sexual violence

1. Journal of Forensic and Legal
Medicine(2020)volume 74
Dr.Nafeeya
Department of Forensic Medicine &Toxicology

2. Violence against women and drug-
facilitated sexual assault (DFSA): A review
of the main drugs
Yanna Richelly de Souza Costan et al
Biological Science and Health Center, Federal University of
Western Bahia,Brazil

3. Overview
• Introduction
• Aim of the study
• In detail about the study &
drugs
• Discussion
• Investigations
• Sample collection
• Medicolegal importance

4. Introduction
• Sexual violence is a major public health concern
• Many do no report
• Drug detection –short half life
• High cost chromatographic method
• This violence causes devastating effect in physical & mental health
• Observed in both long term & short term
• Consequences – Pregnancy, Reproductive tract infection ,STI

5. Aim of the study
1. Gender violence,
2. The drugs used to facilitate sexual assault,
3. Addressing their mechanism of action and pharmacokinetics,
4. As well as drug detection times in human body
5. Pharmacological and diagnostic mechanisms
6. Time the drug remains in the body,
7. Helps to validate the promotion of evidence to prove abuse.

6. Date rape drugs
• Date rape drugs consist of a range of chemical substances that are used to
facilitate crimes, such as rape
• “Good night, cinderella”,
• It causes physical and psychological damage
• Affecting women from all social segments
• The toXicological analysis- such as urine, plasma, whole blood, oral fluid
and hair.
• Gold standard –blood
• Gas chromatography

7. Society of Forensic ToXicologists
1. Analgesics (fentanyl, codeine, tramadol);
2. Antidepressants (citalopram, fluoXetine, amitriptyline);
3. Antihistamines (diphenhydramine and hydroXyzine);
4. Antipsychotics such as clozapine and barbiturates such as phenobarbital.
5. Ethanol, benzodiazepines, gamma-hydroXybutyrate (ghb) and ketamine
(ket).

8. Ethanol
• Most widely used drugs
• Neurochemical systems
• Colorless, volatile, flammable and water-
soluble liquid
• Responsible for causing greater morbidity
and mortality,
• Amnesia, loss of motor coordination and
mental confusion
Symptoms of Intoxication
Dizziness, lack of motor
coordination and mental
disorientation
Severe Intoxication
General anesthesia and
progressing to alcoholic
coma

9. Enzymatic systems
• Alcohol dehydrogenase
• Aldehyde dehydrogenase
• Cytochrome p450-dependent monooXygenases.
• The half-life of alcohol is approXimately 4 h
• The elimination rates are between 0.1 and 0.25 g/L/h.
• Women are more sensitive to alcohol- lower levels of this enzyme
Factors
influencing
alcohol
elimination
Tolerance
Enzyme levels

10. Detection
• Gas chromatography with flame
ionization detection by direct
injection (GC-FID) or headspace
(HS-GC-FID).
• Levels down to 1mg/100 ml

11. Benzodiazepines
Seizures,
Sleep
disorders
and
Anxiety

12. • In Brazil-Clonazepam, Bromazepam and
Alprazolam
• Ultrashort-acting - half- life shorter than 6 h, such
as triazolam;
• Intermediate-acting - half-life of 6–24 h, like
Estazolam
• Long-acting - half-life longer than 24 h, such as
diazepam and flurazepam.
• Flurazepam- short half-life 2 to 3 h
•High potency
•Desired effects
with the
administration of
low doses
•Short half-life

13. •Flunitrazepam- most prescribed
sedative and hypnotic potential
•To treat insomnia, tension, anxiety
seizures.
•Side effects -poor-quality sleep,
speech, balance impairments
psychological and physical
dependence.
•Rape facilitator -memory blackouts
Colourless
Impaired judgement
Anterograde amnesia

14. Rohypnol (flunitrazepam)
• Available as a pill dissolving quickly in liquids
• Usually round and white but newer pills are oval and green-gray
• When slipped into a drink, the dye in this pill makes clear liquid
turn bright blue and dark drinks turn cloudy
• Colour change will be difficult to appreciate in darker coloured
liquids like cola r

15. Detection

16. Gamma-hydroXybutyrate
•French researcher henry-1960
•Treatment of seizures, GH stimulator
•Side effects such as delusions, muscle
contraction, seizures and coma,
•No longer used for therapeutic
purposes

17. •Physical forms: a liquid with no odour
or colour/ a powder/ a pill
•Gives the drink a mild salty taste
•Mixing GHB in a sweet drink like fruit
juice masks the salty taste
•GHB also passes through the skin
and attempts have been made by
applying it to a jewellery and gifting
the victim
• They act on GABA type B
receptor
• Uses- Narcolepsy

18. Ketamine
• Ultra Fast-acting anesthetic drug
• In Brazil- controlled drug
• Brazilian controlled drugs and substances
act
• Available in both liquid form and also
powder form
• Victim might be aware of happenings but
couldn’t resist
• Also causes amnesia
Analgesia & dissociative anaesthesia

19. Detection
• For determination of KET and its metabolites
in blood or hair,
• Liquid chromatography coupled to mass
spectrometry is commonly used.
• Ultrahigh performance liquid
chromatography - tandem mass spectrometry
combined with the extraction method

