Drug-facilitated sexual assault is believed to be increasing, particularly among young adults and adolescents who commonly attend parties and clubs with loud music and fast-beat tempos. More than 20 drugs have been implicated, the most common of which are alcohol, tetrahydrocannabinol (THC), benzodiazepines and gamma-hydroxybutyrate (GHB). These agents are more commonly detected in alleged victims than the widely-publicized “date rape drug” flunitrazepam (Rohypnol) and sedatives such as alprazolam and triazolam. Other agents include precursors of GHB such as gamma butyrolactone (GBL) and 1,4 butanediol (BD). All of these agents have rapid onset of action (within 20 minutes) and cause disinhibition, passivity, muscle relaxation and lasting retrograde amnesia. These actions are potentiated by alcohol. A review by Schwartz and colleagues stresses the important role of the primary care physician in recognizing cases of drug-facilitated sexual assault and in counseling patients to avoid situations in which it could occur.

Flunitrazepam is banned in the United States but available as a sedative/tranquilizer in Europe and other parts of the world. Legally manufactured 1-mg and 2-mg tablets are blue and discolor beverages. Illicit flunitrazepam tablets (“Roofies” or “R2s”) are colorless and do not produce taste or odor when dissolved in beverages. The disinhibition and loss of consciousness induced by this drug may progress rapidly to coma but may be reversed by flumazenil. Flunitrazepam may not be detected by routine screening for benzodiazepines. In cases of suspected sexual assault, free testing for flunitrazepam and other agents is available through a drug company–sponsored hotline (800–608–6540).

Although GHB and related compounds have not been labeled by the U.S. Food and Drug Administration for this purpose, they are often used illicitly for bodybuilding, as well as for sexual assault. These drugs may be synthesized from common ingredients and have a variety of names. Powdered GHB is colorless and odorless but has a salty taste that is often masked by mixing it in fruit punches. Within 15 minutes of ingestion, 2 g of the drug induces sleep, and 4 g induces coma. This action is potentiated by alcohol. Several chemical precursors of GHB are available as commercial solvents or dietary supplements. GHB and GBL are associated with “drop attacks” of vomiting and sudden, severe muscle weakness. At least 10 deaths have been directly attributed to these agents. As with flunitrazepam, the legal implications of the manufacturing and distribution of these drugs are influenced by state regulations.

Victims may report a variety of symptoms from the ingestion and any subsequent assault. Disassociation of mind and body, and residual muscle weakness are common. Within six to eight hours of the episode, vital signs may be depressed. Within 24 hours, blood should be collected in a sodium fluoride and potassium oxalate tube for detection of drugs. At least 100 mL of urine should be collected for screening. Urine testing may be positive for 96 hours after ingestion. The suspicion of date rape should be conveyed to the laboratory, and careful documentation ensured in case of criminal prosecution. Other tests and interventions for sexual assault should be arranged as appropriate.

The authors recommend practical measures to avoid contamination of drinks with date rape drugs and suggest resources such as those available from university medical centers to help young women avoid being victimized in this fashion.