Mitigating consequences of a drug-facilitated sexual assault First published: 27 Jan 2017 Revised: 19 Jan 2020 Drug-facilitated sexual assault (DFSA) is not just bad sex. It occurs either without the victim’s consent or with consent that cannot be considered valid due to incapacitation of the victim by alcohol or drugs. While opportunistic DFSA is carried out once the victim has been rendered unconscious by own actions, pro-active DFSA describes situations when the perpetrator spikes the victim’s drinks covertly. The most frequently used drug in DFSA is alcohol. Other drugs often involved include flunitrazepam (Rohypnol), gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), carisoprodol (Soma) and ketamine. Ecstasy (MDMA) and other benzodiazepines are occasionally used also. These drugs rapidly induce drowsiness, sedation and muscle relaxation. Typical symptom is decreased inhibition. Most of the drugs used for DFSA are odorless and tasteless, with the exception of GBL that has a bitter taste. Memoryy loss is common, most victims have little to no recollection of the previous night. The most common way of obtaining these drugs is through the darknet. Benzodiazepines, GHB (Xyrem), and ketamine (an anesthetic used in human and veterinary medicine) are often diverted from legitimate medical use for illicit purposes. In 2012, in U.S. v. Caronia became one of the landmark cases in the promotion of prescription drugs for unapproved (off-label) indications. Physicians who prescribe Xyrem (GHB) have to pass special certification to ensure safe prescription, handling, and storage of the drug (REMS). Sedative or tranquilizer Flunitrazepam is still legally manufactured in Europe and some countries in Latin America. The drug has been reformulated, so it imparts an easily identifiable blue color to clear beverages and haziness to colored drinks. Drugs obtained from illegal manufacturing sources naturally do not display this effect. DFSAs are increasingly popular in bars, clubs, and raves, but also fraternities and at college campuses. Mishandling of cases of sexual assault at college campuses has been subject to much criticism. It is very difficult to estimate the total number of DFSAs. The main reason for failure to report sexual assault is the reluctance of the victims to go to the police. Indications exist that the numbers are on the increase. Because of memory loss associated with these drugs, victims often feel embarrassed or guilty. Additional reasons for not reporting sexual assault include need to avoid further stigmatization, especially when the evidence does not seem to be sufficient to support the claim confidently. Forensic evidence is difficult to obtain and often lost after first urination the morning after. All drugs used for DFSA are metabolized rapidly by the body, rendering them undetectable within 24 to 48 hours after ingestion.

1. Mitigating consequences of a drug-facilitated sexual assault
First published: 27 Jan 2017
Revised: 19 Jan 2020
Drug-facilitated sexual assault (DFSA) is not just bad sex. It occurs either without the victim’s
consent or with consent that cannot be considered valid due to incapacitation of the victim by
alcohol or drugs. While opportunistic DFSA is carried out once the victim has been rendered
unconscious by own actions, pro-active DFSA describes situations when the perpetrator spikes
the victim’s drinks covertly [1].
The most frequently used drug in DFSA is alcohol. Other drugs often involved include
flunitrazepam (Rohypnol), gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL),
carisoprodol (Soma) and ketamine. Ecstasy (MDMA) and other benzodiazepines are occasionally
used also. These drugs rapidly induce drowsiness, sedation and muscle relaxation. Typical
symptom is decreased inhibition. Most of the drugs used for DFSA are odorless and tasteless,
with the exception of GBL that has a bitter taste. Memoryy loss is common, most victims have
little to no recollection of the previous night [2].
The most common way of obtaining these drugs is through the darknet [3]. Benzodiazepines,
GHB (Xyrem) [4], and ketamine (an anesthetic used in human and veterinary medicine) are often
diverted from legitimate medical use for illicit purposes.
In 2012, in U.S. v. Caronia [5] became one of the landmark cases in the promotion of prescription
drugs for unapproved (off-label) indications. Physicians who prescribe Xyrem (GHB) have to
pass special certification to ensure safe prescription, handling, and storage of the drug (REMS)
[6].
Sedative or tranquilizer Flunitrazepam is still legally manufactured in Europe and some countries
in Latin America. The drug has been reformulated, so it imparts an easily identifiable blue color
to clear beverages and haziness to colored drinks [7]. Drugs obtained from illegal manufacturing
sources naturally do not display this effect.
DFSAs are increasingly popular in bars, clubs, and raves, but also fraternities and at college
campuses. Mishandling of cases of sexual assault at college campuses has been subject to much
criticism [8].
It is very difficult to estimate the total number of DFSAs. The main reason for failure to report
sexual assault is the reluctance of the victims to go to the police. Indications exist that the
numbers are on the increase [9], [10]. Because of memory loss associated with these drugs,
victims often feel embarrassed or guilty. Additional reasons for not reporting sexual assault
include need to avoid further stigmatization, especially when the evidence does not seem to be
sufficient to support the claim confidently. Forensic evidence is difficult to obtain and often lost
after first urination the morning after. All drugs used for DFSA are metabolized rapidly by the
body, rendering them undetectable within 24 to 48 hours after ingestion [11].

