Drug-Facilitated Sexual Assault
Testing and Treatment
Drug Testing
Some drugs used to facilitate sexual assault are rapidly absorbed by the body and rapidly excreted, so there is little evidence of the drugging.
Whenever drugging is suspected, urine samples should be collected from a patient as soon as possible. Blood samples should also be collected if the patient presents within 72-hours of the suspected drugging.
Police involvement is required to perform the testing, and your regional or municipal police force should be contacted as soon as possible. After urine and/or blood samples have been collected, police will have the samples tested at an accredited police laboratory.
Note: though police involvement is required for drug testing, this does not necessarily mean that a patient will be forced to press charges or proceed with a full investigation.
Sample Collection
The following samples should be taken if drugging is suspected:
Symptoms and Medication
If a recent drugging is suspected, it is important to note any symptoms a patient may have, as well as record any medication, such as sedatives, that are administered before urine/blood samples are collected.
Urine
Urine should be collected as soon as possible. A standard, screw-top sample container is fine. For testing purposes, larger samples are preferred. A filled 50ml container is suggested.
Urine should be refrigerated, and properly identified on the container (not on the lid). Identification information should include patient's first and last name, hospital and/or personal health identification number, date and time of sample collection, treating physician, and time of suspected drugging. Chain of custody procedures must be followed to guarantee the integrity of the sample.
Blood
Blood should also be collected if the patient presents within 72-hours of suspected drugging. Sample should be collected as soon as possible. 7-8 ml of blood should be collected in a blood sample tube containing preservatives (gray stopper). Sample should be properly labeled (as noted above) and chain of custody procedures must be followed to guarantee the integrity of the sample.
Treating Victims
If you suspect a patient may be a victim of a drug-facilitated sexual assault:
- The patient should be treated with respect and with a non-judgmental approach.
- Offer to have the police involved.
- In some cases, such as if the victim is under 16 or if they were abused by a current partner or family member and are still in danger, you may be required to report the assault to authorities. Consult local police or sex crimes unit for more information.
- If the patient does not meet the above criteria, police may allow the victim to determine whether an investigation is performed or if charges are laid. Drug testing and forensic examinations can sometimes be performed even before a victim has made these decisions.
- Advise the patient not to bathe, shower or change his or her clothes. These tips can help preserve evidence if the victim reports to police.
- If drugging is suspected, victim should avoid urinating before a sample can be collected.
- Standard drug testing can be arranged. Depending on the presentation of the patient, police involvement and additional testing for Flunitrazepam and GHB should be considered.
- Also offer a forensic examination at an accredited centre. Contact regional police for advice and centre locations.
- Offer testing for Sexually Transmitted Infections including samples required for the rape kit as well as serology for HIV, Syphilis, Hepatitis B & C.
- Offer antibiotic prophylaxis (Table 2).
- The patient should be tested to exclude pre-existing pregnancy where this is appropriate.
- A patient should be offered emergency contraception where there is a risk of pregnancy.
- Referral to a sexual assault crisis center, social worker, psychologist or psychiatrist.
- Offer follow-up screening for Sexually Transmitted Infections as well as psychological support.
Contributor: Nathalie Fleming, MD
Last Revised: September 2005
Last Modified: September 5, 2006
