Drug-facilitated Sexual Assault Research Articles

A safe place to learn? Examining sexual assault policies at Canadian public universities

ABSTRACTSexual assault on university campuses is a pervasive problem that affects approximately 25% of female students and has wide-reaching negative outcomes [DeKeseredy, W., and K. Kelly. 1993. ‘The Incidence and Prevalence of Woman Abuse in Canadian University and College Dating Relationships.’ The Canadian Journal of Sociology 18 (2): 137–59; Krebs, C. P., C. H. Lindquist, T. D. Warner, B. S. Fisher, and S. L. Martin. 2009. ‘College Women’s Experiences with Physically Forced, Alcohol- or Other Drug Enabled, and Drug-Facilitated Sexual Assault Before and Since Entering College.’ Journal of American College Health 57 (6): 639–49]. It is important that universities develop and implement comprehensive policies and procedures to address this complex issue. This research explores sexual assault-related policies (N = 119) at all public universities in Canada (N = 72). We examine four elements suggesting comprehensiveness of a university’s sexual assault response (policy comprehensiveness, availability of campus support resources, and sexual assault information webpage presence and comprehensiveness), and test whether these elements are related to various institutional features. Results show significant differences related to university characteristics across the measures of comprehensiveness, and indicate a need for increased focus at the institutional level to ensure that policies are sufficiently comprehensive to handle the complexities that arise in sexual assault cases.

Direct Monitoring of Exogenous γ-Hydroxybutyric Acid in Body Fluids by NMR Spectroscopy.

γ-Hydroxybutyric acid (GHB) is a popular drug increasingly associated with cases of drug-facilitated sexual assault (DFSA). Currently, expanding procedures of analysis and having forensic evidence of GHB intake in a long term are mandatory. Up to now, most studies have been performed using GC/MS and LC-MS as analytical platforms, which involve significant manipulation of the sample and, often, indirect measurements. In this work, procedures used in NMR-based metabolomics were applied to a GHB clinical trial on urine and serum. Detection, identification, and quantification of the drug by NMR methods were surveyed, as well as the use of NMR-based metabolomics for the search of potential surrogate biomarkers of GHB consumption. Results demonstrated the suitability of NMR spectroscopy, as a robust nondestructive technique, to fast and directly monitor (detect, identify, and quantify) exogenous GHB in almost intact body fluids and its high potential in the search for metabolites associated with GHB intake.

Hair testing of GHB: an everlasting issue in forensic toxicology.

In this paper, the authors present a critical review of different studies regarding hair testing of endogenous γ-hydroxybutyrate (GHB), concentrations in chronic users, and values measured after a single GHB exposure in drug facilitated sexual assault (DFSA) cases together with the role of a recently identified GHB metabolite, GHB-glucuronide. The following databases (up to March 2017) PubMed, Scopus and Web of Science were used, searching the following key words: γ-hydroxybutyrate, GHB, GHB glucuronide, hair. The main key words "GHB" and "γ-hydroxybutyrate" were searched singularly and then associated individually to each of the other keywords. Of the 2304 sources found, only 20 were considered appropriate for the purpose of this paper. Summing up all the studies investigating endogenous GHB concentration in hair, a very broad concentration range from 0 to 12 ng/mg was found. In order to detect a single GHB dose in hair it is necessary to commonly wait 1 month for collecting hair and a segmental analysis of 3 or 5 mm fragments and the calculation of a ratio between the targeted segment and the others represent a reliable method to detect a single GHB intake considering that the ratios presently proposed vary from 3 and 10. The only two studies so far performed, investigating GHB-Glucuronide in hair, show that the latter does not seem to provide any diagnostic information regarding GHB exposure. A practical operative protocol is proposed to be applied in all suspected cases of GHB-facilitated sexual assault (GHB-FSA).

Drug-Facilitated Sexual Assault and Chemical Submission

In recent years, the use of psychoactive substances for sexual assault has taken on a greater role. The practice of sexual crimes associated with drug use is called Drug-Facilitated Sexual Assault (DFSA), while 'Chemical Submission' (CS) is used to include all type of crimes related to this activity. This paper reviews the epidemiology of this type of offenses, the main characteristics of the chemical substances consumed and the profiles of victims and aggressors. There have been also addressed principal signs of clinical suspicion to detect possible victims and the keys to the toxicology screening in case the victim presents evidences of being subject to chemical submission.

