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The author(s) shown below used Federal funds provided by the U.S.
Department of Justice and prepared the following final report:
Document Title: Estimate of the Incidence of Drug-Facilitated
Sexual Assault in the U.S.
Document No.: 212000
Date Received: November 2005
Award Number: 2000-RB-CX-K
This report has not been published by the U.S. Department of Justice.
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Department of Justice.
AWARD NUMBER 2000-RB-CX-K
ESTIMATE OF THE INCIDENCE OF DRUG-FACILITATED SEXUAL
ASSAULT IN THE U.S.
FINAL REPORT
Report prepared by:
Matthew Juhascik, Ph.D.^ Adam Negrusz, Ph.D. R.E. Gaensslen, Ph.D.
Draft report: Final report: March 23, 2005June 2, 2005
Forensic Sciences Department of Biopharmaceutical Sciences (M/C 865) College of Pharmacy University of Illinois at Chicago 833 South Wood Street Chicago, IL 60612
is most likely to be between these two estimates. This work is the first to include toxicological analyses with the subject’s statements to determine DFSA.
LIST OF ABBREVIATIONS
AMPS - Amphetamines BZ - Benzodiazepines BSTFA - Bis(trimethylsilyl)trifluoroacetamide CNS - Central Nervous System DEA - Drug Enforcement Agency DFSA - Drug Facilitated Sexual Assault DOA - Drug of Abuse FBI - Federal Bureau of Investigation GABA - Gamma Aminobutyric Acid GC/MS- Gas Chromatography / Mass Spectrometry GHB - Gamma-hydroxybutyrate IRB - Institutional Review Board LOD - Limit of Detection MBHFBA- N-Methyl-bis(heptafluorobutyramide) MDMA- Methylenedioxy-n-methylamphetamine MG - Milligram ML - Milliliter MTBSTFA- N-(tert-butyldimethylsilyl)-N-methyltrifluoroacetamide MTF - Monitoring the Future NAD - Nicotinamide Adenine Dinucleotide NCVS - National Crime Victimization Survey NFLIS - National Forensic Laboratory Information System
SUMMARY
Sexual assault is a serious problem that is estimated to affect 64 per 100,000 females each year. The use of drugs in sexual assault has recently been reported in journals and through the media. Individuals who use drugs, with or without alcohol, are thought to be at a significantly higher risk for sexual assault. In some cases, the substances are taken voluntarily by the victims, impairing their ability to make decisions. In other cases the substances are given to the victims surreptitiously which may decrease their ability to identify a dangerous situation or to resist the perpetrator. The term drug-facilitated sexual assault (DFSA) has been coined to describe this subset of sexual assault. However, it is not precisely known how often drugs are used to facilitate sexual assault. Some of the drugs that could be used in DFSA cause unconsciousness, impair the victim’s memory, or limit their decision-making ability. There has been one previous study that attempted to determine the prevalence of drugs in sexual assault complainants. However, the study only accepted subjects with a drug history or those who believed that they were given a drug surreptitiously. Analytically, the study did not include many prescription and over-the-counter drugs that could be used in DFSA. The study also did not attempt to determine if the subjects were victims of DFSA, only to describe the drugs in their system when they presented to the clinic. This study was developed to correct the problems in the previous study by accepting subjects without any bias. Urine and hair specimens were then analyzed for approximately 45 drugs that have either been detected in sexual assault victims, or whose pharmacology could be exploited for DFSA. Each case was then analyzed based on the subject’s description of the assault, the drugs they admitted to using, and the toxicology analysis. For this work, two definitions of DFSA were used; one only included presumed surreptitious drugging, while the
second included subject’s whose intended drug use may have led to the assault. The estimated prevalence of DFSA was then assessed. An IRB-approved, multi-jurisdictional study was conducted that included four regionally diverse clinics. The clinics were located in Texas, California, Minnesota, and Washington State. Each clinic was provided with sexual assault kits and asked to enroll willing sexual assault complainants. When a subject was enrolled, a urine specimen was initially provided. One week later, the subject was asked to provide an additional urine specimen as well as a hair specimen. The subject then completed a questionnaire describing the details about the alleged assault, as well as any illegal, prescription or OTC drugs they were using. The three specimens were then analyzed to evaluate the validity of self-reporting of sexual assault complainants, the number of drugs found in the subjects, and whether drugs that could be used in DFSA were found. Following this analysis, the