Transcript No Slide Title

Appendix 20
Drug-Facilitated Rape
National Judicial Education Program
Drug-Facilitated
Sexual Assault
US Department of Justice
Federal Bureau of Investigation
FBI Laboratory
Chemistry Unit
Washington, DC 20535
(202) 324-4329
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
Drugs Reportedly Used to Commit DFR
• Ethanol
• Benzodiazepines
–
–
–
–
–
–
–
–
Flunitrazepam
Clonazepam
Lorazepam
Alprazolam
Triazolam
Chlordiazepoxide
Diazepam
Temazepam
• Zolpidem
• Barbiturates
•
•
•
•
•
•
•
•
•
•
GHB
Ketamine
Opiates
Antihistamines
Hallucinogens
Antidepressants
Chloral Hydrate
Muscle Relaxants
Clonidine
Yohimbine
7
Challenges with Drugs that are Used
•
•
•
•
Dosages
Number of Candidates
Pharmacokinetics
Pharmacodynamics
8
Fate of Drugs in Body
Distribution
Absorption
Excretion
Biotransformation
(Metabolism)
9
Where is the Drug ???
The Toxicological Problems
Absorption and Distribution
Metabolism and Excretion
Conc
Plasma
Urine
Time
10
Challenges Surrounding
Reporting of the Crime
• Is it Even Reported?
• Time Elapsed Since Drugging
11
El Sohley Study:
80
Time of Collection vs % Positives
70
60
50
% 40
30
20
10
0
0-12
13-24
25-36
37-48
49-60
61-72
73-84
>84
Hours Since Drugging
M.A. ElSohly, S.J. Salamone. Journal of Analytical Toxicology,
May/June 1999, pages 141-146
12
Challenges Surrounding
Reporting 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
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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
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 Benzodiazepines
Good 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
25
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Pharmacology of Flunitrazepam
• Metabolized to 7-Aminoflunitrazepam, 3OH-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 1.54.0 hours
• Urinary metabolites
are glucuronide
conjugates of
hydroxylated
products
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32
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
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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 GHB
a 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
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Hallucinogens
• 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.)
43
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 Ketamine
a Good DFR Drug
• Has dissociative, analgesic, and mild sedative
effects
• Becoming popular drug of abuse
– More readily available
• Many times victim voluntarily ingests
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What Makes Marijuana
a 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
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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 Opiates
Good DFR Drugs
•
•
•
•
Very sedating
Analgesic effect
Readily available
May be voluntarily ingested
51
Antihistamines
Antidepressants
Barbiturates
Chloral Hydrate
Muscle Relaxants
Zolpidem
Telazol
52
Amitriptyline (Elavil®)
• Causes heavy sedation
– May be prescribed as
anti-anxiety medication
• Additive effects when
combined with ethanol
• Additional side-effects:
–
–
–
–
–
–
–
Dizziness
Hallucinations
Confusion
Disorientation
Incoordination
Ataxia
Weakness
53
Diphenhydramine (Benadryl®)
• Antihistamine
– One of the first effective
• Becoming very popular
drug of abuse
• Available OTC
• Some hallucinogenic
properties at high doses
• Other antihistamines
cause similar effects
(Chlorpheniramine;
Brompheniramine)
• Causes heavy sedation
– May be prescribed for this
54
Chloral Hydrate
• “Mickey Finn”
• Oldest Sedative/Hypnotic
still used today
• Very rapidly metabolized;
must look for metabolite
(TCE)
• Very strong sedative effect
• Need to perform
specialized assay to detect
55
Zolpidem (Ambien®)
• Newer popular hypnotic
agent
• Not a benzodiazepine, but
acts on the same receptor
in the brain
• Very low-dose medication
• Most laboratories will not
be able to detect at
therapeutic levels
• Metabolite is difficult to
obtain
56
Telazol®
•
•
•
•
•
•
Veterinary anesthetic agent
Tiletamine (dissociative anesthetic)
Zolazepam (tranquilizer)
Increasingly popular drug of abuse
No reported cases (yet)
Potential of being good DFR drug since it
possesses both sedative and hallucinogenic
properties
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Challenges Surrounding the
Investigation
•
•
•
•
Drugs Used
Reporting the Crime
Collection of Evidence
Laboratory
Methodologies
59
Recommendations for Victims of
DFR
• Collect the first urine
• Call police
• Get medical attention
– Sexual Assault Kit
• Be truthful about
ethanol and drug use
• Call a rape crisis
center for information
and support
60
Recommendations for Medical Professionals
• GET URINE if reported
within 96 hours of
“drugging”
– 100 mL (if available)
• GET BLOOD if reported
within 24 hours of
“drugging”
– 10 mL in gray-top tubes
– Get additional blood for
other forensic testing
• Immediately refrigerate
specimens
• Document
– when drug ingested
– # of urinations
– drug and/or medication
used by victim
– all symptoms of victim
• Pick an appropriate forensic
toxicology laboratory
61
Recommendations for Toxicologists
• Know the LODs for your immnoassays!!!
