Stay informed about date rape drugs
Learn to recognize the reactions they can cause
Several date rape drugs have been widely publicized, but there are many more commonly used substances, says Patty C. Feneski, RN, ENP, prehospital coordinator at Desert Samaritan Medical Center in Mesa, AZ. "The three drugs you usually hear about are gamma hydroxybutyrate (GHB), Rohypnol, and ketamine, but they certainly aren’t the most common ones," she says.
Any drug that causes central nervous system depression can be used to facilitate rape, says Feneski. "You can put any drug in a drink. This includes benzodiazepenes, opiates, amphetamines, barbiturates, and cocaine. Chlorohydrate is a drug that’s been around since the 19th century, and is still used as a knockout pill."
Alcohol is by far the most common drug used in sexual assault, says Feneski. "Alcohol is a central nervous system depressant, and the drug I’ve found most often in victims of sexual assault," she notes. "There are four stages of depression. The first stage is sedation, with decreased mental and physical response to stimuli. The second stage is disinhibition, where rapes can occur, and there is impaired judgment and loss of control. The third stage is sleep, and the fourth is anesthesia."
There actually have been very few cases of Rohypnol use in sexual assaults, reports Feneski. "Rohypnol certainly can be used, but it’s not common. It’s not marketed in this country, but you can get it in Mexico. However, Hoffman La Roche has reduced the number of pharmacies that have it," she adds.
Here are some things to consider when managing patients who may have been victims of drug-facilitated sexual assault:
• Know signs of date rape drugs. Some signs a patient may have been a victim of drug-facilitated rape include:
— inability to remember details of the assault;
— confusion;
— impaired judgment;
— dizziness;
— drowsiness and impaired coordination;
— appearance of intoxication, despite lack of alcohol consumption, or out of proportion to the amount of alcohol consumed.
• Patients may say they think they’ve been raped, but aren’t sure. "They might have awakened in a strange place with their clothes off, or been redressed with their clothes on backward," Feneski says.
• Victims may not have full memory of the assault. "For example, ketamine is used as a veterinary anesthetic, but it also has amnesiac qualities. So patients will have spotty memory, seem disoriented, and won’t have all the details," Feneski notes. "If the history is vague, say, You seem fuzzy on details; are you having trouble remembering?’ If they say yes, ask if there is any potential that they have been drugged."
• Victims of date rape drugs can have a wide spectrum of behavior. "They may come in crying hysterically because they think something’s happened and don’t remember, or they may be very calm and controlled and not talk much," explains Feneski.
• Suggest to police and physicians that a urine sample be sent to a federally certified forensic toxicology lab. "They can test for some specific things that our tests in hospitals and routine crime labs don’t usually pick up," says Fenseski. "We don’t screen quite as carefully, and some of our tests aren’t as sensitive as ones they use."
A free drug testing service is available to EDs at the ElSohly Laboratories in Oxford, MS, whose cost is underwritten by Hoffman La Roche. The testing program can be accessed by calling a toll-free hotline, and a strict chain-of-custody procedures is followed.
"They will fax you a form to complete and give you a FedEx number to send the urine sample," says Feneski. "The results are sent back confidentially in about a week." (See list on p. 108 for contact information.)
As of this year, 1,598 samples were tested at the lab, says Feneski. "Six hundred sixteen of the tests didn’t find any drugs at all; and several of the tests were positive for more than one substance, including 649 for alcohol, 292 for marijuana, 218 for a benzodiazepene other than Rohypnol, 137 for cocaine, 115 for amphetamines, 59 for GHB, 47 for opiates, 21 for propoxyphene, 18 for barbiturates, seven for Rohypnol, and one for PCP," she reports.
• Don’t be suspicious of delayed reports. "Many of these reports are delayed, because the victim will be asleep for awhile. It may be the next morning before they come in," she says. "People tend to question the delayed report more. However, a study of false allegations found they were all reported in a timely manner, so that refutes that old myth."1
• Obtain a urine sample promptly. "If patients call before coming to the ED, tell them if they have to void, to save the urine and bring it in with them in a sealed jar," says Linda Ledray, PhD, RN, FAAN, director of the Sexual Assault Resource Service in Minneapolis. "This is something new that we’re just learning."
If it was a potentially drug-facilitated rape, the urine sample should be obtained as quickly as possible, says Ledray. "Substances are metabolized so quickly out of the system, that if there is a delay, the likelihood of positive results goes down dramatically," she explains. "We have collected samples up to 36 hours later, but never got positive results beyond 27 hours. The best results come from samples taken within six, seven, or eight hours of the incident."
Reference
1. Garardin B, et al. The Color Atlas of Sexual Assault. St. Louis: Mosby;1997.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content