Drug Facilitated Sexual Assault is poorly understood and often not adequately investigated. This program seeks to describe the reality of drug facilitated sexual assault and to point out ways to improve outcomes for victims, law enforcement and social service providers.

1. Dr. Janet Parker DVMMedical Whistleblower

2. Sexual Assault There are 198,850 sexual assaults each year Disabled Women - rate of abuse and rape twice that of the general population of women. 545 women are raped every day Only one in 50 women who have been raped reports the crime to the police National Crime Victims Rights Resource Guide 2005

3. False Reports? Did you know that... Less than 2 percent of the reported rape cases are found to be false. "More people falsely report their own death than file a false report alleging sexual assault.” It is more likely that women will not report a rape that occurred. (Federal Bureau of Investigation statistics)

4. DFSA Definition Victim is subjected to non-consensual sexual act(s) while incapacitated by alcohol and/or drugs Effect of the substance(s) prevents resistance and ability to consent

5. Myth: Stranger in the club or singles bar Reality is: Perpetrator could be a date or a trusted “friend” Health care provider in a medical setting Could be a neighbor Drug can be placed in non-alcoholic beverage Can occur at a workplace, a church or any social gathering

6. DFSA Victims All social categories, race, ethnicity, education levels, social and economic classes, sexual orientation, religions, and physical and mental abilities.

7. DFSA Effects Fear, profound psychological damage to victim, serious injury, or death Adverse long-term psychological, emotional, physical, and economic effects on all family members and affects the community at large

8. Statistics 1 in 6 women has been the victim of an attempted or completed rape in her lifetime. Among developmentally disabled adults, as many as 83% of the females and 32% of the males are the victims of sexual assault About 44 percent of rape victims are under age 18. One in 10 is male.

9. Workplace Violence 29,000 acts of rape or sexual assault in the workplace each year Both an emotional and financial impact on the workplace Victims report diminished work functioning and even loss of their employment

10. Criminal Profileof a Rapist In about two-thirds of all rape cases, the victim knows the assailant. 99 in 100 are male 6 in 10 are white Average age is the early 30s

11. DFSA Rapists Strongly defend their violence by denying, minimizing, blaming, justifying, and rationalizing their behavior. Appear logical and rational when convincing others of their innocence.

12. Rapists Control the Victim Rape drugs make it relatively easy for rapists to gain control of their victims. They can even make it seem as though the victim is consenting. Drugs they administer immobilize and silence the victim. Rapist does not have to overcome any form of resistance. No need for physical force or threats.

13. Many Repeat Offenders Drugs used often cause rapid loss of ability to walk –the assault very near the location of the drugging Perpetrators target someone who can be easily “carried” home – The Rescuer, The Helper

14. DFSA Rapist Criminal Profile High functioning Grandiose, self-absorbed Narcissistic Appear to be functioning well Two groups College students Men > 30 years of age Often single (never married or divorced)

15. Modus operandi Good verbal social skills, “Wine and dine” Charming, Usually not psychiatrically ill Can quickly establish “trust” Usually not drunk or stoned, Very much in control of the situation Usually not violent, Often makes NO effort to hide identity In the morning, dares her to tell someone

16. Act Out Fantasies Anal sex Ejaculate onto victim’s face, into the mouth Shave the victim Dress the victim up in “special” clothes

17. DFSA v Coercive Rapist General lack of violence Clothes not torn off No mutilation No threats prior to the rape – maybe a threat afterwards that no one will believe her DFSA have superb verbal skills

18. Clinical Psychologist Dr. Nicholas Groth “ All sexual assault is an act of aggression, regardless of the gender or age of the victim or the assailant. Neither sexual desire nor sexual deprivation is the primary motivating force behind sexual assault. It is not about sexual gratification, but rather a sexual aggressor using somebody else as a means of expressing their own power and control” author of Men Who Rape: The Psychology of the Offender

19. Serial Rapists Drug rapists are most commonly serial rapists……..They will commit this crime again. Rapists usually have raped approximately 14 times for each time they are caught

20. Two Common Presentations Complete “loss of consciousness” I passed out…I was gone. He could have sawed me in half and I would not know it Fragmented memory – brief, intermittent periods of visual and/or auditory memories I was awake some of the time but I couldn’t move. I couldn’t talk

21. Anterograde amnesia Anterograde amnesia is a condition in which events that occurred during the time the drug was in effect are forgotten May not seek help for days Inability to recognize signs of sexual assault Feel powerless & out of control

22. Most rapists are not caught Only 10 percent of rapes are reported Less than 25 percent reported rapists are arrested 3 percent arrested are charged No more than 35 percent charged are convicted (according to FBI)

23. Victim’s Feelings Anxious Suspicious Helpless Frustrated Guilty

24. Support the Victim Believe the person when they tell you that they believe they were drugged. Do not fault them for what they may have done before, during, or after.

25. Misjudging and MinimizingVictims’ Trauma Because most victims of drug-facilitated rapes have no memory of the sexual assault, people may mistakenly minimize the trauma Victims feel powerlessness, and humiliated by not knowing what was done to them.