Further evidence for GHB naturally occurring in common non-alcoholic beverages

GHB has been implicated in many cases of suspected surreptitious administration with the purpose of increasing victim vulnerability to sexual assault. Low amounts of endogenous (or naturally occurring) GHB, which do not reach pharmacologically active levels, have been detected in alcoholic and non-alcoholic beverages. Due to the continued requirement to obtain data on the presence of endogenous GHB in various beverage types, GHB concentrations were measured in a series of non-alcoholic beverages.Tonic water and lemon flavoured tonic water beverages were analysed at 0, 24 and 96h after the bottle opening using gas chromatography coupled to tandem mass spectrometry (GC–MS/MS) on an Agilent 6890/7000C Triple Quadrupole. GHB was detected in all beverages at very low amounts ranging from 89 to 145ng/mL (0.089–0.145mg/L) and did not demonstrate a general trend of variation for concentration along the tested time span (96h). The presented data provide additional evidence for the endogenous nature of GHB in non-alcoholic beverages at very low concentrations, which are many orders of magnitude lower than those described to produce any pharmacological effect on the subject. However, when considering a case of alleged drug-facilitated sexual assault, a low level of GHB detected in a drink may be related both to a surreptitiously GHB administration with subsequent dilution for concealment or to the presence of endogenous GHB. On this basis, a comprehensive analysis of all the available information, including circumstantial data demonstrating possible attempts to conceal GHB administration and an assessment of levels of endogenous GHB in the suspected beverage type, is of the utmost importance for a proper interpretation of the toxicological results.

Alleged drug-facilitated sexual assault in a Spanish population sample

Between 2010 and 2013, the National Institute of Toxicology and Forensic Sciences (Madrid, Spain) conducted a descriptive and retrospective study on alleged drug-facilitated sexual assault (DFSA) cases reported during this period. Out of a total of 445 received, 152 alleged sexual assault cases were assessed. The case-selection criterion was the presence of factors associated with suspected DFSA. Analysis revealed the victims’ profile corresponded to that of a young woman who admitted to drinking alcohol in entertainment venues prior to the sexual assault and who claimed total or partial amnesia about the facts. Biological samples sent for toxicological analysis were blood (28.9%), urine (15.8%) or both (53.9%) and they were mostly collected between 6 and 12h after the incidents (40.33% of documented cases). Toxicological analyses were positive in 85.5% of the cases; the substances identified being ethanol (76.9%), pharmaceuticals (36.1%, mainly benzodiazepines) and illicit drugs (29.2%, mainly cocaine), either alone or in combination.

Postmortem concentrations of gamma-hydroxybutyrate (GHB) in peripheral blood and brain tissue — Differentiating between postmortem formation and antemortem intake

Gamma-hydroxybutyrate (GHB) is a recreational drug, a drug of abuse, as well as an endogenous molecule in mammals. The drug has become infamous as a tool for drug-facilitated sexual assault. GHB is found in low concentrations in living humans, while at postmortem the concentration of GHB rises due to fermentation processes. The endogenous nature of GHB leads to difficulty in interpretation of concentrations, as the source of GHB is not obvious.Postmortem brain and blood samples were collected from 221 individuals at autopsy. Of these, 218 were not suspected of having ingested GHB, while GHB intake was reported for the last three (cases A–C). Decomposition level was estimated and cases classified into no/minor and advanced decomposition. Brain samples were extracted from the frontal lobe; only gray matter from the cerebral cortex was used. Blood was drawn from the femoral vein. Brain samples were homogenized and diluted with water. Brain homogenates or femoral blood were then prepared using protein precipitation and GHB was quantified with UHPLC–MS/MS.For 189 cases where ingestion of GHB was not suspected and where no/minor decomposition had occurred the concentrations were in the range 4.8–45.4mg/kg (median 15.3mg/kg) in blood and not-detected to 9.8mg/kg (median 4.8mg/kg) in brain tissue. For case A, where intoxication with GHB was deemed to be the sole cause of death, the concentrations were 199 and 166mg/kg in blood and brain, respectively. For case B, where intoxication with GHB was a contributing factor of death, the respective concentrations were 142 and 78.4mg/kg. For case C, where GHB was ingested but the cause of death was opioid poisoning, the concentrations were 40.3 and 12.7mg/kg.The results demonstrate that postmortem-formed levels of GHB are much lower in brain than peripheral blood. Analysis of GHB in brain tissue thus provides for an improved capability to identify an exogenous source of GHB. By measuring GHB in brain tissue and employing a cut-off concentration of 10mg/kg, a tentative distinction can be made between an endo- and exogenous source of GHB. An exception to this strategy is for extensively decomposed corpses, where endogenous GHB concentrations can be high even in brain.