results were combined with the subject’s account of the assault and evaluated as to whether DFSA was a possibility. A total of 144 subjects were enrolled from all four participating clinics with only two clinics supplying the desired amount of 35 subjects. The racial profile of the enrolled subjects correlates well with the census data for the U.S. The ages of the subjects ranged from 18 to 56 years of age, with a mean of 26.6 years, which corresponded well with previous studies on sexual assault complainants. Only 41% of the enrolled subjects returned for the second visit, which was considerably lower than desired. The analyzed drugs were found in 61.8% of the subjects with 4.9% positive for the classic “date-rape” drugs. For the evaluation of the validity of self-reporting of drug use, three drugs were employed; marijuana, cocaine, and amphetamines. These were chosen as they would
This study demonstrated the need for toxicological analyses in sexual assault cases. This is due to the high number of subjects positive for drugs and the subsequent need for a complete drug profile of the complainant. It was also demonstrated that sexual assault complainants severely underreport their illegal drug usage. This could be corrected if the administering nursing staff was better educated on taking a truthful drug history. This study also confirmed that DFSA is more of a problem due to the subject’s own drug use, rather than surreptitious drugging by the perpetrator.
I. INTRODUCTION
A. Sexual Assault Sexual assault is a problem significantly studied in the scientific literature (1-21). According to a 1998 survey, one in five women will be sexual assaulted in their lifetime (22). RAINN (www.rainn.org) estimates that an American is sexually assaulted every two minutes. In recent years, researchers have noticed a decline in the number of reported violent crimes in the United States, including rape and sexual assault (Table I). However, estimates of sexual assault incidence and prevalence are widely divergent for several reasons, but mainly in part because of underreporting of the crime. The Department of Justice uses two different programs to estimate the number of sexual assaults that happen each year in the U.S. and the numbers presented can vary widely between the programs. When using data provided by each of these programs, it is best first to examine how the two methods differ. While the methods for gathering data on specific crimes are internally consistent within each program, for the purposes of this work, only data on sexual assault is noted. The programs are the Uniform Crime Reports (UCR) conducted by the Federal Bureau of Investigation (FBI) and the National Crime Victimization Survey (NCVS) conducted by the Bureau of Justice Statistics (BJS). UCR began in 1929 and collects information about crimes based on their being reported to law enforcement. Each month, law enforcement agencies submit a report to the FBI that details how many sexual assaults have been reported in the previous month. In 2001, law enforcement agencies submitting to UCR represented 89.6% of the total population in the U.S. It should be noted that states which do not follow precise FBI guidelines in reporting are not represented in the final tallies (23). UCR’s main goal is to
of in the past year. If the interviewee has been the victim of a crime, it is further determined if the crime was reported and if not, the reason why it wasn’t reported. The NCVS works in conjunction with UCR by attempting to measure crimes that weren’t reported to law enforcement agencies. There are several major differences between UCR and NCVS that need to be addressed before analyzing data from either program. First, sexual assaults perpetrated on males are not included by UCR’s reporting, but are included by NCVS. It is commonly assumed that most sexual assaults are committed against females, however sexual assaults involving males is a reality (24). Therefore, the NCVS results could be more accurate in estimating total sexual assaults. Second, UCR’s data are based on reporting from a large percent of law enforcement agencies across the U.S. and any estimates for nonparticipating agencies represent a small percent of the total. NCVS estimates are based on a much smaller sample (160,000 interviews out of about 300,000,000 people) and thus any sampling error could bias the results. Despite NCVS’s small sample, it may provide better estimates for sexual assault due to the underreporting of sexual assault. There are several reasons why victims of a sexual assault may be unwilling to report the crime to a law enforcement agency. The main reason is that sexual assaults violate someone both physically and psychologically. Not only do victims suffer these effects during the assault, many have significant problems for years after the assault took place. Holmes et al. found in her study that 71.3% of sexual assault complainants expressed one or more fears following the alleged assault (5). The most common fear, retaliation, is expressed when the complainant knows the perpetrator and worries that by filing a police report, the perpetrator will