2. Suggestions for prevention include limiting drinking to slow consumption of one to two drinks
per hour, caution when accepting drinks provided by strangers or male acquaintances, avoiding
punch bowls and beverages that are passed around, and refraining from participation in drinking
games. A glass that was left unattended is better left alone. Finally, the first signs of intoxication
mean it is the last opportunity to call for help [12].
There are ways how to detect DFSAs in spiked drinks. In a laboratory, the method of choice is
Gas Chromatography-Mass Spectrometry [1]. Field tests have been developed, such as
fluorescent dye [13], that makes spiked drinks change color. Nail polish designed by Undercover
Colors received a lot of media attention long before it reached the market [14]. The most reliable
detection technology currently on the market is pd.id produced by High-Tech [15].
Telltale signs of intoxication can be difficulty breathing and feeling too drunk, considering the
amount of alcohol consumed. Additional symptoms include loss of bladder or bowel control,
nausea, sudden body temperature change, dizziness, disorientation, or blurred vision. Victims
typically wake up with no recollection of the events of the last night [16]. With no memory of
having sex the night before, the first sign of something being amiss is waking up in unfamiliar
location sore in the wrong places, with a hangover, and clothes in a strange condition. It is
essential to get to the hospital as early as possible. Ideally, the woman should not shower and
should wait with the first pee for the hospital so forensic evidence can be obtained.
Urine is the body fluid of choice, and the earlier it is collected, the better. The longer time has
passed, the lower the concentration of the drug, and the higher the chance of the drug being
missed [7].
Source: UN Drug Report, 2016 [3]

3. Increasingly politicized healthcare makes post-incident management potentially a nightmare.
Treatment of most STDs is usually straightforward [17], and even if HIV is suspected, an
antiviral cocktail of drugs called Post-Exposure Prophylaxis [18] should prevent infection [17].
Obtaining emergency contraception can still be difficult in some hospitals and some regions [19].
Achieving justice is a different matter altogether. Not only some hospitals charge rape victims
$1.000 or more for rape kits [20], [21], most of these rape kits are only processed with very long
delays due to the long backlog [22], [23].
Handling of rape cases by the police [24] and the courts [25] further discourages women from
speaking up. Those who wish to go ahead despite all odds, and report the incident, should leave
the premises intact and leave any glasses, clothing, biological fluids and hair for forensic
examination [26].
To add insult to injury, videos and photographs of sexual assault can quickly end up online for
everyone to see, causing even more damage to the victim’s reputation and making a recovery
effectively impossible [27].
Long story short, sexual assault, primarily when facilitated by alcohol and date rape drugs, can be
a devastating and life-changing event. Post-incident care can be costly, especially if rape-kits and
STD prophylaxis have to be paid out of pocket.
References
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