T C DRUG AND LCOHOL FACILITATED SEXUAL ASSAULT
Transcript of T C DRUG AND LCOHOL FACILITATED SEXUAL ASSAULT
Marc A. LeBeau, PhD FABFTSenior Scientist
Scientific Analysis Section
FBI Laboratory
Quantico, Virginia
USA
THE CHALLENGES OF DRUG AND
ALCOHOL FACILITATED SEXUAL ASSAULT
INTRODUCTION
Increased reports of Drug-Facilitated Crimes (DFCs) in the media and the scientific literature
Belief that DFCs have increased Rise in commission?
Greater awareness?
Increased reporting?
True prevalence of DFCs will never be known Pharmacodynamic effects on reporting
Delayed reporting
Statistically capturing DFCs
OBJECTIVES
Describe media’s role in establishing myths about drug-facilitated crimes
List four major challenges encountered in alcohol and drug-facilitated sexual assault investigations
Categorize the most common drugs associated with drug-facilitated crimes and compare/contrast pharmacological effects
Recognize at least three “obscure” drugs associated with drug-facilitated crimes and reflect upon why they are used
Describe how to overcome some of the challenges of drug-facilitated crimes to improve the SART response
DRUG-FACILITATED CRIMES
Victim subjected to crime in which the pharmacological effects of a drug or drugs help the perpetrator carry out the crime
Usually strong, CNS depressants
Types:
Robbery
Human trafficking / kidnapping
Neglect by caregiver
Sexual Assault
SEXUAL ASSAULT
Incapacitated Sexual Assault
Voluntary ingestion of drug and/or alcohol
Strong CNS depression
Perpetrator takes advantage
Drug-Facilitated Sexual Assault
Perpetrator gives drug or alcohol to victim without their knowledge
Goal is to incapacitate the victim and commit the assault
COMMON SIGNS OF DFSA
Recalls having drink but cannot recall what happened for period of time afterwards
Suspects someone had sex with them but cannot remember the incident
Feels more intoxicated than their usual response to same quantity of alcohol
Wakes up hung over, experiences memory loss or cannot account for a period of time
MICKEY FINN
Bartender / Owner of the Lone Star Saloon and Palm Garden Restaurant
Located in the “Whiskey Row” section of Chicago’s State Street
Finn or one of his employees would slip chloral hydrate concoction into the drink of unsuspecting patrons.
In December of 1903, the bar was closed by Chicago authorities
CHALLENGES OF SURREPTITIOUS ADMINISTRATION
Most “drugs” will dissolve or disperse in beverages or food
Tablets / capsules contain insoluble fillers
Medications are bitter
CHALLENGES SURROUNDING DFSA INVESTIGATIONS
• Dosages
• Number of Candidates
• Pharmacokinetics
• Pharmacodynamics
Drugs
DRUGS REPORTEDLY USED TO COMMIT DFSA
Ethanol
Benzodiazepines
Flunitrazepam
Clonazepam
Lorazepam
Alprazolam
Triazolam
Chlordiazepoxide
Diazepam
Temazepam
Zolpidem
Barbiturates
GHB and analogs
Ketamine
Opiates
Antihistamines
Hallucinogens
Sedative Antidepressants
Chloral Hydrate
Muscle Relaxants
Scopolamine
Herbal Sedatives
Inhalants
• 1000 consecutive cases received from March 2015 to June 2016
• From 37 U.S. states and 1 territory (Puerto Rico)
• California (26%); Maryland (7.9%); Massachusetts (6.6%); Mississippi (5.4%)
• 78.4% were positive for one or more intoxicating substances
• Nearly 100 different intoxicating substances identified
PHARMACOKINETICS OF DFSA DRUGS
Variation in speed DFSA drugs are metabolized and eliminated
Wide window of time after ingestion drugs detected in samples
Presence may only be detectable 4 hours
For others, the drug is detectable for weeks
Not knowing drugs used makes it very difficult to interpret a negative toxicological finding
PHARMACODYNAMIC EFFECTS
Most DFSA drugs are strong, fast-acting CNS depressants
Effects mimic severe intoxication or general anesthetics
Includes amnesia and unconsciousness
DFSA cases less likely to be reported compared to forcible rape
Some victims are “unclear if a crime was committed” or didn’t think it was “serious enough” (Kilpatrick et al. 2009)
CHALLENGES SURROUNDING DFSA INVESTIGATIONS
• Dosages
• Number of Candidates
• Pharmacokinetics
• Pharmacodynamics
Drugs
VICTIM REENGAGEMENTVictims reengage with offendersAttempt to reclaim lost dignity
Denial that the rape actually happened
Foggy memoriesVeronique N. Valliere, Psy.D.
