What urine tests should be run to investigate suspected drug-facilitated sexual assault (DFSA) in a female with concerns of being drugged while consuming alcohol?

From the Guidelines

If you suspect someone has been drugged through alcohol, seek immediate medical attention at an emergency room or urgent care facility and request a comprehensive urine toxicology screen that checks for common date rape drugs such as GHB, Rohypnol, ketamine, MDMA, and benzodiazepines, as well as blood tests if necessary, as soon as possible after the suspected incident, ideally within 12-72 hours 1.

When it comes to testing for date rape drugs, it's essential to note that these substances are not included in standard drug-screening panels, and their effects can be short-lived, making timely testing crucial 1. The most commonly used date rape drugs include:

• GHB (gamma-hydroxybutyrate)
• Rohypnol (flunitrazepam)
• Ketamine
• MDMA (ecstasy)
• Benzodiazepines

These substances can cause a range of symptoms, including amnesia, somnolence, decreased anxiety, muscular relaxation, and profound sedation, making it difficult for the victim to recall the events surrounding the assault 1.

Key points to consider when testing for date rape drugs include:

• Testing should be done as quickly as possible after the suspected incident, ideally within 12-72 hours, as many of these drugs metabolize rapidly 1.
• The standard urine drug panel often doesn't detect these specific substances, so explicitly request testing for date rape drugs 1.
• Blood tests may also be necessary as some substances like GHB disappear from urine within 12 hours 1.
• Preserve any remaining drinks as evidence if possible, as they may contain the substance used to facilitate the assault.
• Medical professionals can also check for signs of assault and provide appropriate care and support, including counseling and follow-up care 1.

It's also important to note that voluntary use of alcohol or other drugs proximate to a sexual assault is common and should not influence the perceived legal status of the event or result in reductions in standards of care for presenting victims 1. Documentation of substance use history may be used by opposing attorneys to undermine the credibility of a victim in court, but may also be used to support the victim’s vulnerability and inability to provide legal consent 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Urine Tests for Detecting Date-Rape Drugs

To detect date-rape drugs in urine, several tests can be run, including:

• Gas Chromatography-Mass Spectrometry (GC-MS) for gamma-hydroxybutyric acid (GHB) and its metabolites 2, 3, 4
• Immunoassays for benzodiazepines, such as flunitrazepam (Rohypnol) and its metabolites 5, 6
• Liquid-liquid extraction and derivatization for GHB and its metabolites 2, 3, 4

Specific Tests for Common Date-Rape Drugs

Some common date-rape drugs and their corresponding urine tests are:

• GHB: GC-MS, liquid-liquid extraction and derivatization 2, 3, 4
• Flunitrazepam (Rohypnol): Immunoassays, GC-MS 5, 6
• Clonazepam, diazepam, oxazepam: Immunoassays, GC-MS 5

Interpretation of Results

When interpreting the results of these tests, it is essential to consider the following:

• The sensitivity and specificity of the test 5, 2, 3, 4, 6
• The time frame since the alleged incident 5, 6
• The presence of other substances that may interfere with the test results 2, 3, 4