges Surrounding Reporting of the Crime • • • • Is it Even Reported? Time Elapsed Since Drugging Convincing Law Enforcement Is the Victim Being Truthful? 13 Challenges with Evidence Collection • Proper Specimen(s) • Enough Specimen • Preservation of Specimen 14 Challenges with Laboratory Methodologies • Immunoassays • Limit of Detection • Non-Existent Procedures • Having Time to Focus 15 Interpreting Results • Blood: – Positive Result = Good indicator of recent (hours) exposure – Negative Result = No exposure or collected too late • Urine: – Positive Result = Good indicator of exposure within last few days – Negative Result = No exposure or collected too late 16 17 What Makes Ethanol a Good DFR Drug • • • • Easy to obtain Drug most commonly associated w/ rape Victims commonly consume voluntarily Can cause decreased inhibitions, impaired perceptions, loss of consciousness and amnesia • Prosecution may not be likely 18 Pharmacology of Ethanol • Pharmacokinetics: – Rapidly absorbed into bloodstream after ingestion – Distribution to entire body including CNS – Rapidly eliminated – Detection periods: • blood 5-15+ hrs • urine 5-24 hrs 19 Diazepam (Valium®) Flunitrazepam (Rohypnol®) Triazolam (Halcion®) Clonazepam (Klonopin®) Alprazolam (Xanax®) Temazepam (Restoril®) 20 Benzodiazepines • Common misconception: – ONLY flunitrazepam is capable of being a “Date Rape Drug” among the benzodiazepines • FACT: All benzodiazepines are able to exert the same effects – the dose determines the effect 21 Sources of Benzodiazepines • Prescription – – – – Anxiolytic Sedative/Hypnotic Anticonvulsant Muscle Relaxant • Induction Anesthetic • Street • Smuggled from Other Countries 22 What Makes Benzodiazepines Good DFR Drugs • Decrease anxiety, induce sedation, may cause amnesia • Fairly rapid & complete absorption from the GI tract after oral dose • Distribution to CNS where they exert their effect within 15-30 minutes • Excretion primarily as glucuronide conjugates or other polar metabolite 23 Flunitrazepam ® (Rohypnol ) • Primarily used as a sedative or anesthetic inducing agent (80 countries world-wide) • 7-10x more potent than diazepam • 4-8x less potent than triazolam 24 Flunitrazepam • Not available for medical use in the U.S. • 0.5, 1, or 2 mg tablets • Old tablets: – Single score on 1 side – “1” or “2” and ROCHE on other side • New tablets: – Olive green color – “542” on 1 side, single score on other – Blue dye released when dissolved 25 26 Pharmacology of Flunitrazepam • Metabolized to 7-Aminoflunitrazepam, 3OH-Flunitrazepam, and Norflunitrazepam (active) • FLU, 7-AMF, 3-OH-F and NF are glucuronidated and eliminated via the kidney – T½ of FLU = 20-30 hours • Detectable in urine 96 hours; blood 24 hrs 27 Pharmacology of Flunitrazepam • Side-effects: – – – – – – – Profound Sedation Dizziness Lack of coordination Slurred speech Confusion Anterograde Amnesia Impaired Psychomotor Function 28 Clonazepam (Clonapin®, Rivotril®) • Similar to flunitrazepam • Legally available by prescription in U.S. • Illegally sold as flunitrazepam • Similar potency as FLU 29 Alprazolam (Xanax®) • Available in US as antidepressant and anxiolytic agent • Major urinary metabolites are conjugates of -hydroxyalprazolam and HMTBP 30 Triazolam (Halcion®) • Used for insomnia • Very short t½ of 1.54.0 hours • Urinary metabolites are glucuronide conjugates of hydroxylated products 31 32 Liquid Ecstasy Grievous Bodily Harm Soap Georgia Home Boy Easy Lay Scoop Salty Water 33 Introduction - GHB • Naturally occurring metabolite of GABA • Strong CNS depressant • Abuse / misuse – Bodybuilders – Recreational – Drug-facilitated sexual assault 34 History of GHB • 1960s: First studied for sleep disorders • 1970s: Used to treat narcolepsy and reported to increase release of GH • 1990-93: Recreational use increased; FDA declared “unsafe and illicit” • 1996: First cases of its use for sexual assault • 1999: DEA recommended scheduling • 2000: Federally controlled schedule 1 drug 35 36 37 38 Pharmacology of GHB • Synergistic effect with ethanol, marijuana, and other CNS depressants • Metabolism to carbon dioxide and water • Detectable <8 hours in blood; <12 hours in urine 39 GBL and 1,4-Butanediol Abuse • Both are metabolized to GHB very quickly – GBL via lactonase – 1,4-BD via alcohol dehydrogenase and aldehyde dehydrogenase • Products