Understanding the Non-Stranger Rapist
2007
Marsalis exploited their confusion Acted gentlemanly afterwards
Asked to see them again
Pennsylvania law prevented expert testimony to explain the behavior of rape victims
ETHANOL AND DFSA
Easy to obtain
Can be administered in a social environment without suspicion
Victims commonly consume voluntarily
Drug most commonly associated with rape
Can cause decreased inhibitions, impaired perceptions, loss of consciousness and amnesia
Prosecution more challenging than with others
ALCOHOL -ABSORPTION
Numerous variables affect how intoxicated one becomes after consuming alcohol
Some variables are easy to control
Others are not
4-6%
12 oz
12-15%
4-5 oz
40-50%
1-1.5 oz
Each contain about 0.6 oz (14 g) of pure ethanolEach contain about 0.6 oz (14 g) of pure ethanol
STANDARD ALCOHOLIC DRINKS
ALCOHOL UNITS(UK VERSION)
Simple way of expressing quantity of pure ethanol in drinks
1 Unit = 10mL (8g) of pure ethanol
Approximate amount of alcohol the average adult can process in an hour
Number of units in a drink dependent on size and alcohol strength
5%
12 oz
12%
5 oz
40%
1.5 oz
Each contain about 10 ml (8 g) of pure ethanol = “Unit”Each contain about 10 ml (8 g) of pure ethanol = “Unit”
UNITS OF ALCOHOL (UK VERSION)
1.8 units 1.8 units 1.8 units
ALCOHOL UNITS(UK VERSION)
Simple way of expressing quantity of pure ethanol in drinks
1 Unit = 10mL (8g) of pure ethanol
Approximate amount of alcohol the average adult can process in an hour
Number of units in a drink dependent on size and alcohol strength
Drink Type # of Units
Small shot (25mL, 40%) 1
Large shot (35mL, 40%) 1.4
Small wine (125mL, 12%) 1.5
Bottle of beer (330mL, 5%) 1.7
Pint of low alcohol beer or cider
(568mL, 3.6%)2
Standard wine (175mL, 12%) 2.1
Pint of high alcohol beer or cider
(568mL, 12%)3
Large wine (250mL, 12%) 3
PHARMACOKINETICS OF ETHANOL
Mainly by ingestion, but also by dermal contact, inhalation, or injection
Rapidly absorbed into the blood
Faster drinking enhances
Carbonated beverages enhances
Fatty/oily beverages slows
Ethanol concentration effects absorption
Higher altitude promotes
Dehydration enhances
Food delays
Widely distributed in body water and CNS
Elimination averages about 0.015 g% / hour
CNS DEPRESSION OF ETHANOL
Impairs judgment
Depresses learned social and cultural inhibitions
Impairs self-evaluation
Euphoria
Memory loss
Shortened attention span
Sedation
Blurred vision
Nystagmus
Altered distance perception
Impaired hearing
Reduced muscle coordination
Increased reaction time
Light fixation
STAGES OF ALCOHOL INTOXICATION
0.00% 0.10% 0.20% 0.30% 0.40% 0.50%
Subclinical 0.01 to 0.05% Behavior nearly normal
Euphoria Diminished attention, judgement, and control;0.03 to 0.12% decreased inhibitions; loss of efficiency; talkativeness
Excitement Loss of judgement; impaired balance, perception, 0.09 to 0.25% and memory; loss of vision; drowsiness
Confusion Disorientation; emotional; slurred speech;0.18 to 0.30% blurred vision; staggering; pain tolerance
Stupor Unable to stand or walk; vomiting;0.25 to 0.40% no response to stimuli
Coma0.35 to 0.50% Unconscious