26. Secondary Victimization Inappropriate actions by others can so closely mimic victims' experiences at the hands of their assailants “The second rape" or "the second assault."

27. Emergency Care You or someone you know believes that they have been given a drug and are unsure what has happened to them ………….. Get them to the ER and Request to be tested!

28. Delayed Reports Delayed reports also are common, particularly in acquaintance rapes. The majority of mental health professionals surveyed (84%) agreed that contact with social service providers re-traumatizes rape victims.

29. PTSD Post-Traumatic Stress Disorder is a normal emotional and psychological reaction to trauma (a painful, shocking experience such as rape, war or a natural disaster) that is outside of a person's normal life experiences.

30. Recovery Takes Time Survivors recover in stages. Each person processes the event his or her / his own way. Survivors need a safe environment to work through their fears.

31. Mind Rape The surreptitious drugging of a victim is, in and of itself, a cruel and criminal violation of the person. There are estimates that as many as 62% of all rapes are facilitated with drugs. University of Illinois at Chicago Sam Hostettler May 2006

32. Rapists Can Appear to BeRescuers Victim may appear drunk or impaired and the rapist taking the victim to another place may appear to onlookers as assisting an impaired person. While the victim is still under the effects of the drug which may last 72 hours, the rapist has plenty of time to create a plausible cover story.

33. Drugs Used to Rape Ethanol Amphetamines: Methamphetamine MDMA-Ecstacy Benzodiazepines: Alprazolam Clonazepam Chlordiazepoxide Diazepam Flunitrazepam Flurazepam Lorazepam Triazolam Cocaine Marijuana Muscle Relaxants: Carisoprodol Cyclobenzaprine Meprobamate Gamma Hydroxybutyrate (GHB) Antihistamines: Diphenhydramine Scopolamine Zolpidem Chloral Hydrate Opiates Ketamine

34. Most Rapes Involve Alcohol 75% of men 50% of women had been drinking at the time.

35. Street Terms for “Club Drugs”

36. Gay Drug Scene According to recent study ….. 70% of gay men attending circuit parties in Seattle use drugs GHB is widely accessible Meth use is escalating Hanne Thiede, DVM, MPH. Clinical Assistant Professor, Epidemiology

37. METH and SEX Meth causes the release of dopamine, the brain's pleasure chemical, which makes sex more pleasurable, which heightens the desire for the drug, which speeds the physiological addiction. Sexual desire and craving for the drug become psychologically intertwined. Meth increases violent sexual behavior

38. Male Rape Rape is a violent crime that affects heterosexual men as much as gay men Lack of sympathy Lack of support Victim’s concern for being perceived as homosexual

39. Did you know that... Women can sexually assault other women? Lesbian domestic violence often includes lesbian rape? Lesbian rape is almost always unreported? It is estimated that 1 out of 3 lesbians have been sexually assaulted by another woman. GHB/GBL, meth and Ecstacy use by Lesbians increasing

40. Window for Testing Remember, each of the drugs metabolize at various rates GHB 12 hours Ketamine for up to 48 hours Rohypnol for up to 72 hours.

41. Ketamine Not legal to possess for personal use in the United States, because its legitimate use is as a veterinary anesthetic or animal tranquilizer

42. Effects of Ketamine Dissociation of the mind from the body Produces similar side-effects to LSD or PCP Hallucinations and feelings as through they have entered another reality Amnesia which may make recollection nearly impossible

43. Additional Effects - Ketamine Small doses block the bodies pain response, causing self-injury Larger doses lower the heart-rate, leading to oxygen depletion of the brain and muscles Overdoses can cause the heart to stop beating and, possibly, temporary paralysis

44. Duration of Effects - Ketamine Immediate effects may only last an hour or less, but person's senses, judgment, and coordination may be affected for 18 to 24 hours. Tests can detect Ketamine in a person's system up to 48 hours of ingestion.

45. GHB GHB (gamma-hydroxybutyrate) exists under many names. Although initially thought to build muscle, it has quickly become the rapist's drug of choice.

46. GHB Physical Characteristics Clear, syrupy liquid White powder form, like laundry detergent Tastes unpleasant, salty, and plastic-eque, and has a mild odor.

47. Duration of Effects The symptoms of GHB peak may peak in as few as 15 minutes and last from 3 to 6 hours. Extremely intoxicated Impaired judgment.

48. Other Effects GHB Nausea, vomiting Uncontrollable twitching Violent, aggressive behavior Extreme drowsiness, weakness Reduced muscle-tone, blood pressure and respiratory rate Dizziness and confusion Hypothermia and seizure-like activity Suppression of the Gag Reflex and coma/death

49. Sexual Effects GHB may cause enhanced sexual feelings by the victim Victim may participate in reciprocal acts, as a result of the drug, rather than free will.