• Develop assays with very low LODS for
common DFR drugs
– < 10 ng/mL for benzodiazepines and ketamine
– 1 g/mL for GHB
• Know your limitations
• Educate the public!
62
Conclusions
• DFR cases are increasing
• Many different drugs are being used - not just the
ones reported in the media
• Forensic toxicologists play a key role in the
investigation of victim allegations
• The successful investigation depends upon a
“team approach” involving the law enforcement,
medical professionals, scientists, and prosecutors
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Tracy L. Bahm, Senior Attorney
65
American Prosecutors Research Institute
Using Expert Testimony
Example: Steven Sera case in Arkansas
State of Arkansas v. Steven Sera, CN. 97-70-2,
10th Judicial District, Bradley County,
Arkansas, March 10 - 13, 1998. Sera was
convicted of rape, attempted rape, and the
introduction of a controlled substance,
Rohypnol. He was sentenced to 30 years per
offense, served concurrently. He will be
eligible for parole after serving 21 years.
Three experts testified in the case.
66
1. Toxicologist: tests the urine
sample in the lab
• Testified about the fact that Rohypnol metabolites
were found in the victim’s urine.
• Explained what his analysis revealed, e.g. the
levels of metabolites of flunitrazepam that were
present in the sample.
• Discussed the significance of high and low levels
of Rohypnol in reference to how long ago the drug
had been ingested.
67
2. Pharmacologist: use especially
when there is no urine sample
• Has a broader base of knowledge: can educate the
jury as to what the drug does.
• Testified about the properties of Rohypnol and
benzodiazepines in general.
• Discussed the general effects of the drugs
• Discussed the effects of Rohypnol’s interaction
with alcohol.
• Discussed the residual effects of the drugs over
different time periods.
68
3. Chemist: (may not need this witness)
• Testified about the “solid dosage analysis”:
the way the drug exists outside the body,
e.g. the Rohypnol tablets themselves.
(In Sera’s Arkansas case, the police found
actual Rohypnol tablets in his apartment as
well as other drugs).
69
What if no blood or urine
sample?
AKA
REALITY
EXAMPLE: Virginia Law
• § 18.2-67.10
• RAPE = Sexual assault accomplished through
use of the complaining witness’s mental
incapacity or physical helplessness….
• § 18.2-61
• Physical Helplessness = unconsciousness or
any other condition existing at time of
offense which rendered CW physically unable
to communicate unwillingness to act &
accused knew/should have known
71
A Thorough Investigation is
absolutely crucial!!!
Teamwork is the Key…
It starts with a
properly trained
Police Officer
72
Ask the sexual assault victim :
• What does she remember before receiving
the drink?
• What were her symptoms before she passed
out or blacked out?
• Does she have any bits and pieces of
memory of the sexual assault incident?
• What does she remember about other
individuals present?
73
• How much control did she have over her
drink?
• How much did she have to drink that night
and how much does she normally drink?
• In the past, if she has drunk excessively,
what have been the physical effects?
• Did she use any other drugs that night or
has she at other times?
74
• Did she experience any unusual side-effects
the day after?
• Were any of her belongings stolen?
• Was there anyone home when she came
home?
Did they notice anything unusual about her
behavior and appearance?
• Who was the first person she told about the
incident?
75
Other factual witnesses
• Interview friends of the victim– they may be able
to fill in some of the “blanks” in the victim’s
memory.
• Try to account for as much of the victim’s lost
time as possible. Interview everyone you can who
saw her before or after the incident.
• Interview bartender/waitperson/anyone else that
saw the victim drinking– can they confirm how
much & what the victim had to drink?
76
Drafting a Search Warrant
Items to look for:
77
• Packages of Rohypnol and other drugs.
• Bubble packages and other packaging.
• Cooking utensils (for GHB).
• Precursors/Reagents.
(chemical ingredients of GHB).
• Prescriptions from the U.S. and other countries.
• Liquor bottles, Margarita Salt, mixers, etc.
• Glasses, soda cans, and bottles … any containers.
