Drug-facilitated sexual assault in ontario, canada: toxicological and dna findings

Journal of Forensic and Legal Medicine xxx (2010) 1e6 Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings Janice Du Mont EdD Research Scientist, Associate Professor ,,Sheila Macdonald MN ProvincialCoordinator Nomi Rotbard MPH Research Associate, PhD Student , Deidre Bainbridge BSc NursePractitioner Eriola Asllani BSc Data Analyst , Norman Smith PhD Associate Professor ,Marsha M. Cohen MD Research Scientist, Professor , a Women's College Research Institute, Women's College Hospital, Toronto, Canada b Department of Public Health Sciences, University of Toronto, Toronto, Canadac Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, Canadad Mailman School of Public Health, Columbia University, NY, USAe Sexual Assault and Domestic Violence Care Centre, Women's College Hospital, Toronto, Canada f Therapeutic Drug Monitoring & Toxicology, Clinical Biochemistry, St. Joseph's Health Care, London, Canada g Department of Biochemistry, University of Western Ontario, London, Canadah Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada The purpose of this study was to determine which persons reporting sexual assault to a hospital-based treatment centre may have been covertly drugged and to provide information about whether a sexual Each consecutive adolescent and adult presenting at a sexual assault treatment centre was screened for drug-facilitated sexual assault (DFSA). Urine was collected and tested for central nervous system active drugs. Oral, vaginal, and/or rectal swabs were tested for male DNA. Unexpected drugs weredefined as those not reported as having been voluntarily consumed within the previous 72 h. Positive swabs for unexpected DNA were determined by whether the person reported having had consensual A total of 184 of 882 eligible participants met suspected DFSA criteria. Mean age was 25.8 years (SD ¼ 8.5), 96.2% were female and 64.7% White. Urine samples were positive for drugs in 44.9% of cases,alcohol in 12.9%, and both drugs and alcohol in 18.0%. The drugs found on toxicological screening wereunexpected in 87 of the 135 (64.4%) cases with a positive drug finding and included cannabinoids(40.2%), cocaine (32.2%), amphetamines (13.8%), MDMA (9.2%), ketamine (2.3%), and GHB (1.1%). MaleDNA was unexpected in 30 (46.9%) of 64 cases where it was found.
Among those persons presenting to a sexual assault treatment centre with a suspicion of DFSA, the presence of unexpected drugs and male DNA was common, lending support for their contention thatthey had been intentionally drugged and sexually assaulted. Most unexpected drugs found were notthose typically described as 'date rape drugs'.
Ó 2010 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
The typical scenario involves a male assailant putting a drug intothe drink of an unsuspecting woman and waiting for her to lose Since the mid-1990s unconfirmed reports have described the consciousness before assaulting her. Later, the woman may expe- increased use of covert substances to perpetrate sexual assault.
rience sensations such as hangover, nausea, vomiting, and/or Most commonly described as drug-facilitated sexual assault partial or total amnesia. Flunitrazepam (RohypnolÒ) has garnered (DFSA), those suspecting having been drugged and sexually the most media attention, although alcohol itself, other benzodi- assaulted are frequently seen at emergency department azepines (e.g., lorazepam), and street drugs (e.g., gamma-hydrox-ybutyrate [GHB]) reportedly have been used to facilitate ra Definitions of what constitutes a DFSA are still emerging so that * Correspondence: Women's College Research Institute, 790 Bay Street, 7th Floor, it is difficult to ascertain the extent of the problem. Many studies Toronto, Ontario M5G 1N8, Canada. Tel: þ1 416 351 3732x2705; fax: þ1 416 351 have been based on assessments of drugs in specimens sent to laboratories for analysisand provide numerators only. The 1752-928X/$ e see front matter Ó 2010 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
doi:10.1016/j.jflm.2010.05.004 Please cite this article in press as: Du Mont J, et al., Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings, Journal ofForensic and Legal Medicine (2010), doi:10.1016/j.jflm.2010.05.004 J. Du Mont et al. / Journal of Forensic and Legal Medicine xxx (2010) 1e6 proportion of suspected victims who provided a sample and the (suspected) sexual assault and drugs (prescription, over-the- characteristics of these victims are not known. Nor is it clear which counter, and street) within the previous 72 h of examination.