containing GBL or 1,4-BD began replacing GHB-containing products • Early 1999, the FDA called for a voluntary discontinuation of sale and distribution of GBL-containing supplements • Early 2000, GBL became federally “listed” chemical 40 What Makes GHB a Good DFR Drug • • • • • • • Easy to obtain Fast acting, sedative properties Mimics ethanol Amnesiac Rapidly eliminated from the body Many labs don’t have assays for GHB Naturally occurring 41 42 Hallucinogens • Although some are sedative, many of these function by causing dissociation – Semi-consciousness separation from sensation without deep CNS depression • Wide variety of hallucinogens – Hundreds – Many will not be analyzed for • 3 Categories: – Ketamine/PCP – Marijuana – Others (scopolamine, LSD, mushrooms, MDMA, etc.) 43 Special K Vitamin K Jet Super Acid Bump 44 Ketamine • Anesthetic induction agent since 1972 – Also used in veterinarian medicine • Structurally similar to PCP • Becoming a popular hallucinogen – Users deem effects superior to PCP or LSD • $40-50/half gram 45 What Makes Ketamine a Good DFR Drug • Has dissociative, analgesic, and mild sedative effects • Becoming popular drug of abuse – More readily available • Many times victim voluntarily ingests 46 47 What Makes Marijuana a Good DFR Drug • Is both a sedative, hallucinogen, and impairs memory • Nearly always voluntarily consumed • Additive effects when mixed with ethanol • Very easy to obtain 48 49 Opiates • Analgesics (“Pain Killers”) that also produce euphoria and a sense of well-being • Include codeine, morphine, hydrocodone, hydromorphone, meperidine • Strong CNS depression • Side effects may include nausea/vomiting and constipation 50 What Makes Opiates Good DFR Drugs • • • • Very sedating Analgesic effect Readily available May be voluntarily ingested 51 Antihistamines Antidepressants Barbiturates Chloral Hydrate Muscle Relaxants Zolpidem Telazol 52 Amitriptyline (Elavil®) • Causes heavy sedation – May be prescribed as anti-anxiety medication • Additive effects when combined with ethanol • Additional side-effects: – – – – – – – Dizziness Hallucinations Confusion Disorientation Incoordination Ataxia Weakness 53 Diphenhydramine (Benadryl®) • Antihistamine – One of the first effective • Becoming very popular drug of abuse • Available OTC • Some hallucinogenic properties at high doses • Other antihistamines cause similar effects (Chlorpheniramine; Brompheniramine) • Causes heavy sedation – May be prescribed for this 54 Chloral Hydrate • “Mickey Finn” • Oldest Sedative/Hypnotic still used today • Very rapidly metabolized; must look for metabolite (TCE) • Very strong sedative effect • Need to perform specialized assay to detect 55 Zolpidem (Ambien®) • Newer popular hypnotic agent • Not a benzodiazepine, but acts on the same receptor in the brain • Very low-dose medication • Most laboratories will not be able to detect at therapeutic levels • Metabolite is difficult to obtain 56 Telazol® • • • • • • Veterinary anesthetic agent Tiletamine (dissociative anesthetic) Zolazepam (tranquilizer) Increasingly popular drug of abuse No reported cases (yet) Potential of being good DFR drug since it possesses both sedative and hallucinogenic properties 57 58 Challenges Surrounding the Investigation • • • • Drugs Used Reporting the Crime Collection of Evidence Laboratory Methodologies 59 Recommendations for Victims of DFR • Collect the first urine • Call police • Get medical attention – Sexual Assault Kit • Be truthful about ethanol and drug use • Call a rape crisis center for information and support 60 Recommendations for Medical Professionals • GET URINE if reported within 96 hours of “drugging” – 100 mL (if available) • GET BLOOD if reported within 24 hours of “drugging” – 10 mL in gray-top tubes – Get additional blood for other forensic testing • Immediately refrigerate specimens • Document – when drug ingested – # of urinations – drug and/or medication used by victim – all symptoms of victim • Pick an appropriate forensic toxicology laboratory 61 Recommendations for Toxicologists • Know the LODs for your immnoassays!!! • Develop assays with very low LODS for common DFR drugs – < 10 ng/mL for benzodiazepines and ketamine – 1 g/mL for GHB • Know your limitations • Educate the public! 