further cause harm to them. RAINN estimates that two-thirds of sexual assault victims knew the assailant. Holmes et al. found a comparable rate of 71% in her study (5). Many complainants also may not want friends and family to find out about the assault, so they do not report it. Some complainants also believe that the assault is their fault or that they will not be believed. Another factor in the underreporting of sexual assault could be if the complainant was using alcohol or drugs at the time of the alleged assault. Fear of prosecution may dissuade them from reporting the assault. Ledray et al. reported that complainants who were using alcohol or drugs were more likely to either delay reporting the assault or not report it at all (25). Another study found that 41.7% of the alleged victims studied had been using alcohol when victimized (2). Ledray notes that when sexual assault complainants do report to the hospital, only 68% are certain that they want to file a police report (25). When all of these factors are combined, it becomes clear that underreporting of sexual assaults is a reality. What is not known is to what degree sexual assaults are underreported. Another common characteristic of sexual assaults is reluctance among the complainants to follow-up their initial visit to the hospital. It is strongly suggested that sexual assault victims should be reassessed within 6 weeks of the assault (9). This follow-up will evaluate the mental health of the victim (i.e. presence of post-traumatic stress) and to confirm that HIV or other sexually transmitted diseases were not contracted during the assault. One retrospective study of 389 sexual assault complainants found that only 31% of the complainants returned for the recommended follow-up visit (5). This study also found that if the complainant had admitted to using drugs or alcohol, this
working in the late 1970’s, but their achievements were not officially recognized until 1995, when the American Nurses Association made SANEs a nursing specialty. Ledray’s study found that of the 38% of alleged victims that did not report the crime before presenting to the hospital, 12% did report after talking to a SANE. Only 3% were certain that they would never report, with the remaining 23% still undecided (25). This demonstrates that specialized nurses may be able to increase the amount of sexual assaults reported to law enforcement agencies. B. Drug-Facilitated Sexual Assault (DFSA) The idea of using a drug to incapacitate someone in order to victimize him or her is not novel. Chloral hydrate, historically referred to as a “Mickey Finn”, is one of the best-known examples of a drug that can be added into someone’s drink to induce unconsciousness. Alcohol is the best-known incapacitating drug found in sexual assaults, and the most studied (1, 27-30). It is commonly accepted that there is a high degree of correlation between alcohol intoxication and the risk of being sexually assaulted. However, in recent years there has been increased attention in the literature of people using other drugs to render their victims unconscious or lower their level of resistance with the intent to sexually assault them (7, 31-43). A common scenario might involve a young woman out at a bar. She meets a man who buys her a drink and she then proceeds to consume the beverage. The drink is normally alcoholic and she may have already had several drinks before meeting this man. But this drink is different; it has been spiked with a drug that will disorient and confuse her, facilitating the man’s attempts at getting the woman out of the bar and into a secluded location. Because the woman is in a bar and has been seen drinking alcohol,
other patrons would not find it odd that she is now having a hard time standing and must rely on the man to walk. He then leaves the bar with her and takes her some place where he can sexually assault her. During the assault, the woman may be completely unconscious or going in and out of consciousness. The next day when she wakes up, she may be in unfamiliar surroundings or at home confused as to how she got there. She may also feel sore in her vaginal or anal regions and wonder what happened to produce these pains. She may be wondering if she was sexually assaulted, but has no recollection of the event happening. Many people in this situation may not immediately go to the police or hospital to report a sexual assault. If they do not remember the sexual assault, they might