Slipping a Mickey? Facts around drugs, alcohol and sexual assault DR CATHY STEPHENSON OCTOBER 2011 Slipping a Mickey? Phrase coined in late 19th century Chicago barman Mickey Finn used “knock-out” drops to incapacitate and rob his patrons Probably used chloral hydrate Centuries old practise – other drugs in historical literature include alcohol, barbiturates and scopolamine Recently much media coverage of “date rape” drugs and “drink-spiking” Case 1 18 yo girl, seen 7 hours post sexual assault Party, 5 RTDs in 2.5 hours – left one open on the table Shortly after felt “strange” Taken home by friend’s father In car, forced oral and vaginal penetration Diazepam found on hair samples, but not urine Case 2 16 year old girl Seen 6 months after SA Risk-taking behaviour prompted disclosure ETOH + marijuana + antidepressant Much more common scenario Case 3 23 year old girl Seen 20 hours after sexual assault In town with friends Drinking Offered a ride home Raped in car outside her flat DFSA? Victims subjected to non-consensual sexual activity while they are incapacitated or unconscious through the effect of alcohol or drugs (1) Thereby prevented from resisting and unable to give consent Ingestion can be voluntary, involuntary or both DFSA may be “proactive” or “opportunistic”(2) So how often does it really happen? No reliable data in literature Reporting of SA in general very low 21% of females and almost 5% of males in Australia report a lifetime history of sexual coercion(3) Analysis of 1200 urine samples from sexual assault cases in the USA revealed 60% positive for one or more drugs including alcohol (4) What drugs are found in DFSA? Alcohol – vast majority of cases (5,6,7,8) Cannabis Prescription medicines Benzodiazepine Antidepressant Antipsychotic Opiate Antiepileptics Recreational drugs – including amphetamine, ecstasy, benzodiazepines, cocaine, heroin, ketamine OTC drugs Gammahydroxybutyrate (GHB) and flunitrazepam found in <3% of positive samples (8) Alcohol Alcohol affects sexual behaviour Significant number had consumed >20 standard drinks (5) Causes disorientation, amnesia, poor judgement, inability to consent, loss of consciousness, CNS depression All effects exacerbated if combined with other CNS depressants – unpredictable results Issues specific to DFSA Complainant often intoxicated Incomplete recall and history Court appearance unlikely due to evidential “gaps” Blame vs responsibility Delay in reporting Delay in treatment and obtaining forensic evidence Poorer outcomes How should we test for drugs/alcohol? Urine samples Collect as early as possible Refrigerate They may be of use up to 4 days post-assault Blood (especially if < 24 hrs) Hair and nail samples from 2-4 weeks Conclusions? The “Mickey Finn” of the media is probably uncommon Drugs taken involuntarily are rarely detected Alcohol is the single drug consistently associated with sexual assaults Consumed alone or in unpredictable combinations with other drugs Adverse outcomes for these victims Headline News? “Drink-spiker rapist on the rampage in Courtney Place” Or “Alcohol the biggest factor associated with sexual assault in young people” References 1. LeBeau M, Moyazani A. Drug Facilitated Sexual Assault. A Forensic Handbook. London: Academic Press; 2001. 2. Operation Matisse. Investigating Drug Facilitated Sexual Assault. Association of Chief Police Officers. 3. De Visser R, Smith A et al. Sex in Australia: experiences of sexual coercion among a representative sample of adults. Aust NZ J Public Health 2003; 27:198-223. 4. Negrusz A, Gaensslen RE. Drug-facilitated Sexual Assault. Sexual Offences, Adult/Drug- Facilitated Sexual Assault 2005; 107-111. 5. Hurley M, Parker H, Wells D. The epidemiology of drug facilitated sexual assault. Journal of Clinical Forensic Medicine 2006; 13:181-185. 6. MacDonald J, Shand C et al. Prevalence of injury after recent rape in New Zealand. Ven Troppo, Conference of the Australasian College of Sexual Health Physicians, Darwin 2000. 7. Hindmarch I, ElSohly M et al. Forensic urinalysis of drug use in cases of alleged sexual assault. Journal of Clinical Forensic Medicine 2001; 8:197-205. 8. Slaughter L. Involvement of drugs in sexual assault. J Reprod Med 2000; 45:425-430. 9. Hall J, Moore C. Drug facilitated sexual assault – A review. Journal of Forensic and Legal Medicine 2008; 15:291-297. .