of the drugs detected is the result of a deliberate spiking or Supplemental data were collected by the health care provider for a voluntarily consumption. Testing for the presence of male DNA in those meeting the predetermined DFSA criteria. These data included the absence of recent consensual sexual intercourse might help information about whether the client had engaged in consensual determine whether someone was sexually assaulted, but studies to sexual intercourse within one week of being examined.
date have not included analyses of vaginal, rectal, and/or oral swabs During a physical examination of each participant, a urine for biological material. Shas commented, "frustrated sample was collected and biological samples e oral, vaginal, and/or attempts to remember 'what actually happened' and the fear of the rectal swabs e were taken. While forensic cut-off points for col- 'unknown' can become a fixation for the survivor" lecting DNA samples may vary across jurisdictions,in accor- The objective of this study was to determine which of those dance with standard sexual assault treatment guidelines used at sexual assault reports made to a sexual assault treatment centre participating centres, oral swabs were collected within 24 h, rectal may have involved covert drugging and to provide further infor- swabs within 48 h, and vaginal swabs within 72 h of the (sus- mation about whether sexual intercourse may have occurred. Our first goal was to identify the type and frequency of central nervous Urine specimens were packaged and shipped to a toxicology system (CNS) active drugs that had not been voluntarily consumed.
laboratory where they were tested for CNS active substances most Our second goal was to determine the percentage of suspected commonly implicated in the literature as facilitating sexual assault: victims for whom unexpected male DNA was present. Strengths of alcohol (ethanol), cannabinoids, cocaine, opiates, GHB, amphet- our study include a prospective data collection on every person amines, benzodiazepines (e.g., flunitrazepam [RohypnolÒ], diaz- attending several sexual assault centres, a blinded assessment of epam, nordiazepam, lorazepam, clonazepam, alprazolam), MDMA drugs from urine specimens, and the determination of whether (Ecstasy), ketamine, and others (e.g., antidepressants, cough suppressants, muscle relaxants, anticonvulsants).All specimenswere analyzed according to a predetermined blind prot Anonymized oral, vaginal, and rectal swabs were shipped to a government forensic laboratory where they were analyzed for the We conducted a prospective study of women and men reporting presence of male DNA. Again, all specimens were analyzed sexual assault to seven hospital-based sexual assault treatment according to a predetermined blind protocol.For men who centres in Ontario, Canada. Information was collected over a 22- suspected sexual assault, the laboratory was instructed to look for month period beginning in June 2005. The study was approved by the institutional ethics review boards of each participating hospital.
Data were entered into a secure database on a bi-weekly basis.
The seven centres serve rural and urban catchment areas repre- Frequencies were generated for each variable and inconsistencies sentative of the culturally diverse population of the province. The detected in the data reconciled by: (1) reviewing study forms for centres provided emergency care to women and men who presented missing data; (2) asking program coordinators at participating sites within 72 h of a sexual assault. Staff of these centres were sexual to provide missing data; (3) checking with the laboratories about assault nurse examiners and nurse/physician teams who were on- outstanding and/or missing test results; and (4) reviewing all hard call 24 h a day, 7 days a week and were able to come to the hospital copy toxicological and biological test results to ensure that the within 1 h of being paged. Care provided included the following: information had been correctly entered into the database.
crisis intervention and support, physical assessment of injuries, Descriptive statistics were generated for characteristics of the collection of forensic evidence, medication for the prevention of sample. The type and percentages of CNS active substances were pregnancy and sexually transmitted infections, as well as referral to determined by time of collection. On a case-by-case basis we next community agencies for ongoing support and counselling.
