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Transcript
DRUG FACILITATED SEXUAL ASSAULT (Content areas reflective of current practice 7/16/09 – revise as appropriate to reflect current standards of care.) 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 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 MOST Common “Date Rape” Drugs GHB Ketamine Ecstasy Alcohol Challenges Surrounding Reporting Is it even reported ? Time elapsed since drugging Convincing law enforcement Is the victim being truthful? Challenges With Evidence Collection Proper specimens Enough specimens Preservation of specimens Testing facilities 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. 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. 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 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 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 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. Gammahydroxybuterol GHB Liquid E Grievous Bodily Harm Soap Georgia Home Boy Easy Lay Scoop Salty Water Blue Verve Goop G Gamma - oh 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 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 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 Ketamine Special K Vitamin K Jet Super Acid Bump Kit Kat Cat Valium 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 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 What Makes Ketamine A Good DFSA Drug? Dissociative, analgesic and mild sedative effects Popular drug of abuse Readily available Often victim voluntarily ingests Ecstacy X XTC Candy Love Drug Light Show Hug Drug Smurfs Love Drug 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 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 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 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 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