0.45+ Death
Adapted from K.M. Dubowski “Stages of Acute Alcoholic Influence/Intoxication”
ESTIMATIONS OF ETHANOL CONCENTRATIONS
Widmark Formula:A = (WRC / 0.8)
A = Amount of ethanol (mL)
W = Body Weight (grams)
R = Distribution ratio
(0.68 males / 0.55 females)
0.8 = Specific gravity of ethanol
Useful exercise to evaluate the role that ethanol may have played
in contributing to the symptoms that the DFC victim described
Useful exercise to evaluate the role that ethanol may have played
in contributing to the symptoms that the DFC victim described
0.00% 0.10% 0.20% 0.30% 0.40% 0.50%
Subclinical 0.01 to 0.05% Behavior nearly normal
Euphoria Diminished attention, judgement, and control;0.03 to 0.12% decreased inhibitions; loss of efficiency; talkativeness
Excitement Loss of judgement; impaired balance, perception, 0.09 to 0.25% and memory; loss of vision; drowsiness
Confusion Disorientation; emotional; slurred speech;0.18 to 0.30% blurred vision; staggering; pain tolerance
Stupor Unable to stand or walk; vomiting;0.25 to 0.40% no response to stimuli
Coma0.35 to 0.50% Unconscious
0.45+ Death
?
STAGES OF ALCOHOL INTOXICATION
ALCOHOL-INDUCED
BLACKOUTS
Memory loss (anterograde amnesia) that occurs during any part of a drinking episode without loss of consciousness
Not the same as “passing out”
May be awake and conscious, engaged in activity or conversation, and may appear to be oriented
Memory loss may be significant, but may be reversible
Information may be recalled later, sometimes spontaneously
Women seem to be more susceptible to blackouts and undergo a slower recovery from cognitive impairment than men
AMNESIA
Retrograde
Loss of earlier memories
Usually from cerebral injuries or disease states
Far more common
Anterograde
Impaired information acquisition, consolidation, and storage
Alcohol and some CNS depressants cause
Likely due to impact on GABA-receptor complex
Less clear when these end because people tend to fall asleep before they are over
Goodwin, D.R. et al. Am J of Psychiatry 66 (1975)
ALCOHOL-INDUCED BLACKOUTS
Two types of alcohol blackoutsComplete (en bloc) Begins and ends at definitive points
Full permanent amnesia
Loss of time
Requires high BACs to disrupt memories from encoding
Fragmentary (gray outs) Memories often recalled when prompted
Occur more often
Experienced over wider range of BACs
ALCOHOL-INDUCED BLACKOUTS
Two mechanisms Encoding deficit
Alcohol temporarily inhibits biochemical processes in brain needed to form new memories
Retrieval deficit
Information stored as a memory while intoxicated is inaccessible when the individual is sober
Ingestion of large amounts of alcohol may have more significant effect on input, acquisition, or processing of new memories
Research suggests alcohol-induced blackouts disrupt transfer of information from short-term to long-term storage
PROBLEMS WITH BLACKOUT STUDIES
Most have involved white, male alcoholics as subjects
Many have relied upon subject’s ability to recall previous episodes of blackout months or years before“remember not remembering”
Number of drinks consumed over what period of time?