A long-lived iridium(iii) chemosensor for the real-time detection of GHB.

Gamma-hydroxybutyric acid (GHB) is a commonly used "date rape" drug in drug-facilitated sexual assaults (DFSA) due to its low price and ready availability, and it is more quickly excreted from the human body than other drugs. Therefore, the development of a real-time detection method for GHB could help facilitate law enforcement agencies in tackling DFSA. In this work, a long-lived iridium(iii) chemosensor 1 has been synthesized for the switch-off detection of GHB. Upon addition of GHB to an aqueous solution of the iridium(iii) complex 1, a significant luminescence quenching occurred that could be observed by the naked eye under UV illumination. The luminescence signal of the iridium(iii) complex 1 could also be distinguished from strongly fluorescent media using time-resolved emission spectroscopy.

Determination of cause of death using paper-based microfluidic device as a colorimetric probe

In recent years, the use of benzodiazepines has increased in the commission of crime, homicide, suicide, drugs overdoses, robbery, and drug-facilitated sexual assault.

Development and validation of a HPLC–QTOF-MS method for the determination of GHB-β-O-glucuronide and GHB-4-sulfate in plasma and urine

Gamma-hydroxybutyric acid (GHB) is used as a so-called knock-out drug in drug-facilitated sexual assault. Due to GHB’s short detection window in blood and urine, crime verification remains problematic in many cases. Phase II metabolites can enhance the detectability and prolong the detection window of some lower-molecular-mass molecules, as exemplified by ethanol. GHB-β-O-glucuronide (GHB-Gluc) was recently introduced as one phase II metabolite, and GHB-4-sulfate (GHB-Sulf) was also postulated to represent a urinary metabolite of exogenous GHB. To unambiguously verify the presence of GHB-Sulf in urine, the reference standard material of GHB-Sulf was synthesized, together with its deuterated analogue, GHB-Sulf-d6. This reference standard material, together with GHB-Gluc and GHB-Gluc-d4, was employed to develop and validate a quantitative method for determining both target analytes in plasma and urine samples. Compounds were separated by high-performance liquid chromatography on a Hypercarb column and detected by electrospray ionization time-of-flight-mass spectrometry. Calibration curves were linear over the entire calibration range up to 20 mg/L, and quantification limits of <0.01 mg/L were achieved. Accuracy and interday and intraday precision fulfilled all forensic guidelines criteria. In plasma, only GHB-Gluc was detected, while both metabolites were clearly identified in urine, even in real human specimens. Stability was investigated under different temperature conditions for up to 4 weeks, and both phase II metabolites were found to be stable under refrigerated conditions. This method proved to be suitable for this purpose, and allowed for the first time the analysis and quantification of two different GHB metabolites from plasma and urine samples.

An Examination of Victim, Assailant, and Assault Characteristics among Cases Classified as Predatory Drug-Facilitated Sexual Assault

IntroductionDrug-facilitated sexual assault (DFSA) can be characterized as predatory, where the survivor is covertly or forcibly administered an incapacitating or disinhibiting drug. The purpose of our study was to determine what factors, if any, are associated with cases classified as predatory DFSA. MethodsCases were classified on toxicological testing as predatory where there was an unexpected drug(s) found and non-predatory where a drug(s) found had been voluntarily consumed or no drugs at all were found in collected urine samples. ResultsOne hundred eighty-four suspected intentional drugging cases were seen at one of seven participating hospital-based sexual assault treatment centers. Urine specimens were analyzed from 178 of these cases, of which 48.9% were classified as predatory. In a logistic regression model, the odds of having experienced a predatory DFSA were lower if the survivor was a student or assaulted by a single assailant, but higher if the survivor self-reported mental health problems in the previous 6 months or that the mode of suspected drugging was a recreational drug or non-alcoholic drink (versus an alcoholic drink). ConclusionsThese differences in survivor, assailant, and assault characteristics between cases classified as predatory and non-predatory DFSAs may have important implications for intervention and prevention.

Simultaneous analysis method for GHB, ketamine, norketamine, phenobarbital, thiopental, zolpidem, zopiclone and phenytoin in urine, using C18 poroshell column.

