The author(s) shown below used Federal funds provided by the U.S. Department of Justice and prepared the following final report: Document Title: Estimate of the Incidence of Drug-Facilitated Sexual Assault in the U.S. Document No.: 212000 Date Received: November 2005 Award Number: 2000-RB-CX-K003 This report has not been published by the U.S. Department of Justice. To provide better customer service, NCJRS has made this Federally- funded grant final report available electronically in addition to traditional paper copies. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice. AWARD NUMBER 2000-RB-CX-K003 ESTIMATE OF THE INCIDENCE OF DRUG-FACILITATED SEXUAL ASSAULT IN THE U.S. FINAL REPORT Report prepared by: Adam Negrusz, Ph.D. Matthew Juhascik, Ph.D. R.E. Gaensslen, Ph.D. Draft report: March 23, 2005 Final report: June 2, 2005 Forensic Sciences Department of Biopharmaceutical Sciences (M/C 865) College of Pharmacy University of Illinois at Chicago 833 South Wood Street Chicago, IL 60612 ABSTRACT The term drug-facilitated sexual assault (DFSA) has been recently coined to describe victims who were given a drug by an assailant and subsequently sexually assaulted. Previous studies that have attempted to determine the prevalence of drugs in sexual assault complainants have had serious biases. This research was designed to better estimate the rate of DFSA and to examine the social aspects surrounding it. Four clinics were provided with sexual assault kits and asked to enroll sexual assault complainants. Subjects provided two urine specimens, a hair specimen and completed a questionnaire describing the assault, as well as any drugs they were using. The three specimens were then analyzed to evaluate the self-reporting of illegal drugs and the number of drugs found in the subjects. Following this analysis, the results were combined with the subject’s account of the assault and evaluated as to whether DFSA was a possibility. A total of 144 subjects were enrolled and the drugs analyzed for were found in 61.8% of the subjects with 4.9% positive for the classic “date-rape” drugs. For the evaluation of the validity of self-reporting of drug use, three drugs were employed; marijuana, cocaine, and amphetamines. We hypothesized that sexual assault complainants would be more truthful in their reporting than other populations studied. However, in this study, subjects’ positive for these drugs reported their usage approximately 40% of the time. DFSA was evaluated for each subject based on criteria developed for this work. In this study, 4.2% of the subjects were evaluated as to have been victims of DFSA through surreptitious drugging. When voluntary drug use by the subject is included, 35.4% of our subjects were estimated to have been victims of DFSA. The true value of DFSA for our subjects 2 is most likely to be between these two estimates. This work is the first to include toxicological analyses with the subject’s statements to determine DFSA. 3 LIST OF ABBREVIATIONS AMPS - Amphetamines BZ - Benzodiazepines BSTFA - Bis(trimethylsilyl)trifluoroacetamide CNS - Central Nervous System DEA - Drug Enforcement Agency DFSA - Drug Facilitated Sexual Assault DOA - Drug of Abuse FBI - Federal Bureau of Investigation GABA - Gamma Aminobutyric Acid GC/MS- Gas Chromatography / Mass Spectrometry GHB - Gamma-hydroxybutyrate IRB - Institutional Review Board LOD - Limit of Detection MBHFBA- N-Methyl-bis(heptafluorobutyramide) MDMA- Methylenedioxy-n-methylamphetamine MG - Milligram ML - Milliliter MTBSTFA- N-(tert-butyldimethylsilyl)-N-methyltrifluoroacetamide MTF - Monitoring the Future NAD - Nicotinamide Adenine Dinucleotide NCVS - National Crime Victimization Survey NFLIS - National Forensic Laboratory Information System 4 NG - Nanogram NIDA - National Institute of Drug Abuse NIJ - National Institute of Justice OTC - Over the Counter PCP - Phencyclidine RAINN - Rape, Abuse, & Incest National Network (www.rainn.org) SAMHSA- Substance Abuse and Mental Health Services Administration SIM - Selected Ion Monitoring SOFT - Society of Forensic Toxicologists SOP - Standard Operating Procedure SSRI - Selective Serotonin Reuptake Inhibitor TCA - Tricyclic Antidepressant THC - Tetrahydrocannabinol (marijuana) TMCS - Trimethylchlorosilane UCR - Uniform Crime Reports UCT - United Chemical Technologies USDTL- United States Drug Testing Laboratories 5 SUMMARY Sexual assault is a serious problem that is estimated to affect 64 per 100,000 females each year. The use of drugs in sexual assault has recently been reported in journals and through the media. Individuals who use drugs, with or without alcohol, are thought to be at a significantly higher risk for sexual assault. In some cases, the substances are taken voluntarily by the victims, impairing their ability to make decisions. In other cases the substances are given to the victims surreptitiously which may decrease their ability to identify a dangerous situation or to resist the perpetrator. The term drug-facilitated sexual assault (DFSA) has been coined to describe this subset of sexual assault. However, it is not precisely known how often drugs are used to facilitate sexual assault. Some of the drugs that could be used in DFSA cause unconsciousness, impair the victim’s memory, or limit their decision-making ability. There has been one previous study that attempted to determine the prevalence of drugs in sexual assault complainants. However, the study only accepted subjects with a drug history or those who believed that they were given a drug surreptitiously. Analytically, the study did not include many prescription and over-the-counter drugs that could be used in DFSA. The study also did not attempt to determine if the subjects were victims of DFSA, only to describe the drugs in their system when they presented to the clinic. This study was developed to correct the problems in the previous study by accepting subjects without any bias. Urine and hair specimens were then analyzed for approximately 45 drugs that have either been detected in sexual assault victims, or whose pharmacology could be exploited for DFSA. Each case was then analyzed based on the subject’s description of the assault, the drugs they admitted to using, and the toxicology analysis. For this work, two definitions of DFSA were used; one only included presumed surreptitious drugging, while the 6 second included subject’s whose intended drug use may have led to the assault. The estimated prevalence of DFSA was then assessed. An IRB-approved, multi-jurisdictional study was conducted that included four regionally diverse clinics. The clinics were located in Texas, California, Minnesota, and Washington State. Each clinic was provided with sexual assault kits and asked to enroll willing sexual assault complainants. When a subject was enrolled, a urine specimen was initially provided. One week later, the subject was asked to provide an additional urine specimen as well as a hair specimen. The subject then completed a questionnaire describing the details about the alleged assault, as well as any illegal, prescription or OTC drugs they were using. The three specimens were then analyzed to evaluate the validity of self-reporting of sexual assault complainants, the number of drugs found in the subjects, and whether drugs that could be used in DFSA were found. Following this analysis, the results were combined with the subject’s account of the assault and evaluated as to whether DFSA was a possibility. A total of 144 subjects were enrolled from all four participating clinics with only two clinics supplying the desired amount of 35 subjects. The racial profile of the enrolled subjects correlates well with the census data for the U.S. The ages of the subjects ranged from 18 to 56 years of age, with a mean of 26.6 years, which corresponded well with previous studies on sexual assault complainants. Only 41% of the enrolled subjects returned for the second visit, which was considerably lower than desired. The analyzed drugs were found in 61.8% of the subjects with 4.9% positive for the classic “date-rape” drugs. For the evaluation of the validity of self-reporting of drug use, three drugs were employed; marijuana, cocaine, and amphetamines. These were chosen as they would 7 not normally be given surreptitiously, thus the subject had to willingly take the drug. Also, these drugs are illegal and may affect the subject’s truthfulness. Previous studies on self-reporting of illegal drug usage have shown that different subsets of the population are more truthful than others. However, no studies have been done on sexual assault complainants. We hypothesized that sexual assault complainants would be more truthful in their reporting than other populations studied. However, in this study, subjects reported their usage of the above three drugs approximately 40% of the time. The number of drugs found in the subjects was compared to previous work on drug use among the general population as well as the drugs found in the previously mentioned DFSA study. This study had nearly 62% of the patients’ positive for one of the drugs being analyzed, which correlates extremely well with the previous DFSA study. When compared to a national survey on drug use, MTF, our subject’s reported drug use compared well with the reported drug use by the general population. However, as seen above, our subjects underreported their drug usage and when the actual number of positives is compared to MTF; our subjects had a much higher rate of drug use. DFSA was evaluated for each subject based on specific criteria we developed. DFSA1 is the conservative estimate of DFSA which only accepts surreptitious drug use as the indicator for DFSA. In this study, 4.2% of the subjects were evaluated as to have been victims of DFSA by this method. DFSA2 includes the criteria for DFSA1; however, it also includes voluntary drug use by the subject which may have facilitated the sexual assault (i.e., the assault might not have happened if the subject had not used the drug).