62 Conclusions • DFR cases are increasing • Many different drugs are being used - not just the ones reported in the media • Forensic toxicologists play a key role in the investigation of victim allegations • The successful investigation depends upon a “team approach” involving the law enforcement, medical professionals, scientists, and prosecutors 63 64 Tracy L. Bahm, Senior Attorney 65 American Prosecutors Research Institute Using Expert Testimony Example: Steven Sera case in Arkansas State of Arkansas v. Steven Sera, CN. 97-70-2, 10th Judicial District, Bradley County, Arkansas, March 10 - 13, 1998. Sera was convicted of rape, attempted rape, and the introduction of a controlled substance, Rohypnol. He was sentenced to 30 years per offense, served concurrently. He will be eligible for parole after serving 21 years. Three experts testified in the case. 66 1. Toxicologist: tests the urine sample in the lab • Testified about the fact that Rohypnol metabolites were found in the victim’s urine. • Explained what his analysis revealed, e.g. the levels of metabolites of flunitrazepam that were present in the sample. • Discussed the significance of high and low levels of Rohypnol in reference to how long ago the drug had been ingested. 67 2. Pharmacologist: use especially when there is no urine sample • Has a broader base of knowledge: can educate the jury as to what the drug does. • Testified about the properties of Rohypnol and benzodiazepines in general. • Discussed the general effects of the drugs • Discussed the effects of Rohypnol’s interaction with alcohol. • Discussed the residual effects of the drugs over different time periods. 68 3. Chemist: (may not need this witness) • Testified about the “solid dosage analysis”: the way the drug exists outside the body, e.g. the Rohypnol tablets themselves. (In Sera’s Arkansas case, the police found actual Rohypnol tablets in his apartment as well as other drugs). 69 What if no blood or urine sample? AKA REALITY EXAMPLE: Virginia Law • § 18.2-67.10 • RAPE = Sexual assault accomplished through use of the complaining witness’s mental incapacity or physical helplessness…. • § 18.2-61 • Physical Helplessness = unconsciousness or any other condition existing at time of offense which rendered CW physically unable to communicate unwillingness to act & accused knew/should have known 71 A Thorough Investigation is absolutely crucial!!! Teamwork is the Key… It starts with a properly trained Police Officer 72 Ask the sexual assault victim : • What does she remember before receiving the drink? • What were her symptoms before she passed out or blacked out? • Does she have any bits and pieces of memory of the sexual assault incident? • What does she remember about other individuals present? 73 • How much control did she have over her drink? • How much did she have to drink that night and how much does she normally drink? • In the past, if she has drunk excessively, what have been the physical effects? • Did she use any other drugs that night or has she at other times? 74 • Did she experience any unusual side-effects the day after? • Were any of her belongings stolen? • Was there anyone home when she came home? Did they notice anything unusual about her behavior and appearance? • Who was the first person she told about the incident? 75 Other factual witnesses • Interview friends of the victim– they may be able to fill in some of the “blanks” in the victim’s memory. • Try to account for as much of the victim’s lost time as possible. Interview everyone you can who saw her before or after the incident. • Interview bartender/waitperson/anyone else that saw the victim drinking– can they confirm how much & what the victim had to drink? 76 Drafting a Search Warrant Items to look for: 77 • Packages of Rohypnol and other drugs. • Bubble packages and other packaging. • Cooking utensils (for GHB). • Precursors/Reagents. (chemical ingredients of GHB). • Prescriptions from the U.S. and other countries. • Liquor bottles, Margarita Salt, mixers, etc. • Glasses, soda cans, and bottles … any containers. • Videotapes, photographs, and CD ROMs. • Victim souvenirs 78 • Pornographic literature containing suggestions of drugging women to facilitate sexual assault. • Videotape/camera equipment. • Standard sexual assault crime scene evidence (sheets, etc.). • Internet information/pamphlets on Rohypnol and GHB and on using these and other drugs in the commission of sexual assaults. • Computers and computer discs. • If robbery is suspected: the victim’s (stolen) possessions and pawn shop slips. 