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A case of drug-facilitated sexual assault involving 3,4-methylene-dioxy-methylamphetamine.

Drug-facilitated sexual assault (DFSA) can be defined as sexual activity occurring where consent is invalid or absent due to drugs, usually including alcohol (Hurley, Parker & Wells 2006). A typical scenario of DFSA usually involves victims having ingested a drink after which they had little, partial or no recollection of events for a period of time (Hurley, Parker & Wells 2006). In France the legal term used is chemical submission, defined as the administration of psychoactive substances without knowledge of the victim in order to induce incapacitation and thus facilitate criminal actions (such as sexual assault, child mistreatment, theft or homicide) (Djezzar et al. 2009). Police had to prove that a substance was administered, providing material evidence of the infraction, including the detection of traces in a physical examination and samples, and prove the absence of consent (Djezzar et al. 2009). Results of four-year French chemical submission survey have concluded that chemical submission is not an anecdotal phenomenon (309 cases in four years) and that the most commonly used psychoactive substances are benzodiazepines (such as clonazepam, zolpidem, bromazepam) (Djezzar et al. 2009).

MDMA (methylene-dioxy-methamphetamine), an amphetamine derivative drug commonly known as Ecstasy, is a popular recreational drug. One MDMA characteristic is the capacity of this drug to increase empathy and emotional contact (it is also called the "love pill"). MDMA use is not associated with amnesia. However, the capacity to recall events can decline if alcohol is also taken (Jansen & Theron 2006). In DFSA epidemiological studies, few cases of MDMA chemical submission have been reported. Drugs commonly involved as date-rape drugs are hypnotic or can lead to amnesia: benzodiazepines, gamma-hydroxybutyrate and its derivates or ketamine (Scott-Ham & Burton 2005; Hurley, Parker & Wells 2006; Jansen & Theron 2006).

We report the case of a 22-year-old woman who had been raped after having been unwittingly drugged with MDMA. The victim remained conscious during the rape and remembered all events. Toxicological analyses and clinical proof have been established.

CASE STUDY

A 22-year-old woman working in a pub in south of France in 2011 was invited by a man she knew slightly, after her job, to drink a glass of alcohol brought by him. She drank the glass, which she found particularly bitter tasting with a white deposit on the edge of the glass. Soon after she had finished drinking, she felt unwell, describing dizziness and weakness of the limbs. She was in a state of amazement (a state of deep astonishment that left her with no voice and no reaction), unable to resist physically or verbally. Theaggressorhad transportedher outside "for some fresh air", and then committed sexual assault. She had been accompanied by the aggressor at his home where she spent the rest of the night and repelled any attempted of caresses. In the morning, she went to the police, who commissioned a forensic physician to carry out a clinical examination and look for foreign biological materials on her person. The physician recorded the presence of damages to the vaginal mucosa and recent bruises on the anal margin and both forearms. She mentioned that she had no amnesia and a jaw tension when awaking. In addition, the police investigation found that during the night, one of the victim's friends finished the glass, and felt ill with nausea and vomiting. The police screened the parking lot video camera, which showed the aggressor carrying the unconscious victim to his car.

First, an immunoassay screen toxicological analysis was carried on the victim's urine. Because of the victim's statement, the urines screening positive for amphetamines, and the video tape, the aggressor was put in police custody. The police found in his jacket pocket an envelope containing powder. Toxicological analysis was carried on the victim's urine and blood, on the aggressor's blood, the victim's friend's blood, and on the powder. The delay between the presumed events and the urine and blood sampling of the victim was 12 hours. Concerning the aggressor and the friend the delay was more important (more than12 hours but less than 24 hours).

MATERIALS AND METHODS

The toxicological analysis was conducted by the Department of Clinical Pharmacology and Toxicology, Montpellier, France. An immunoassay screen using Dade-Behring reagents and a Dimension Xpand[R] clinical chemistry system (Dade-Behring, Paris, France) for drugs of abuse (amphetamines, benzodiazepines, cannabis, cocaine, and opiates) on both blood and urine were performed. Testing for alcohol was done on the blood by gas chromatography (GC)-head space method. A screening to detect opiates, cocaine, amphetamines, benzodiazepines, ketamine, buprenorphine and methadone using QTrap[R] liquid chromatography-tandem mass spectrometry (LC-MSMS; Herrin, McCurdy & Wall 2005) was done on the blood and powder sample. The urine was tested for the presence of gamma-hydroxybutyrate using a gas chromatographymass spectrometry (cut-off 50 ng/ml). After the detection of MDMA in the blood of the victim and the powder sample, quantification of the drug was performed.