compared the drugs found in each urine sample to a list of drugs Using a modified Delphi method,an advisory group, with reported to have been voluntarily used by the participant. We expertise in forensic toxicology, forensic biology, and sexual defined cases with 'unexpected CNS active drugs' as those with one assault, aided in the generation of 16 criteria for identifying cases of the following characteristics: the participant did not report of suspected drugging (e.g., amnesia; conscious paralysis; loss of a history of CNS active drug consumption and at least one CNS active consciousness). Similarly, a list of seven criteria was developed to drug was found; a CNS active drug was found that was different from identify those who thought they had been sexually assaulted, but the one(s) the participant reported voluntarily consuming.
were unable to recall details (e.g., woke unclothed or to find We defined cases of 'unexpected male DNA' as those in which the clothing in disarray; unexplained body fluids such as semen found participant did not report having engaged in consensual intercourse on body; unexplained anogenital injuries). For this study, a case the week prior to being examined and for whom male DNA was was defined as a person who reported at least one valid reason for found. We determined the percentage of biological specimens that suspecting having been drugged and at least one reason for sus- were positive for male DNA according to the type of swab (oral, pecting having been sexually assaulted for more details).
vaginal or rectal) collected. Fisher's exact test was used and an All adolescents and adults aged 16 years or older who presented unadjusted odds ratios and 95% confidence interval was generated to any of the participating sites within 72 h with a belief of having to denote the magnitude of the difference between the examined been sexually assaulted were included in the study. Excluded from groups. A p-value less than 0.05 was considered statistically signif- the study were those younger than 16 years of age, those who did icant. We used Statistical Analysis System (SAS) software, version not believe that they had been sexually assaulted, and those who 9.1.3 (SAS Institute Inc., Cary, NC, USA), to analyze the data.
Health care providers at each site were trained to screen consecutive clients for suspected DFSA. The Screening Form usedgathered sociodemographic (e.g., age, sex, ethnic/racial back- Overall, 977 persons who reported a suspicion of sexual assault ground), health (e.g., physical disability) and assault (e.g., type of were screened e 882 of whom were included in the study ( sex act, use of weapon) information. Details were also collected Of these, 184 (20.9%) met suspected DFSA criteria. This group from clients about their voluntary use of alcohol prior to the averaged 25.8 years of age (SD ¼ 8.5), was overwhelmingly (96.2%) Please cite this article in press as: Du Mont J, et al., Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings, Journal ofForensic and Legal Medicine (2010), doi:10.1016/j.jflm.2010.05.004 J. Du Mont et al. / Journal of Forensic and Legal Medicine xxx (2010) 1e6 Total Persons Presenting and
Screened at SADVTCs:
N = 977 (%)
Excluded:
Eligible Participants
N = 698 (79.1)
N = 184 (20.9)
N = 28 (15.2)
N = 150 (81.5)
N = 6 (3.3)
N = 178 (96.7)
N = 3 (1.6)
N = 3 (1.6)
N = 64 (42.7)
N = 80 (44.9)
N = 23 (12.9)
N = 32 (18.0)
N = 43 (24.2)
N = 86 (57.3)
Fig. 1. Toxicology and male DNA test results.
women and included several ethnic groups: A boriginal (4.9%), (suspected) assault. In the 72 h prior to being examined, Asian (4.3%), Black (2.7%), Latin American (3.8%), and White (64.7%).
a substantial proportion of participants reported having used over- Most were employed (60.9%) and a substantial percentage was the-counter medications (25.6%), prescription medications (29.4%), students (39.7%). One-quarter (25.0%) suffered from mental health and street drugs (25.5%) (The majority (80.4%) reported to problems and 5.4% reported physical or cognitive disabilities. Most a sexual assault treatment centre within one day of being assaulted.
