Drug-Facilitated Sexual Assault

1. National Judicial Education Program Drug-FacilitatedSexual Assault US Department of Justice Federal Bureau of Investigation FBI Laboratory Chemistry Unit Washington, DC 20535 (202) 324-4329

2. 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. Ethanol Benzodiazepines Flunitrazepam Clonazepam Lorazepam Alprazolam Triazolam Chlordiazepoxide Diazepam Temazepam Zolpidem Barbiturates GHB Ketamine Opiates Antihistamines Hallucinogens Antidepressants Chloral Hydrate Muscle Relaxants Clonidine Yohimbine Drugs Reportedly Used to Commit DFR

7. Challenges with Drugs that are Used • Dosages • Number of Candidates • Pharmacokinetics • Pharmacodynamics

8. Fate of Drugs in Body Distribution Absorption Blood Excretion Biotransformation (Metabolism)

9. Absorption and Distribution Metabolism and Excretion Conc Plasma Urine Time Where is the Drug ???The Toxicological Problems

10. Challenges SurroundingReporting of the Crime • Is it Even Reported? • Time Elapsed Since Drugging

11. El Sohley Study:Time of Collection vs % Positives % Hours Since Drugging M.A. ElSohly, S.J. Salamone. Journal of Analytical Toxicology, May/June 1999, pages 141-146

12. Challenges SurroundingReporting 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. Ethanol

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. Benzodiazepines 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 BenzodiazepinesGood 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

26. Pharmacology of Flunitrazepam • Metabolized to 7-Aminoflunitrazepam, 3-OH-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 1.5-4.0 hours • Urinary metabolites are glucuronide conjugates of hydroxylated products

31. Any Questions?

32. GHB 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

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 GHBa 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. Hallucinogens

42. 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.) Hallucinogens

43. Ketamine 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 Ketaminea Good DFR Drug • Has dissociative, analgesic, and mild sedative effects • Becoming popular drug of abuse • More readily available • Many times victim voluntarily ingests

46. Marijuana

47. What Makes Marijuanaa 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. Opiates

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 OpiatesGood DFR Drugs • Very sedating • Analgesic effect • Readily available • May be voluntarily ingested