RESULTS

Methylene-dioxy-methamphetamine (MDMA) was detected in the urine of the victim and was quantified in blood at 0.09 mg/L. Methylene-dioxy-amphetamine (MDA), the metabolite of MDMA, was also detected at 0.013 mg/L. Results were negative for alcohol or other substances. MDMA-trace was also detected in the blood of the aggressor and of the victim's friend. The crystalline powder (1 g) was slightly grey-beige, and contained 50% of MDMA and 11% of paracetamol.

DISCUSSION

The most commonly detected substances in sex crimes are still alcohol (40% to 60% of all cases), followed by illicit substances (cannabis, cocaine) (Madea & Musshoff 2009). In cases of chemical submission leading to sexual assault, the aggressors usually chose substances that can make a person unconscious and hence unable to resist and/or to recall an assault (Madea & Musshoff 2009). The substances most commonly found are benzodiazepines, followed by other hypnotics (Madea & Musshoff 2009).

In France, results of the last three French Medicine Agency (ANSM) inquiries (National Chemical Submission Study) show an increased number of chemical submission cases (2007: 123 cases, 2008: 154 cases, 2009: 162 cases) but a stability in the profile of chemical substances used, mostly benzodiazepines with clonazepam, zolpidem and bromazepam (ANSM 2012).

Illicit stimulant substances such as Ecstasy or amphetamines are dramatically less often found as date rape drugs. Only a few cases including involuntary MDMA intake are reported in each large study of drug-facilitated sexual assaults (Table 1) (Djezzar et al. 2009; Du Mont et al. 2010; Hurley, Parker & Wells 2006; Scott-Ham & Burton 2005).

MDMA, commonly known as Ecstasy, induces release of serotonin, producing a feeling of empathy and euphoria (Jansen & Theron 2006). Moreover, unlike other classic hallucinogens, MDMA have entactogenic effects heightening sensory awareness and ease of contact with others (Nichols 1986). These effects appear between half an hour and one hour and a half after the ingestion and persist for six hours. The symptoms described by our victim were characteristic of MDMA intake.

In France, after cannabis, MDMA is the main illicit substance found in party spaces. It's available under four different forms: tablets matched by a logo, capsule, powder and since 2006 as crystal (OFDT 2012).

According to data provided by French police services, criminal "Ecstasy" samples contain an average amount of pure MDMA of 52% (OFDT 2012).

Other products most commonly found are lactose in tablets and caffeine in powder. In our case, no stimulant (caffeine or others) was found in the collected powder.

In spite of the fact that interpretation of blood concentrations of stimulant drugs remains difficult, and that few data are available, the MDMA concentration found in the victim's blood samples appears to be low. In 13 cases of death attributable to the toxic effects of MDMA alone, Milroy (2011) reported MDMA concentrations in the range of 0.478-53.9 mg/L, mean 8.43 mg/L, median 3.49 mg/L.

Unlike a previous French case describing a MDMA chemical submission and for which establishing the level of consent was difficult due to the absence of amnesia or sedative effect, the various materials elements of the investigation leave no doubt as to the consent of our victim (Abondo et al. 2009).

CONCLUSIONS

It's always surprising to find a stimulant used for carrying out a sexual assault rather than sedative drugs. In the literature this use seems to be limited. In our case, MDMA had produced a victim state of "stupefaction" leading to aggressor opportunities to conduct a sexual assault. The cooperation between police, forensic pathologists, a toxicological laboratory and addictovigilance center allowed for a quick identification of the substance involved and of the criminal activity, leading to the arrest of the aggressor.

DOI: 10.1080/02791072.2013.763573

REFERENCES

Abondo, M.; Bouvet, R.; Baert, A.; Morel, I. & Le Gueut, M. 2009. Sexual assault and MDMA: The distinction between consciousness and awareness when it comes to consent. International Journal of Legal Medicine 123: 155-56.

Djezzar, S.; Questel, F.; Burin, E. & Dally, S. 2009. French Network of Centers for Evaluation and Information on Pharmacodependence. Chemical submission: Results of 4-year French inquiry. International Journal of Legal Medicine 123: 213-19.

Du Mont, J.; Macdonald, S.; Rotbard, N.; Bainbridge, D.; Asllani, E.; Smith, N. & Cohen, M.M. 2010. Drug-facilitated sexual assault in Ontario, Canada: Toxicological and DNA findings. Journal of Forensic Legal Medicine 17: 333-38.

Herrin, G.L.; McCurdy, H.H. & Wall, W.H. 2005. Investigation of an LC MS-MS (QTrap[R]) method for the rapid screening and identification of drugs in postmortem toxicology whole blood samples. Journal of Analytical Toxicology 29: 599-606.

Hurley, M.; Parker, H. & Wells, D.L. 2006. The epidemiology of drug facilitated sexual assault. Journal of Clinical Forensic Medicine 13: 181-85.

