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Since 1996, reports of drug-facilitated crimes have been increasing. Drugs may be used to render the victim helpless or unconscious so that the assailant can commit a rape or robbery. The amnestic effects of many of the drugs used often leave little or no recollection of the events, making investigation, and prosecution of the suspect more difficult.

  1. High-risk populations include single women, men or unsuspecting travelers, new to an area, without companions. Drug administration may occur in a bar, club, or on public transportation when the victim leaves a drink unattended or accepts an opened bottle or drink. In one series of self-reported cases, half the victims reported meeting the assailant in a public place, and more than 70% of the victims knew the assailant (eg, a friend or colleague).

  2. Drugs used. Contrary to the popular belief that specific "date rape drugs" are involved in these crimes, a variety of drugs with amnestic or central nervous system (CNS) depressant effects can be used to facilitate assault, including opioids, anesthetics, benzodiazepines, other sedative-hypnotic drugs, skeletal muscle relaxants, anticholinergics, hallucinogens, clonidine, aromatic solvents, and of course ethanol (Table I–46).

    1. Note that many of these drugs are also commonly used to "get high" and may have been self-administered by the victim for this purpose.

    2. Benzodiazepines are often selected for their anterograde amnestic effect, which is related to but distinct from sedation. The strength of the amnestic effects can be predicted to increase with the dose, rapidity of onset, lipophilic character, and slow redistribution from the CNS.

  3. Routes of surreptitious drug administration

    1. Drink: tablet, ice, liquid in eyedropper.

    2. Smoke: applied to a cigarette or joint.

    3. Ingestion: brownie, gelatin, fruit, other food.

    4. Vaginal syringe: drug in contraceptive gel.

    5. Represented as another drug.

  4. Clinical evaluation. If the victims present early after the assault, they may still be under the influence of the drug and may appear inappropriately disinhibited or relaxed for the situation. Unfortunately, victims often present many hours, days, or even weeks after the assault, making the collection of physical and biochemical evidence much more difficult. Determining the time course of drug effects with estimation of last memory and first recall may provide useful information to investigators.

    1. Use open-ended questions to avoid suggesting symptoms to a victim who may be trying to fill in a lapse in memory.

    2. Perform a thorough examination and maintain the legal chain of custody for any specimens obtained.

  5. Laboratory. Timing of laboratory analysis may be crucial, as elimination rates of commonly used sedative and amnestic drugs vary and some may be extremely short. Immediate collection of toxicology specimens is important to avoid loss of evidence. For a service that deals in assaults or sexual abuse, it is important to confer in advance with the laboratory so that it is clearly understood what type of testing will be performed; the laboratory can then develop a testing strategy (what tests to use, the sequence of tests and confirmations, ...

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