(85.9%) had been drinking alcohol immediately prior to the Toxicology testing was performed on urine samples collected from 178 of the 184 (96.7%) participants meeting the suspectedDFSA criteria. Three (1.6%) clients did not provide a urine sample.
Two (1.1%) samples were not analyzed due to container breakage during shipment and one (0.5%) sample was lost There were 80 (44.9%) urine samples positive for at least one CNS active drug (no alcohol). Alcohol alone (no drugs) was found in23 (12.9%) samples and both alcohol and drugs were found in 32 (18.0 %) samples. Neither alcohol nor drugs was found in 43 (24.2%) samples (). Findings were time dependent: alcohol was detected within 24 h post-assault in 91.3% of cases with alcohol alone; drugs in 76.3% of cases with drugs alone; and alcohol and drugs in 100% of cases positive for both substances.
The most common substances detected in screening were alcohol (30.9% of 178 cases) and the street drugs: cannabinoids (33.7%), cocaine (21.4%), amphetamines (7.3%), and MDMA (7.3%).
The anti-anxiety medication lorazepam was found in 6.2% of cases, and the antidepressant citalopram in 6.7%. GHB (1.1%) and ket- amine (1.1%) were found in a very small proportion of cases. Flu- nitrazepam (RohypnolÒ) was not found in any of the samples examined. Drugs such as these were most likely to be detectedwithin the first day post-assault ().
There were unexpected toxicology results for 87 cases (48.9% of all 178 suspected DFSA cases; 64.4% of the 135 cases for which there was a positive toxicology finding). The most common types ofunexpected drugs found e those not reported as being voluntarily consumed e were similar to those identified above for the entire 178 suspected DFSA cases: cannabinoids (40.2% of 87 cases) and cocaine (32.2%). Some substances were found with greater frequency among this group, but still in a minority of cases: Please cite this article in press as: Du Mont J, et al., Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings, Journal ofForensic and Legal Medicine (2010), doi:10.1016/j.jflm.2010.05.004 J. Du Mont et al. / Journal of Forensic and Legal Medicine xxx (2010) 1e6 participants for whom the samples had been collected, but speci- Toxicological results by delay in presentation and unexpected findings.
Male DNA was found in 64 (42.7%) cases (). Most of the swabs tested were vaginal swabs (49.8% of 283 swabs), which were also the most likely to contain evidence of male DNA (42.6%, p < 0.0001). Approximately one-third (34.4%) of rectal swabs tested positive for male DNA and 3.7% of oral swabs There were 47 (31.3%) participants who reported having engaged in consensual sexual intercourse within seven days prior to being examined. However, in 46.9% (30/64) of cases positive for finding was unexpected as no consensual sexual In 74.2% of suspected DFSA cases with a toxicological finding, at least one CNS active drug and/or alcohol was found. Our ability to detect alcohol and drugs in urine samples was time dependent with most positive results confirmed within 24 h of the (suspected)assault. The presence of unexpected drugs was common. For 48.9% of all suspected DFSA victims (64.4% of cases with a positive toxi- cological finding), a drug was found that had not been reported as voluntarily consumed. This is more than twice the rate of unex- pected toxicological findings in Hurley et al.'schart review of DFSA cases in Victoria, Australia, possibly because ours was a prospective data collection that systematically screened consecutive persons reporting sexual assault for DFSA using predefined criteria.
The voluntary consumption of substances was also common in this sample of clients suspecting drugging. More than one-quarter had used over-the-counter (25.6%), prescription (29.4%), and street drugs (25.5%) in the 72 h before being examined. Hurley et al.