20. Limitation of the study
• Some methological used to confirm the samples –high cost
• By knowing all the limitation of the method then only we want to proceed
• No focus on health action & prevention of women
• Amphetamines –methylene dioxymethylamphetamine

21. Discussion
• According to NCRB, total of 28,153 rape cases have been
registered in the year 2020 on an average of 77cases/day
• Among the states maximum cases of 5337 was registered in
Rajasthan and least of 4 cases were registered from Nagaland
• Among the union territories, Delhi reported highest number of
cases of 997
• Drug facilitated sexual assault is mostly done by persons known to
the victim/survivor
• Hall
Drug facilitated sexual assault- A review. J Forensic Leg Med [Internet]. Jul 1[cited 2021 oct 12];15(5):291-7. Available from:
https://www.sciencdirect.com/science/article/pii/S1752928X08000024

22. History
• First instance of drug facilitated sexual assault was found in bible
• Sexual intercourse using drug also mentioned
• Used wine to sedate him
• In 2001, Michael Welner published pioneering research on drug facilitated
rapists
• Pygmalion is a 1938 British film based on the 1913 George Bernard
Shaw play of the same name

23. • Properties of a typical drug:
• Sedative
• Amnesiac
• Effective in small doses

24. • Effects of these drugs on the body:
• Affect the victim very quick
• Length of the time that the effects last is variable
• Depends on amount of drug intake and whether any
adjuvant is used like alcohol

25. Physical Effects of Drug-Facilitated Sexual Assault
• Blackout
• Woke up in different place
• Intoxication & Hangover does not match consumption
• Remembers assault but unable to move or speak through it
• These are feelings or conditions commonly reported by victims after an
assault.

26. Two types of DFSA
Proactive DFSA– “an incapacitating or disinhibiting substance by an
assailant for the purpose of sexual assault
•Opportunistic DFSA - “a victim who is profoundly intoxicated by his
or her actions, to the point of near or actual unconsciousness”
How this date rape wristband can tell if your drink has been spiked - BBC News [Internet]. [cited 2021 Oct 12]. Available from: https://www.bbc.com/
news/newsbeat-47973372

27. Detection
• Drink spike detector (DSD) has been
developed in recent times which can detect
both GHB and ketamine in drinks
• About the size of a credit card, it changes into
blue colour when comes in contact with GHB
or ketamine
• Each card can test two drinks
• Due to their size and time taken, they can be used
discretely

28. Investigations
• History
• H/O drinking/drug intake to be elicited
• The classic sign of amnesia will be present
• confusion with impaired motor skills and impaired judgement.
• Waking up 8 or more hours
• vaginal soreness or any other signs of sexual activity
• Usually recalls feeling strange or feeling heavily drunk within 15
minutes

29. Crime scene investigation
Mostly Offenders place -violence
Drug used can be found
Balance drink,pills
Dna fingerprint in glass
Victims DNA evidence
Victims clothes and belongings
CCTV footage evidence

30. LAB INVESTIGATIONS
• Samples vary with time of presentation and type of assault
• Early after the assault, urine, blood or saliva can be analysed for
drugs
• For later presentations, hair sample can be used
• Routine Medicolegal examination has to be carried out to collect
evidences in such cases
• Survivor doesn’t know what type of sexual assault took place

31. Samples and timelines:
• Up to 2 days - Blood
• Up to 5 days - Urine
• Up to 4 weeks - Hair
• Urine is preferred sample over blood since it allows for a longer
window of detection of either the parent drug or its metabolite.
• The sampling is also easier and non invasive

32. • In blood, benzodiazepines (4-12 hrs),
• GHB (4-8 hrs)
• In urine, benzodiazepines (48-96 hrs),
• GHB (12 hrs)
World Report on Violence and Health. Geneva: World Health Organization; 2002

33. Sample collection
• Urine: 2 samples, minimum 50 ml in a sterile container, no
preservatives are needed. Analysed within 24 hrs, if not, store at
• -180 C
• Blood: 2 samples, 5ml each in a sterile container with 2.5g/l
sodium fluoride or 2g/l potassium oxalate as preservative. Store at -
180 C
• Hair: Hair from any region except from scalp as it might be
applied with cosmetic treatment so can alter the results

34. Difficulties of Drug-Facilitated Sexual Assault
• Difficult to Statistically Document
• Because Many Don’t Report
• Shame and possible fear of being blamed for what happened
• Concern about criminal charges for drinking or illegal drug use
• Drugs metabolize quickly; hard to detect
• clinical detection is difficult after an assault.
Drug-Facilitated Sexual Assault Fast Facts. U.S. Department of Justice.

35. Challenges in Investigation
• Most survivors do not remember being drugged or assaulted
• Late presentation of the case
• Because of late presentation, most drugs would have left the
system though, hair sample could detect traces
• Also drugs like GHB are endogenous substances and it might
give out false positive results
• So hair is preferred sample as it can be used for quantitative
analysis in suspected GHB intake (under 12ng/mg)

36. Medicolegal importance
• Drug facilitated sexual assault falls under clause 5 of 375 IPC
which defines Rape
• With her consent, when, at the time of giving such consent,
• by reason of unsoundness of mind or
• intoxication or
• the administration by her personally or
• through another of any stupefying or unwholesome substance,
• she is unable to understand the nature and consequences of that
to which she gives consent

37. •THANK YOU