Drug-Facilitated Sexual Assault ('Date Rape')

Richard H. Schwartz, MD, Regina Milteer, MD, Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, Va; and Marc A. LeBeau, MS, Chemistry Unit, FBI Laboratory, Federal Bureau of Investigation, Washington, DC

South Med J. 2000;93(6) 

In This Article

gamma-Hydroxybutyrate and gamma-Butyrolactone

A CNS depressant, GHB is used as a euphoriant and/or anabolic agent and is said to enhance muscle strength and growth hormone release. It is a metabolite of gamma-aminobutyric acid (GABA), though it does not bind well to GABA receptor sites. Although flunitrazepam has the reputation of being the date-rape drug, GHB was found six times more frequently than flunitrazepam in 578 urine samples from date-rape victims.[8] The drug has never been approved for any use outside of Food and Drug Administration (FDA)-approved research trials. gamma-Hydroxybutyrate is obtainable at selected bars and gymnasiums.[9,10] It is inexpensive and easy to synthesize. Approximately 100 g may be produced from common ingredients with recipes readily available on the Internet[11,12] and in underground literature. Street names include Somatomax, Grievous Body Harm, Easy Lay, Gamma-G, Growth Hormone Booster, Liquid Ecstasy, and others. In powder form, GHB is mixed in water, fruit punch, an energy drink, or an alcoholic beverage. Produced underground (in home-based laboratories), it is also available in liquid form. It is colorless and odorless but may have a distinct salty taste. It exerts its effect within 15 minutes of ingestion and has a short half-life (27 minutes). Ingestion of 2 g of GHB results in deep sleep and 4 g results in coma.[13] Mixed in alcoholic beverages, the two sedatives are synergistic.

Several chemical precursors of GHB are readily converted to GHB, including GBL, a commercially available solvent found in many commercial floor strippers; BD; and pine needle oil. gamma-Butyrolactone, which at present is not a banned chemical, is available as a dietary supplement (ie, RenewTrient, Blue Nitro, Revivarant).[13] The manufacturers advertise it as a nutrient, a stimulant for growth hormone release, an anabolic agent, and a gentle sedative. In the body, as in the beaker, GBL is converted to GHB, and GBL has greater bioavailability than GHB on an equimolar basis. The FDA warned of the dangerous effects from the deliberate use of products containing GBL and BD and asked that the suppliers voluntarily halt their manufacture and distribution. After an FDA warning about GBL was issued, three companies whose products contained GBL agreed to recall their products, but four more companies face litigation. Some suppliers appear to have circumvented the FDA warning by replacing GBL with BD, which has already been responsible for at least three deaths. Distribution of GHB is illegal in at least 23 states. However, there appears to be a legal loophole that permits sale of GHB powder to so-called "companies" that send the order using "company" letterhead. The Internet sales company states that it trusts the buyer and "does not check the validity of the company." Moreover, some states that have listed GHB as a controlled substance have been tolerant toward GHB- and BD-containing products.

Symptoms of GHB and GBL toxicity are similar to those of flunitrazepam; however, the former drugs produce a higher frequency of drop attacks, whereby the victim suddenly loses all muscular control and drops to the floor, conscious but unable to resist the assault of an attacker. Additionally, there appears to be an increased tendency for vomiting with the use of GHB in selected individuals. The mechanism for vomiting is unknown. This may last for hours after the sedative effects wear off. Victims of GBL- or GHB-facilitated sexual abuse often have anterograde amnesia, so that the victim may not recall the assault even if she was conscious throughout the ordeal. There have been 10 known deaths, the immediate cause of which tended to be respiratory failure, associated with ingestion of GHB.[14,15,16,17] The drug was typically taken in combination with alcoholic beverages. Although there is no proven antidote for GHB-induced coma, some evidence indicates that the administration of physostigmine (2 mg) will reverse the sedative effects by an as yet unknown mechanism.[18] Because they are difficult to analyze, GHB and GBL detection requires targeted analysis such as gas chromatography- mass spectrometry (GC-MS).

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