reported that in 49% of their suspected DFSA cases prescription medications had been consumed and in 26% street drugs. Although detected in less than a third (30.9%) of urine samples, alcohol was reported to have been consumed by 85.9% of participants in our study immediately prior to the (suspected) assault, a rate of ingestion similar to that found by Hurley et (77%). Theseauthors cautioned that, "alone or in combination [use of] these substances may [a]ffect conscious state, the ability to consent to sexual activity and proper recall of events." Although there has been a lot of media attention aimed at so- called 'date rape drugs', in particular, GHB, MDMA, ketamine, and flunitrazepam, we found cannabinoids, alcohol, and cocaine to be the most common substances in the obtained urine specimens where drugging was suspected. Even accounting for substances reported to having been voluntarily consumed and focusing on only Note. Percentages do not total to 100 as more than one drug could be found in unexpected toxicological results, 'date rape drugs' were found in findings confirm some of those reported in Toxicology results were available for 178 participants.
earlier chart review and toxicology database studies.
amphetamines (13.8%), MDMA (9.2%), and ketamine (2.3%). Unex- It is important to note that our findings may under- or over- pected alcohol was found in just one (1.1%) case estimate the true rate of intentional drugging in this sample. Given Most of the anti-anxiety medications, analgesics, and street drugs the delayed presentation of many who suspected DFSA and the detected in urine were not expected. The presence in samples of short half-life of some 'date rape drugs', it is possible that failure to diazepam, nitrazepam, benzodiazepine metabolites (nordiazepamand oxazepam), morphine, hydromorphone, desipramine, amitrip- tyline, and ketamine was infrequent but, without exception, unex- Biology testing was performed on biological specimens collected from 150 of the 184 (81.5%) clients meeting suspected DFSA criteria. Swabs were not collected in 28 (15.2%) cases: either participants did not agree to the testing or health care providers determined the testing to be unnecessary based on the history of the (suspected) assault and the time delay from the (suspected) a Biology results were available for a total of 283 swabs.
assault to the examination. There were six (3.3%) additional b Male DNA was denoted as found if any of the swabs tested positive.
Please cite this article in press as: Du Mont J, et al., Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings, Journal ofForensic and Legal Medicine (2010), doi:10.1016/j.jflm.2010.05.004 J. Du Mont et al. / Journal of Forensic and Legal Medicine xxx (2010) 1e6 sometimes find unexpected drugs is the result of not being able to screen for substances in a more timely However, it is The authors have no conflict of interest.
possible that some of the unexpected drugs found in toxicology screening are the result of client inaccuracy in recalling voluntary The study was funded by a peer-reviewed grant from the drug or alcohol use due to trauma or reluctance to disclose such Ontario Women's Health Council (now ECHO), Ministry of Health consumption.The latter may be true, particularly in the case of and Long-Term Care, Ontario. J. Du Mont is the recipient of a New illicit substances such as cannabinoids, where their role in DFSA is Investigator Award in Gender and Health from the Canadian less clear. As well, cannabinoids and cocaine can be detected Institutes of Health Research and is supported by the Atkinson beyond the 72 h time frame for screening for their use established Male DNA was found in 42.7% of suspected DFSA cases with biological results and was most likely to be identified in samples Ethics approval was granted by the institutional ethics review collected on vaginal swabs. Notably, in 46.9% of cases with male boards of each participating hospital.
DNA, the client denied having had consensual sexual intercourse inthe week prior to being examined. Although occasionally DNA evidence has been found up to 10 days post-consensual sexualintercourse,this latter finding lends support to complaints that The authors are indebted to participating sites' sexual assault a sexual assault occurred.In cases in which no consensual nurses, physicians, and program coordinators and the women and sexual intercourse was reported and no male DNA was found, it is men who participated in this study. They would also like to thank possible that no sexual assault had occurred. However, a negativefi the project advisory committee, Margaret McGregor, Roger Frap- nding may also have been related to the time delay between the pier, and Kathy McKague for their assistance with the Drug-Facili- (suspected) assault and when the swabs were taken. The assailant may have worn a condom or may not have ejaculated. In addition,the client may have washed, bathed, showered, douched, defe-cated, and/or urinated prior to reporting to a site e activities that would further have reduced the ability to detect DNA.
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