Modern Internal Review Boards would not likely approve of normal subjects “binge” drinking to increase BACs to levels consistent with blackouts
RISK FACTORS FOR ALCOHOL-INDUCED BLACKOUTSPrior or current history of alcoholism
Family history of alcoholism
Age of drinking onset
Prior history of blackouts
Family history of blackouts
Capacity/tolerance for high quantities of alcohol
Ingests high quantity of alcohol such that they often exceed 0.2%
Rapid drinking – gulping or binging
Head trauma
Loss of control
Failure to eat properly Pressman, MR and Caudill, DS; J Forensic Sci; Vol 25, 4, 2013
GHB AND DFSA
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
Requires careful interpretation of results
BACKGROUND AND OVERVIEW
-Hydroxybutyrate (GHB) and its metabolic precursors are among the most favored for DFSA
Hard to prove because of strong sedative, amnesiac effects and rapid elimination
Naturally occurring metabolite of GABA
Human urine and other biological specimens contain measurable amounts
Popular recreational drugs of abuse
HISTORY
Three groups use GHB:
Bodybuilders/Dieters
Recreational abusers
Rapists / Robbers
Nearly always abused orally
Disguised in aqueous matrix
Consumed by capful or teaspoon
Street names include “Easy Lay”, “Georgia Home Boy”, “Liquid Ecstasy”, “G”, “Liquid X”, “Fantasy”
Club drug
GHB AND ANALOGS PHARMACOKINETICS
Rapidly absorbed after ingestion
GBL and 1,4-BD quickly metabolize to GHB
If co-ingestion of 1,4-BD and alcohol, effects may be more severe and detection times may be longer
Less than 5% of the original dose of GHB is excreted unchanged into the urine
GHBCLINICAL EFFECTSUsers pass from full consciousness to unconsciousness within 10-15 minutes
Strong CNS depressantOften confused with effects of alcohol
Symptoms:drowsiness, confusion, dizziness, vomiting, respiratory depression, bradycardia, amnesia
Alert patients may show tachycardia, combativeness, hypertension, agitation, psychotic symptoms (paranoia and hallucinations)
GHB-assisted sleep generally only lasts about 3-4 hrs People exposed to GHB usually wake up without a so-called “hangover” effect
Forensic Science Review 14: 101-121; 2002
BENZODIAZEPINES AND DFSA
One of the world’s most widely prescribed drug class
Anxiolytics, muscle relaxants, sedative/hypnotics, anesthetic adjuncts, anticonvulsants, panic disorders, obsessive-compulsive disorders
Symptoms: slurred speech
irritability
agitation
loss of inhibition
sedation
sleepiness
memory impairment
anterograde amnesia
Forensic Science Review 14: 1-14; 2002
PHARMACOKINETICS OF BENZODIAZEPINES
Most benzodiazepines are administered orally in DFSA cases, but injections have also occurred
Peak blood levels within 30 min to 6 hrs. after ingestion
When pre-dissolved into a liquid, absorption is much faster
The duration of action of benzodiazepines is based largely on their pharmacokinetic half-lives
Short-acting benzodiazepines (e.g., midazolam, triazolam) will be detected for much shorter periods than long-acting benzodiazepines (e.g., diazepam, clonazepam)
Long-acting benzodiazepines tend to exhibit a longer and more severe “hangover”
CATEGORIES OF BENZODIAZEPINES
FDA Approved
Alprazolam (Xanax®)
Chlordiazepoxide (Librium®)
Clonazepam (Klonopin®)
Diazepam (Valium®)
Flurazepam (Dalmane®)
Lorazepam (Ativan®)
Temazepam (Restoril®)
Triazolam (Halcion®)
Non-FDA Approved
Approved in Other Countries:
• Etizolam
• Flunitrazepam (Rohypnol®)
• Phenazepam
Designer:
• Clonazolam
• Cloniprazepam
• Flualprazolam
• Flubromazelam
• Flubromazepam
• Ketazolam
FLUNITRAZEPAM (ROHYPNOL®)
MORE potent than diazepam (Valium)
Onset 15-30 minutes, duration 2-12 hours
Passivity, disinhibition, lack of resistance, muscle relaxation, slurred speech, confusion, ataxia
Anterograde amnesia
Soluble in alcohol, colorless, odorless, tasteless
Requires sensitive methods of analysis
In 1990s, Rohypnol became popular drug to use in DFSA
Very potent drug
Typically used as an adjunct to general anesthetics
Not available for use in U.S.