79 Pretext phone calls: (Getting the suspect to admit to any part of the crime) check the statute regarding the taping of conversations 80 Setting Up a “Controlled Buy” 81 IN ORDER TO SET UP A CONTROLLED BUY • The Assault Detective should connect with Street Narcotics Officers to determine potential “dealers”. • Suspect’s friends and/or school and/or neighborhood kids may be able to provide information on who is selling drugs in the area. 82 IN ORDER TO SET UP A CONTROLLED BUY • If the suspect is the dealer, a successful controlled buy identifies the drug and provides evidence that the suspect had access to the drug. • If the suspect is not the dealer, then locating the local/neighborhood dealer will help you identify the drug and show access. The dealer may also “flip” in exchange for a shorter sentence and identify the suspect as one of his “clients” and purchaser of the drug. 83 In order to set up a controlled Buy Piggy - Back Warrants If any drugs can be purchased from the suspect, you may be able to obtain a search warrant, which will enable you to search for the purchased drug and the suspected rape drug, as well as other evidence. 84 “It’s important to work together with victim advocates.” 85 CONCERNS OF THE SEXUAL ASSAULT ADVOCACY COMMUNITY REGARDING THE USE OF THE “FULL DRUG SCREEN” There is a recommendation in this video that prosecutors ask for full drug screens of victims of sexual assault who present with signs and/or symptoms of drug - facilitated sexual assault. The sexual assault advocacy community is very concerned about any recommendations in which victims of sexual assault are asked to provide specimens to be used for “full drug screening.” 86 Depending upon the results of such a drug screen, the information may be used by the defense to discredit the victim, thereby hurting her chances of a successful prosecution. In addition, the testing procedures for “date rape drugs” specifically are not currently standardized, therefore, some laboratories may not have the capabilities to run the tests necessary to detect small levels of Rohypnol or GHB. 87 It is essential that victims have an advocate available to thoroughly explain the ramifications of any type of drug testing, be it a full or partial drug screen. Without all of the accurate information, victims will not be able to truly give informed consent to such a test. 88 Law enforcement and/or prosecutors should not use the results of such a full drug screen (revealing the existence of other drugs in addition to “date rape” drugs) to automatically stop a sexual assault case from going forward in the criminal justice system. The presence of recreational drugs in addition to date rape drugs is not evidence of the victim’s consent to the sexual act. 89 Voluntary Consumption • Be aware that voluntarily taking GHB or any other drug does not mean that the victim is consenting to sexual intercourse, and does not negate a rape charge. 90 FOCUS ON: • • • • • • Victim’s account Statutory definition of incapacitated Statutory definition of consent Witness accounts Remember that the victim is PASSED OUT! Overcome jury nullification in voir dire w/ examples they can relate to…. – Unlocked door & burglary; – intoxicated & robbed 91 Teamwork The key to successfully prosecuting rapists who use drugs to incapacitate their victims is teamwork. Law enforcement, prosecutors, victim advocates, hospitals, laboratories, and the community all play a role. 92 There are many potential crimes that a suspect could be charged with: • Look at your State Statute for all possible sexual assault charges. • Be Imaginative… Rape may not be the only possible charge. 93 Other Potential Charges • • • • • • • • • Sexual Battery with an Incapacitated Victim Sexual Battery with a Helpless Victim Sexual Battery with a Deadly Weapon Aggravated Battery Kidnapping/False Imprisonment Drug Possession/Distribution Contributing to the Delinquency of a Minor (If applicable) Burglary/Robbery/Grand Theft Auto Adulteration of Food or Drink 94 20-minute Instructional Video for Prosecutors & Police Officers Accompanying Binder 95 Call us . . . APRI Tracy Bahm (703) 519-1679 [email protected] Website: www.ndaa-apri.org 96