Date-rape drugs have the potential to be used in drug-facilitated sexual assault, organ theft and property theft. Since they are colorless, tasteless and odorless, victims can drink without noticing, when added to the beverages. These drugs must be detected in time, before they are cleared up from the biofluids. A simultaneous extraction and determination method in urine for GHB, ketamine, norketamine, phenobarbital, thiopental, zolpidem, zopiclone and phenytoin (an anticonvulsant and antiepileptic drug) with LC-MS/MS was developed for the first time with analytically acceptable recoveries and validated. A 4 steps liquid-liquid extraction was applied, using only 1.000mL urine. A new age commercial C18 poroshell column with high column efficiency was used for LC-MS/MS analysis with a fast isocratic elution as 5.5min. A new MS transition were introduced for barbital. 222.7>179.8 with the effect of acetonitrile. Recoveries (%) were between 80.98-99.27 for all analytes, except for GHB which was 71.46. LOD and LOQ values were found in the ranges of 0.59-49.50 and 9.20-80.80ngmL(-1) for all the analytes (except for GHB:3.44 and 6.00μgmL(-1)). HorRat values calculated (between 0.25-1.21), revealed that the inter-day and interanalist precisions (RSD%≤14.54%) acceptable. The simultaneous extraction and determination of these 8 analytes in urine is challenging because of the difficulty arising from the different chemical properties of some. Since the procedure can extract drugs from a wide range of polarity and pKa, it increases the window of detection. Group representatives from barbiturates, z-drugs, ketamine, phenytoin and polar acidic drugs (GHB) have been successfully analyzed in this study with low detection limits. The method is important from the point of determining the combined or single use of these drugs in crimes and finding out the reasons of deaths related to these drugs.

Codeine-spiked beer in a date rape case?

A case of suspected drug-facilitated sexual assault, involving codeine and acetaminophen, possibly mixed in beer, was recently addressed at the Norwegian Institute of Public Health. To examine the case, a small study was performed, spiking beer with preparations containing codeine and acetaminophen and observing the concentrations, appearance, and taste of the solutions. The study revealed the majority of the preparations to be quickly soluble in beer, achieving high concentrations, but at the expense of strong taste and drastic visible changes in the beer.

Flunitrazepam Conversion by CYP3A4 is Altered by Caffeine and Ethanol

Flunitrazepam (FNTZ) is prescribed to treat insomnia due to its sedative effects. These effects have been abused in cases of drug-facilitated sexual assault (DFSA), where the drug is slipped into a drink, typically containing the compounds ethanol and caffeine. Both of these compounds have been shown to interact with CYP3A4, a liver enzyme responsible for the metabolism of FNTZ. Steady-state kinetics of CYP3A4 conversion of FNTZ were measured to evaluate what effects caffeine and/or ethanol have on enzyme activity. The rate of formation for the two metabolites, 3-hydroxyflunitrazepam (3-OH FNTZ) and desmethylflunitrazepam (DM FNTZ), was shown to decrease in the presence of caffeine or ethanol. The conversion rate of 3-OH FNTZ had a reduction in kcat of about 77% when incubated with 14 mM caffeine. DM FNTZ had similar but less drastic effects, with a kcat reduction of about 19% with 14 mM caffeine. After a replot, the Kis of 3-OH were determined to be 9.1 mM and 224.1 mM for caffeine and ethanol, respectively. Alprazolam (ALP) and diazepam (DZ), two other drugs in the family that includes FNTZ were also analyzed. ALP to 4-hydroxy alprazolam (4-OH ALP) conversion was found to be reduced by 40%, and DZ to nordiazepam conversion was found to be reduced by 20% in the presence of 200 μM and 20mM ethanol. When taken together, the combination of the inhibitory potential of these compounds can begin to provide an explanation of the effects in cases of DFSA.

Triazolam Impairs Avoidance Reaction-A Scientific Proof Why the Victim does not Escape from Drug-Facilitated Sexual Assaults

Following closely behind levels in Western countries, the number of drug-facilitated sexual assaults (DFSAs), involving the illicit use of medicine, has been recently increasing in Japan. Tirazolam is the most frequently used date-rape drug in DFSAs occurring in Japan. In this study, the effect of triazolam on behavior in response to fear and anxiety was evaluated using an elevated plus-maze test in mice. Triazolam-treated animals (0.01 mg/kg) showed no significant difference in total locomotor activity compared with vehicle-treated mice (controls). On the contrary, activity levels on the open arms of the apparatus (time spent, mean value of movement), where mice would normally feel anxiety or fear, were significantly increased in triazolam-treated mice compared with controls. However, total locomotor activities on the plus-maze were not different between two groups, indicating that sedation was not induced by tirazolam under these conditions. These results suggest that triazolam treatment led the mice to become insensitive to fear and anxiety; their defence reactions were impaired. We conclude that this finding provides scientific evidence in reply to defence arguments presented in court trials that there is little or no evidence of the victim attempting to escape from a sexual assault. Additionally, the finding is as true of other benzodiazepine receptor agonists as of triazolam.