believe that it did not take place or that they have no case against the perpetrator. This differs from sexual assaults that do not involve drugs because the complainant remembers the entire event and can describe exactly what took place to the proper authorities. Reporting of sexual assaults has been shown to be limited. If data from 1995 is examined when only 36% of sexual assaults were reported, how will this number change if DFSA is increasing? This question has not currently been answered. There is no known estimate of the number of DFSA’s that take place every year. There have been many anecdotal and news reports (44-47) on DFSA, but no scientific study has been conducted to examine this problem. Two studies have examined which drugs were present in sexual assault complainants. Slaughter’s work showed that two-thirds of the specimens collected (N=2003) were positive for alcohol and/or drugs (48). ElSohly’s research involved 1, specimens and 60.3% of their specimens tested positive for at least one drug (49). The two best-known so-called “date-rape” drugs, GHB and flunitrazepam, were found in less
DFSA also presents challenges for successful prosecution in court. In order to analyze a sexual assault complainant’s urine for drugs, the complainant must first give their consent for the analysis to happen. If they were using illegal drugs on their own accord, they may be worried about being prosecuted. The complainant may also believe that the presence of cocaine or marijuana in their system will weaken their story and cause the authorities to not believe that an assault happened. However, to conduct a thorough investigation of the alleged assault it is very important that investigators know exactly what was in the complainant’s system. Finding drugs in a sexual assault complainant does not always hurt their case. Wiley’s study of 132 sexual assault trials found that amnesia about the alleged assault negatively influenced the legal outcome, while alcohol or drug use had no effect (12). This is due to the fact that finding drugs with the ability to produce amnesia in the alleged victim may strengthen their case and provide a reason why they are unable to remember the assault. Another study found that cases involving alcohol were three times more likely to result in conviction, but as the alleged victim’s age increased, the likelihood of a conviction decreased (2). This was thought to be due to a generalized perception that older women are more sexually experienced. C. Date-Rape Drugs Any drug that is given to a sexual crime complainant before they are assaulted could be classified as a “date-rape” drug. However, we are only interested in drugs that could be given to the complainant in order to render them unable to consent to sexual activities. There are two well-known drugs that have been implicated in DFSA. Flunitrazepam, or Rohypnol®, is probably the best-known example of a “date-rape” drug
and has received the most attention in the literature (38, 39, 50-71). Flunitrazepam is a member of the benzodiazepine family, and is ten times more potent than diazepam (Valium®). Flunitrazepam binds to the GABA receptor in the CNS. GABA is an inhibitory neurotransmitter and when it binds to its receptor, chloride conductance increases leading to neuronal hyperpolarization resulting in less synaptic transmission. Flunitrazepam binds non-selectively to the omega receptors on the GABA receptor complex, enhancing the ability of GABA to bind to its receptor. There are several subtypes of the the omega receptor with omega-1 responsible for the sedative effects and omega-2 responsible for the amnestic effects. Flunitrazepam binds to both subtypes; however, it binds preferentially to the omega-2 receptor and thus exhibits more amnestic properties than other benzodiazepines (70). Flunitrazepam produces anterograde amnesia, which affects the ability to remember anything after taking the drug. This leaves the complainant with no recollection of the assault ever taking place. It has been shown that flunitrazepam interferes with the formation of new memories by disrupting the encoding of memories (33). Secondly, flunitrazepam begins to produce an effect very quickly (i.e. 20 to 30 minutes) and does not require a large dose to produce a state of unconsciousness (e.g. a 1 to 2 milligram tablet is given). There are several anecdotal stories of people on benzodiazepines, like flunitrazepam, who are able to function normally but have no memory of anything they did. Friends and co-workers do not realize anything is wrong until the medicated individual begins to replicate their actions (e.g. reports to work after already having been there for four hours) or asks questions that have already been answered (72). When combined with alcohol’s sedative effects, flunitrazepam becomes