Old tablets vs New Tablets Blue dye in core is released when dissolved
Not incorporated into generic versions
Relatively few proven cases of this drug’s use in DFSA
Other benzodiazepines more likely to be used
FLUNITRAZEPAM (ROHYPNOL®)
KETAMINE
Dissociative anesthetic with analgesic properties
Also used as veterinarian tranquilizer
Structurally similar to PCP
Club drug
Smoked, injected, snorted, or taken orally
Popular hallucinogen
Users deem effects superior to PCP or LSD
Less connected with a sense of self and reality around them
“K-hole” – when large amounts ingested and no idea what is going on around them
KETAMINE
May not remember the experience after regaining consciousness – similar to how one may forget a dream
Emerging from under the influence is slow
User gradually becomes aware of surroundings
At first they may not remember their name
Movement may be extremely difficult
Ketamine is quickly metabolized to norketamine and dehydronorketamine
May be excreted in the urine for at least 72 hours after ingestion
RESERVE, NM
Wildlife researchers were studying behavior of black bears in rural NM
Woman was hospitalized in 1997
Investigators found 6 hours of video tape showing the man drugging and raping victim
Ketamine found in hair of victim
Sentenced to 33 years
CANNABINOIDS AND DFSA
Sedative properties
Hallucinogenic properties
Impairs memory
Impairs cognition
Popular recreational drugs
Very easy to obtain
Additive effects when mixed with ethanol
OPIOIDS
Buprenorphine
Codeine
Fentanyl
Heroin
Hydrocodone
Hydromorphone
Meperidine
Methadone
Morphine
Oxycodone
Oxymorphone
Pentazocine
Propoxyphene
Tramadol
PHARMACODYNAMICS OF OPIOIDS
Analgesics (“Pain Killers”) that also produce euphoria and a sense of well-being
Strong CNS depression
When morphine is combined with alcohol, the depressant effects of alcohol are enhanced; the elimination of morphine is slowed, and potent metabolites are produced at a faster rate
Opioids act by binding to opioid specific receptors
Side effects may include nausea/vomiting and constipation
M.A. LeBeau and A. Mozayani. (2001) Drug-Facilitated Sexual Assault A Forensic Handbook. San Diego, CA: Academic Press
ANTIHISTAMINES
Recent increase abuse of first-generation antihistamines
Oldest and cheapest of the antihistamines on the market
Widespread availability
Effects include sedation, euphoria, dizziness, blurred vision, ringing in the ears (tinnitus), incoordination, hallucinations, and psychosis
Additive depressant effect when combined with alcohol
May experience paradoxical effect
Readily absorbed after oral administration
Onset of action generally occurring within 1 hr
Detectable for hours to days
M.A. LeBeau and A. Mozayani. (2001) Drug-Facilitated Sexual Assault A Forensic Handbook. San Diego, CA: Academic Press
TRICYCLIC ANTIDEPRESSANTS
First used in 1950s
Common TCAs:
amitriptyline (Elavil)
clomipramine (Anafranil)
desipramine (Norpramin)
doxepin (Adapin)
imipramine (Tofranil)
nortriptyline (Pamelor)
protriptyline (Vivactil)
trimipramine (Surmontil)
TRICYCLIC ANTIDEPRESSANTS
Causes heavy sedationMay be prescribed as anti-anxiety medication
Additive effects when combined with ethanol and other CNS depressants
Additional side-effects:Sleepiness
Lightheadedness
Slight drop in BP
Unsteadiness
Amnesia
R.C.Baselt. (2004) Disposition of Toxic Drugs and Chemicals in Man. Foster City, CA: Biomedical Publications
M.A. LeBeau and A. Mozayani. (2001) Drug-Facilitated Sexual Assault A Forensic Handbook. San Diego, CA:
Academic Press
TRUTH OR CONSEQUENCES, NEW MEXICO
March 1999 –woman reports kidnapping and sexual torture in Elephant Butte, NM
Find Ray’s “Toy Box”
Investigation suggests hundreds of victimsAt least 14 victims were dismembered and discarded
DAVID PARKER RAY
Evidence suggests Ray used alcohol combined with amitriptyline to keep women sedated and under control
April – May 2001: Ray convicted and sentenced to 224 years
May 2002: Ray died of heart attack in prison
THE “Z” DRUGS