Detection of synthetic cathinones in victims of sexual assault

Drug facilitated sexual assault (DFSA) can be defined as sexual activity occurring whereby the victim is incapacitated by drugs and/or alcohol and thereby unable to consent. A new wave of designer drugs is emerging in the community at large and one group, the synthetic cathinones, is described in this study.Analyzing urine samples from reported sexual assaults submitted to the University of Miami Toxicology Lab in 2013 determined that methylone has become a popular drug encountered in these cases. Derivatization of these synthetic cathinones enabled a validated a qualitative method to identify ten different designer drugs.Of the forty-five sexual assault samples submitted, 13% were positive for synthetic cathinones without any toxicological finding of ethanol, GHB or ketamine. This study illustrates the recent correlation of drug-facilitated sexual assaults and the use of synthetic cathinones.

A potential new metabolite of gamma-hydroxybutyrate: sulfonated gamma-hydroxybutyric acid.

Detection of gamma-hydroxybutyric acid (GHB) became crucial in many clinical and forensic settings due to its increasing use for recreational purposes and drug-facilitated sexual assault. Its narrow window of detection of about 3-12 h in urine represents a major problem. Analogous to ethyl glucuronide, the recently identified GHB-glucuronide exhibits a longer window of detection than the parent drug. It appeared reasonable that a sulfonated metabolite of GHB (GHB-SUL) will also be formed. Due to the lack of an appropriate standard, GHB was incubated with a human liver cytosolic fraction to produce GHB-SUL. Following development of a liquid chromatography/tandem mass spectrometry (LC-MS/MS) assay to measure GHB and GHB-SUL, authentic urine samples (n = 5) were tested for GHB-SUL. These investigations revealed detectable signals of both GHB and GHB-SUL, strongly indicating that GHB is not only glucuronidated but also sulfonated. Given that sulfonated metabolites generally have longer half-life times than the corresponding free drugs, GHB-SUL may serve as a biomarker of GHB misuse along with its glucuronide.

Characterizing Drug-Facilitated Sexual Assault Subtypes and Treatment Engagement of Victims at a Hospital-Based Rape Treatment Center.

Variation among existing studies in labeling, defining, identifying, and subtyping cases of suspected drug-facilitated sexual assault (DFSA) poses challenges to integrating research findings for public health purposes. This descriptive study addressed methodological issues of nomenclature and DFSA operational definitions to improve case identification and was designed to distinguish assault subtypes. We studied a 2-year ethnically diverse cohort of 390 patients who presented acutely to an urban rape treatment center (RTC). We abstracted data from RTC medical and mental health records via chart review. Assault incidence rates; engagement into medical, forensic, and mental health services; injury sustained; and weapon use were calculated separately for assault subtypes and compared. DFSA accounted for over half of the total sexual assault (SA) cases. Involuntary DFSA (in which an incapacitating substance was administered to victims without their knowledge or against their will) increased from 25% to 33% of cases over the 2-year period. DFSA victims presented sooner, and more often attended medical follow-up and psychotherapy than non-DFSA victims. Incidence rates indicated increasing risk for young males. These findings indicate that DFSA continues to be a growing and complex phenomenon and suggest that DFSA victims have greater service needs. The field would benefit from innovations to address symptomatology arising from this novel type of trauma and the unique risks and needs of male victims, as well as underscoring the ongoing need for DFSA-specific prevention efforts for both victims and perpetrators.

GHB in Biological Specimens: Which Cut-off Levels Should be Taken into Consideration in Forensic Toxicological Investigation?

Gamma-hydroxybutyrate (GHB) is a central nervous system depressant endogenously produced and also employed as a recreational drug of abuse since the 90s, attracting notable attention particularly in those cases of drug facilitated sexual assault (DFSA). The implication of GHB among DFSA cases generates numerous concerns, making the interpretation of the toxicological findings often significantly difficult. In this review the Authors have explored GHB behaviour in ante-mortem and post-mortem specimens, taking into consideration its endogenous production, the post mortem interval, the time between sampling and analysis, the storage conditions (temperature and presence/absence of preservatives) and the usefulness of alternative matrices such as hair, bile and vitreous humour. Moreover, the cut-off values currently recommended in forensic toxicology in order to discriminate between endogenous and exogenous levels have been examined.

Epidemiology of drug-facilitated sexual assault

Epidemiology of drug-facilitated sexual assault