50. Oral Ulcers Homemade batches of GBH can have high pH levels cause internal burns. Vomiting burns the "second-time round"

51. Duration of Effects GHB - in the blood stream for only 4 - 7 hours. GHB in urine stream - up to 12 hours after ingestion. Delayed reports – loss of precious evidence (National Drug Intelligence Center)

52. Rohypnol Rohypnol is the trade name for the drug flunitrazepam, a benzodiazepine (central nervous system depressant) like Valium, yet 10 times more potent. Outside the United States, Rohypnol is legally manufactured by Hoffman-LaRoche, Inc., and is available by prescription

53. Duration of Effects Rohypnol - begin within 15 to 20 minutes may persist for more than 12 hours. Detectable in urine for up to 72 hours after ingestion.

54. Effects of Rohypnol Headaches Memory impairment Dizziness Nightmares Confusion Tremors Aggression and/or excitability Slowing of psychomotor performance Muscle relaxation Decreased blood pressure Drowsiness Amnesia

55. MDMA - Ecstasy 3,4- methylenedioxymethamphetamine Adam, Ecstasy, XTC, E, and X Stimulant and low-level hallucinogen MDMA is generally taken orally in tablet or capsule form.

56. MDMA Psychological Effects Confusion Depression Sleeplessness Anxiety Paranoia Long-term, even permanent brain damage Memory loss

57. MDMA Physical Effects Muscle tension Involuntary teeth clenching Blurred vision Increased HR Increased BP Kidney Failure Cardiovascular Failure Seizure Stroke

58. Legal Response DFSA - rape achieved with a weapon (that is, the drug). The drug is a weapon that is actively employed or used by a perpetrator to ensure submission thus taking away the victim’s capacity to consent.

59. “Real Rape” Rape allegation is supported by a positive toxicology test. Forensic evidence of a CNS depressant as the weapon used to overcome resistance ultimately signals a lack of consent.

60. Negative Test??? But a negative toxicology report often just means that we didn’t get the evidence taken soon enough, for a variety of reasons. This is still rape!!!!

61. Memory Loss Victim may remember little Victim's account has many missing parts Recall difficult - may cause victim extreme anxiety

62. WITNESS STATEMENTS Persons who saw the victim, or spoke to the victim, before, during and after the assault are critical witnesses. Witnesses establish - time frames notice unusual behavior identify potential sources

63. Variable Effects May at some point render a victim unconscious but not always Depending on which drug is used and/or the amount given, the victim may appear to participate or may even appear to be the aggressor early on in the attack.

64. SIGNS THAT YOU MAY HAVE BEEN DRUGGED Feeling a lot more intoxicated than you normally would, having consumed no more alcohol than usual. Feeling "fuzzy", waking up very hung over, unable to account for a period of time, or memory lapse. Feeling as though someone had sex with you but you can't remember any or all of the incident. Remembering taking a drink but having difficulty recalling what happened after drinking

65. Reducing the Risk Don't leave drinks unattended Don't take any drink from someone you don't know well and trust Don't drink anything that has an unusual taste or appearance (i.e. salty taste, unexplained residue, excessive foam) Don't accept open container drinks Watch bartenders make your drink Don't drink beverages that you didn't open yourself Bring your own drink or watch your drink being poured If you realize that your drink has been left unattended, discard it Don't share or exchange dinks with others

66. Testing Negative “The victim claims she was drugged and raped, but they tested her for ‘date rape drugs’ and there weren’t any. So, it wasn’t a drug rape.” That statement mis-states the reality of the typical drug rape.

67. GHB often not Detected Some drugs stay for a couple of days, but GHB, the most popular for obvious reasons, very quickly dissipates from the system. Hospitals can’t even test for GHB.

68. No Screening Test There is no “screening test” for GHB; it requires a confirmation test that hospitals cannot do and crime labs only do upon specific request

69. Police Response Training for first line responders should include: The drugs utilized in sexual assaults the variety of drugs that are used what to look for in terms of crime scene evidence.

70. Police Response Unable to give a complete narrative, victims often encounter suspicion, disbelief, and/or frustration. This inability compounds their sense of helplessness.

71. DUI The victim may appear intoxicated or "hung-over“ and be arrested for DUI. Refusing to allow the rape kit to be taken is tantamount to the officer destroying evidence.

72. Difficulties in Investigation Many aspects of a rape investigation are facilitated by a victim’s ability to describe what happened. The victim’s narrative helps guide the medical/evidentiary examination and the police investigation.

73. Prosecutor’s Training Drugs used and how they are employed How to investigate these cases Forensic evidence How to best use expert witnesses

74. Rape Victim Rights You have the right to determine whether or not you want to report the sexual assault to law enforcement.You have the right to report the crime, but not proceed with prosecution. However if the prosecutor's office proceeds with the case, you may be subpoenaed. You have the right to reasonable protection by the law. You have the right to be treated in a considerate and sensitive manner by law enforcement and medical personnel. You have the right to request copies of police reports regarding the assault. You have the right not to be exposed to prejudice because of age, race, class, lifestyle, or occupation. You have the right to be considered a rape survivor regardless of the relationship of the assailant to you (i.e. acquaintance, relative, spouse doctor, therapist, clergy or employer.)

75. Contact Dr. Janet Parker DVM P.O. Box C Lawrence, KS 66044 MedicalWhistleblower@gmail.com