Zolpidem (Ambien, Stilnox), Zopiclone (Imovane, Zimovane, Lunesta), and Zaleplon (Sonata, Starnoc)
Not benzodiazepines but act on the same receptor in the brain
Effects include euphoria, drowsiness, muscle relaxation, feeling of drunkenness, hallucinations, amnesia, and strong sedation
Very low-dose medications
Most laboratories will not be able to detect parent drugs at therapeutic levels
Numerous cases in last decade
M.A. LeBeau and A. Mozayani. (2001) Drug-Facilitated Sexual Assault A Forensic Handbook. San Diego, CA: Academic Press
CHLORAL HYDRATE
Oldest Sedative/Hypnotic still used today
Liquid-filled gel-cap or syrup
Very rapidly metabolized; must look for metabolite (TCE)
Very strong sedative effect usually for the treatment of insomnia or presurgical sedative
M.A. LeBeau and A. Mozayani. (2001) Drug-Facilitated Sexual Assault A Forensic Handbook. San Diego, CA: Academic Press
B. Levine. (2003) Principles of Forensic Toxicology. Washington, DC: AACC Press
VOLATILE ORGANIC
COMPOUNDS (VOCS) AND
DFSA
Easy to obtain
Generally overt and forced
Difficult to detect in biological specimens
CHEMICAL SOLVENTS
Chloroform
Ether
Nitrous oxide
Cyclopropane
Propane
Butane
Toluene
Xylene
May be voluntary exposure through “huffing” or “sniffing”
Rag placed over mouth and nose
SOFT DFSA COMMITTEE
1998:
Group of forensic toxicologists met to discuss the problems and challenges we face in DFSA cases
1999:
Published recommendations for investigators, medical professionals, and toxicologists for DFSA cases
2000:
Formation of SOFT DFSA Committee
RECOMMENDATIONS
Get first urine sample from victim
At least 100 mL within first 5 days
# of times urinated prior to collection
Blood supplements urine
At least 10 mL in grey-top tube within first 24 hours
Info about ethanol, recreational, and prescription drug use
Other evidence
Choose your lab carefully
Understand what lab results really mean
WHY WERE NO DRUGS DETECTED?
141
Limit of Detection
Detection Time in Urine
Time
Dru
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on
cen
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BLOOD
Detection Time in Blood
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Limit of Detection
Detection Time in Urine
Time
Dru
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BLOOD
Detection Time in Blood
WHY WERE NO DRUGS DETECTED?
SOFT DFC COMMITTEE
MAXIMUM RECOMMENDED
DETECTION LIMITS FOR
URINE
Contains
most prevalent drugs that have been associated with DFCs (not a complete list of all drugs that may be used)
most significant metabolites
suggested “maximum” detection limits
drugs known to potentiate the effects of DFC drugs
Based upon published methods and/or an estimated concentration from use of single dose
Should be achievable using standard instrumentation
“Maximum” detection limits
Test at even lower limits than these recommendations, if possible, with advanced technology that may be available
STANDARD FOR THE ANALYTICAL SCOPE AND SENSITIVITY OF FORENSIC TOXICOLOGY URINE TESTING IN DRUG-FACILITATED CRIME INVESTIGATIONS
• Delineates the minimum requirements for target analytes and analytical sensitivity for the toxicological testing of urine specimens collected from alleged victims of drug-facilitated crimes (DFC)
• This document does not cover the analysis of blood and other evidence that may be collected in DFC cases
REQUIREMENTS FOR FORENSIC TOXICOLOGICAL TESTING OF URINE SPECIMENS IN INVESTIGATIONS OF DRUG-FACILITATED CRIME
Urine specimen collected from an alleged victim of DFC within 120 hours (5 days) of the incident shall be tested
Case-specific circumstances may warrant testing of specimens collected past 5 days
Toxicological testing of urine specimens collected from alleged victims of DFCs shall include, at a minimum, the compounds listed in Table 1.
Analytical sensitivity shall meet or exceed (be lower than) the concentrations listed in Table 1.
The table reflects total concentrations, which may be achieved via hydrolysis or direct analysis of conjugated compounds.