Jansen, K.L. & Theron, L. 2006. Ecstasy (MDMA), methamphetamine, and date rape (drug-facilitated sexual assault): A consideration of the issues. Journal of Psychoactive Drugs 38: 1-12.

Madea, B. & Musshoff, F. 2009. Knock-out drugs: Their prevalence, modes of action, and means of detection. Deutsches Aerzteblatt International 106: 341-7.

Milroy, C.M. 2011. "Ecstasy" associated deaths: What is a fatal concentration? Analysis of a case series. Forensic Science, Medicine and Pathology 3: 248-52.

National (French) Agency For Safety of Medicines and Health Products (ANSM) 2012. Pharmacodependence. Available at http:// ansm.sante.fr/Activites/Pharmacodependance-Addictovigilance/ Soumission-chimique/(offset)/5

Nichols, D.E. 1986. Differences between the mechanism of action MDMA, MBDB, and the classic hallucinogens. Identification of a new therapeutic class: Entactogens. Journal of Psychoactive Drugs 18: 305-13.

Observatoire Francais des Drogues et Toxicomanies (OFDT). 2012. Recherche Thematique Available at http://www.ofdt.fr/ofdtdev/live/ produits/ecstasy.html

Scott-Ham, M. & Burton, F.C. 2005. Toxicological findings in cases of alleged drug-facilitated sexual assault in the United Kingdom over a 3-year period. Journal of Clinical Forensic Medicine 12: 175-86.

Celine Eiden, Pharm.D., Ph.D. (a) Philippe Cathala, Pharm.D., M.D. (b) Nicolas Fabresse, Pharm.D. (c) Yves Galea, M.D. (d) Jean-Claude Mathieu-Daude, M.D. (e) Eric Baccino, M.D. (f) Helene Peyriere, Pharm.D., Ph.D. (g)

The authors report no conflicts of interest.

(a) Assistant in Clinical Pharmacy, Centre for Evaluation and Information on Pharmacodependence--Addictovigilance, Medical Pharmacology and Toxicology Department University Hospital of Montpellier, France.

(b) Assistant in Forensic Medicine, Department of Forensic Medicine, University Hospital of Montpellier, France.

(c) Pharmacy student, Centre for Evaluation and Information on Pharmacodependence--Addictovigilance, Medical Pharmacology and Toxicology Department, University Hospital of Montpellier, France.

(d) Physician, Department of Forensic Medicine, University Hospital of Montpellier, France.

(e) Lecturer in Biophysics, Toxicology Unit, University Hospital of Montpellier, France.

(f) Professor in Legal Medicine and Clinical Toxicology, Department of Forensic Medicine, University Hospital of Montpellier, France.

(g) Lecturer in Clinical Pharmacy, Centre for Evaluation and Information on Pharmacodependence--Addictovigilance, Medical Pharmacology and Toxicology Department, University Hospital of Montpellier, France.

Please address correspondence to Docteur Celine Eiden, Service de Pharmacologie Medicale et Toxicologie, Hopital Lapeyronie, 191 avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France; phone: 33-4-67-33-05-40; fax: 33-4-67-33-67-51; email: c-eiden@ chu-montpellier.fr
TABLE 1
Cases Involving MDMA as a Date Rape Drug in Drug-Facilitated
Sexual Assault

                              Drug-Facilitated
                               Sexual Assault
 Country        Study           Study Period      Number of Cases

Australia   Hurley, Parker   05/2002 to 04/2003   76 cases / 22
              & Wells 2006                          cases of
                                                    involuntary
                                                    intake

France      Djezzar et al.   10/2003 to 12/2007   79 cases
            2009

UK          Scott-Ham &      01/2000 to 12/2002   1014 cases/ 21
              Burton 2005                           cases of
                                                    involuntary
                                                    intake

Canada      Du Mont et al.   06/2005 to 04/2007   184 cases / 87
              2010                                  cases of
                                                    involuntary
                                                    intake

                                     Cases of
                                    Involuntary
 Country    Main Detected           MDMA Intake
            Drugs

Australia   Alcohol                No case

France      Benzodiazepines        4 cases
              (clonazepam>
              zoldipem>
              bromazepam)

UK          Alcohol (either        3 cases
              alone or with
              a substance) (46%)
            Cannabis (26%)

            Cocaine (11%)
Canada      Cannabinoids           8 cases
            Alcohol
            Cocaine
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Article Details
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Title Annotation:Short Communication
Author:Eiden, Celine; Cathala, Philippe; Fabresse, Nicolas; Galea, Yves; Mathieu-Daude, Jean-Claude; Baccin
Publication:Journal of Psychoactive Drugs
Geographic Code:4EUFR
Date:Jan 1, 2013
Words:2084
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