• Videotapes, photographs, and CD ROMs.
• Victim souvenirs
78
• Pornographic literature containing suggestions of
drugging women to facilitate sexual assault.
• Videotape/camera equipment.
• Standard sexual assault crime scene evidence
(sheets, etc.).
• Internet information/pamphlets on Rohypnol and
GHB and on using these and other drugs in the
commission of sexual assaults.
• Computers and computer discs.
• If robbery is suspected: the victim’s (stolen)
possessions and pawn shop slips.
79
Pretext phone calls:
(Getting the suspect to admit to any part of
the crime)
check the statute regarding the
taping of conversations
80
Setting Up a “Controlled Buy”
81
IN ORDER TO SET UP A
CONTROLLED BUY
• The Assault Detective should connect with
Street Narcotics Officers to determine
potential “dealers”.
• Suspect’s friends and/or school and/or
neighborhood kids may be able to provide
information on who is selling drugs in the
area.
82
IN ORDER TO SET UP A
CONTROLLED BUY
• If the suspect is the dealer, a successful controlled
buy identifies the drug and provides evidence that
the suspect had access to the drug.
• If the suspect is not the dealer, then locating the
local/neighborhood dealer will help you identify
the drug and show access. The dealer may also
“flip” in exchange for a shorter sentence and
identify the suspect as one of his “clients” and
purchaser of the drug.
83
In order to set up a controlled Buy
Piggy - Back Warrants
If any drugs can be purchased from the
suspect, you may be able to obtain a search
warrant, which will enable you to search for
the purchased drug and the suspected rape
drug, as well as other evidence.
84
“It’s important to work together
with victim advocates.”
85
CONCERNS OF THE SEXUAL ASSAULT
ADVOCACY COMMUNITY REGARDING
THE USE OF THE “FULL DRUG SCREEN”
There is a recommendation in this video that
prosecutors ask for full drug screens of
victims of sexual assault who present with
signs and/or symptoms of drug - facilitated
sexual assault. The sexual assault advocacy
community is very concerned about any
recommendations in which victims of sexual
assault are asked to provide specimens to be
used for “full drug screening.”
86
Depending upon the results of such a drug
screen, the information may be used by the
defense to discredit the victim, thereby
hurting her chances of a successful
prosecution. In addition, the testing
procedures for “date rape drugs” specifically
are not currently standardized, therefore,
some laboratories may not have the
capabilities to run the tests necessary to
detect small levels of Rohypnol or GHB.
87
It is essential that victims have an advocate
available to thoroughly explain the
ramifications of any type of drug testing, be
it a full or partial drug screen. Without all
of the accurate information, victims will not
be able to truly give informed consent to
such a test.
88
Law enforcement and/or prosecutors
should not use the results of such a full drug
screen (revealing the existence of other
drugs in addition to “date rape” drugs) to
automatically stop a sexual assault case from
going forward in the criminal justice system.
The presence of recreational drugs in
addition to date rape drugs is not evidence
of the victim’s consent to the sexual act.
89
Voluntary Consumption
• Be aware that voluntarily taking GHB or
any other drug does not mean that the
victim is consenting to sexual intercourse,
and does not negate a rape charge.
90
FOCUS ON:
•
•
•
•
•
•
Victim’s account
Statutory definition of incapacitated
Statutory definition of consent
Witness accounts
Remember that the victim is PASSED OUT!
Overcome jury nullification in voir dire w/
examples they can relate to….
– Unlocked door & burglary;
– intoxicated & robbed
91
Teamwork
The key to successfully prosecuting rapists
who use drugs to incapacitate their
victims is teamwork.
Law enforcement, prosecutors, victim
advocates, hospitals, laboratories, and
the community all play a role.
92
There are many potential crimes that
a suspect could be charged with:
• Look at your State Statute for all possible
sexual assault charges.
• Be Imaginative… Rape may not be the only
possible charge.
93
Other Potential Charges
•
•
•
•
•
•
•
•
•
Sexual Battery with an Incapacitated Victim
Sexual Battery with a Helpless Victim
Sexual Battery with a Deadly Weapon
Aggravated Battery
Kidnapping/False Imprisonment
Drug Possession/Distribution
Contributing to the Delinquency of a Minor
(If applicable) Burglary/Robbery/Grand Theft Auto
Adulteration of Food or Drink
94

20-minute
Instructional
Video for
Prosecutors &
Police Officers
Accompanying Binder
95
Call us . . .
APRI
Tracy Bahm
(703) 519-1679
[email protected]
Website: www.ndaa-apri.org
96