High-Dose Sedatives
Ethanol (alcohol)2 0.01 g/dL
Gamma hydroxybutyrate
(GHB)3
10 µg/mL
Antidepressants
Amitriptyline 10 ng/mL
Nortriptyline 10 ng/mL
Imipramine 10 ng/mL
Desipramine 10 ng/mL
Chlorophenylpiperazine
(Trazodone metabolite)
10 ng/mL
Antihistamines
Brompheniramine 10 ng/mL
Chlorpheniramine 10 ng/mL
Diphenhydramine 10 ng/mL
Doxylamine 10 ng/mL
Norchlorcyclizine 10 ng/mL
Barbiturates
Butalbital 100 ng/mL
Phenobarbital 100 ng/mL
Benzodiazepines
α-hydroxyalprazolam 5 ng/mL
7-aminoclonazepam 5 ng/mL
Lorazepam 5 ng/mL
Nordiazepam 10 ng/mL
Oxazepam 10 ng/mL
Temazepam 10 ng/mL
Cannabinoids
Carboxy-tetrahydrocannabinol
(THC-COOH)
10 ng/mL
CNS Stimulants
Methylenedioxyamphetamine
(MDA)
25 ng/mL
Methylenedioxymethampheta
mine (MDMA)
25 ng/mL
Amphetamine 25 ng/mL
Methamphetamine 25 ng/mL
Benzoylecgonine 50 ng/mL
Miscellaneous
Cyclobenzaprine 10 ng/mL
Methorphan 10 ng/mL
Norketamine 10 ng/mL
Zolpidem carboxylic acid 10 ng/mL
Zopiclone 10 ng/mL
Carisoprodol 100 ng/mL
Meprobamate 100 ng/mL
Opioids
Fentanyl 1 ng/mL
Norfentanyl 1 ng/mL
Codeine 10 ng/mL
Morphine 10 ng/mL
Hydromorphone 10 ng/mL
Hydrocodone 10 ng/mL
Oxymorphone 10 ng/mL
Oxycodone 10 ng/mL
Tramadol 10 ng/mL
SOME WORDS ABOUT HAIR IN DFSA CASESDrugs can be trapped in hair from: Blood
Sebum
Sweat
Environment
Useful when reporting is delayed weeks or longer
Some drugs can remain in hair for months or years
Hair grows about 0.5 inch per month
It takes about 2 weeks for drugs deposited at hair root to emerge above the scalp
Typically head hair is used
SOME WORDS ABOUT HAIR IN DFSA CASESBest to wait 2 months or longer before collection
Collect about 200 strands in a bundle, cut close to the scalp Width of a #2 pencil
Difficulties with hair: Assuming 1x exposure, it may be
difficult to detect Negative results may be misleading Doesn’t always prove “ingestion” Can’t readily screen hair for multiple
drugs Should be done by laboratory with
newer technology and experience with hair
1. Beware of “Fake News”
A lot of misinformation about how crime is committed, drugs used, and prevalence of occurrence
2. “Drugs are Bad”
It’s more than just Roofies and GHB…check the medicine cabinet
3. “Responsible Drinking” doesn’t mean “Don’t spill your drink”
Too many variables in absorption to predict exactly how intoxicated one may become
“1 unit per hour” rule will keep you safe
4. If I were to give a Sermon, it would be About Getting Urine
In most cases, urine improves the chance of finding drugs
5. “Double Negatives” are a “No-No”
A negative toxicology finding does not mean “no drugs were involved”
DRUG-FACILITATED SEXUAL ASSAULT: A FORENSIC HANDBOOK
The Victim - Abarbanel
The Perpetrators and Their Modus Operandi - Welner
Ethanol - Garriott and Mozayani
Rohypnol and Other Benzodiazepines - Robertson and Raymon
Gamma-Hydroxybutyrate (GHB) and Related Products - Ferrara, Frison, Tedeschi and LeBeau
Hallucinogens - Raymon and Robertson
Opioids - Jufer and Jenkins
Miscellaneous Prescription and Over-the-Counter Medications - Jones and Singer
Collection of Evidence from DFSA - LeBeau and Mozayani
Analysis of Biological Evidence from DFSA Cases -LeBeau and Noziglia
Sexual Assault Nurse Examiners - Ledray
Investigating DFSA Cases - Archambault, Porrata and Sturman
Prosecution of DFSA - Kerlin, Riveira and Paterson
CONCLUSIONS
DFSA cases are not new
Today the numbers of DFSA cases are increasing, but the true prevalence will never be known
Many different drugs are being used –and each year new ones will be used
Many of the challenges of DFSA can be overcome Education is key
A thorough investigation is a must
Teamwork is vital