Amnesia, drugs and rape: Narratives for disaster

We’re all aware of the narrative of victimization via date rape drug. It depends on claims that certain drugs, usually GHB or Rohypnol, cause amnesia. So, rather than explore narratives or he-said she-said in individual cases, let’s discuss the tools and effects central to this type of crime.

Two drugs share the nickname date rape drug, Rohypnol and GHB. This reputation as an amnesia trigger is strong enough that Rohypnol has been administered to block patients’ memory of a medical procedure.

Rohypnol, aka flunitirazepam, is the best selling benzodiazepine in Europe, even though it has never been approved for sale in the U.S. Even importing it with a prescription has been illegal since 1996.

A Swiss study published in 2016 collected users’ descriptions of the effects of benzodiazepines alone and in combination with alcohol and other drugs on memory and behavior. This study mentions both Rohypnol and GHB. The abstract notes Rohypnol’s reputation for triggering violent criminal behavior and severe memory disturbances, but also states, “However, data from investigations of this relationship are scarce and have been primarily derived from forensic institutions, where there may be a reporting bias.”

Twenty-five of the 41 subjects reported anterograde amnesia, the loss of memory for events subsequent to the trigger of the amnesia (as opposed to retrograde amnesia, a disturbance of prior memories). Subjects also described disinhibited behavior from petty crimes to sex with strangers, cheating on a lover, violence and aggressive behavior leading to injury. They also described negative consequences on personal relationships, and embarrassment when their behavior was reported to them by others. Participants specifically mentioned Rohypnol, and Midazolam (another benzodiazepine).

But here’s the most important thing in the paper, at the end, “We were unable to verify objectively either the occurrence of anterograde amnesia or the combination and amount of ingested substances that might have contributed to it, limiting the generalizability of the study.” The study also notes there is no clear dose-event relationship. Essentially, data supporting the relationship between benzodiazepines and amnesia is still scarce.

Because of concerns about the potential for misuse, Rohypnol was reformulated in 1997 so that if a tablet is dissolved a blue color will be visible.

The second “date rape drug” is GHB, gamma hydroxybutyric acid, a substance that is in tissue in the human body, most heavily concentrated in the brain. Before made a Schedule 1 drug in 2000, it had been available in the U.S. over the counter, for decades. In those years, GHB was consumed by people with interest in body-building to increase muscle mass, suppress appetite and stimulate growth hormone. GHB also developed a reputation as an enhancer of sexual pleasure.

The 2016 Swiss study of benzodiazepine users says GHB, “has been particularly implicated in triggering violent criminal and sexual behavior, impulsive decision-making & anterograde amnesia. However, there are only limited data available, especially with regard to symptoms of amnesia.”

Amnesia is a medical term for memory loss. The Hollywood version of amnesia is the erasure of memory as if it were an old VHS tape. The loss of memory can be limited to a distinct segment of time, or loss of recall for one’s entire life perhaps including one’s name.

Actual memory loss is much more commonly like a patchy memory. If the memory disruption is caused by a chemical, such as alcohol, bits may begin to return after the alcohol is gone from the body. Talking with others may jog memory. Incomplete memories can also return spontaneously over time.

Amnesia is not only rare, but the empty VHS tape style of amnesia is rarer still.

Amnesia of the type that is part of date rape drug scenarios could be an indication of an emergency. Causes could include head trauma, stroke, infection, inflammation or lack of oxygen from a heart attack or carbon monoxide.

A severe amnesia requires medical evaluation, ideally by a neurologist, with a physical exam, check of reflexes, sensory function, balance, judgment, and short term and long term memory. Other necessary information is the time the memory loss started, the trigger, family history, personality changes, language difficulties, difficulties with self care and seizures. Dementia, Alzheimers, depression and brain tumors must be ruled out. EEG, MRI or CT scans or blood work may have to be performed.

Amnesia is serious business.

Another problem that goes along with the disrupted memories is that the blanks may be filled in with false information, in a process called confabulation. The amnesia sufferer is not intentionally lying, and is unaware that she is confabulating. This phenomenon has disturbing implications in situations where the amnesiac’s story will have real world effects on another person’s life, such as in a criminal trial or a campus proceeding that may lead to suspension, expulsion and/or ruination of a person’s reputation.

A second disturbing implication is what happens when a woman enters a police station and reports that she has missing memory, and believes she has been drugged and raped. Considering the serious nature of the medical conditions that cause amnesia, and the fact that the person doing the reporting is reporting memory deficits, one would think that an examination at an emergency room would be the first order of business. But you would think wrong.

John Gordon Jones, Andrew Luster and twins George and Stefan Spitzer were all prosecuted, and all but Jones, convicted, based on an individual woman turning up at a police station and reporting she had no memory of the night before, but suspected herself of having been drugged and raped by a particular man. Luster’s initial accuser was immediately asked by police to place a call to him to try to record incriminating admission. A woman making a similar complaint about George lead to a search that turned up Rohypnol for which his dad had a prescription and video tapes showing George and Stefan in sexual activities.

The frequency of drugs being deployed to inflict harm on an unconscious and unaware person are very rare. Testimony given to the U.S. Sentencing Commission by Jodi L. Avergun of the Dangerous Drug Section of the Criminal Division at the Department of Justice in 2004 noted the following:

How large is the problem of drug-facilitated rape, and how often is GHB the tool of sexual predators? Reliable data are simply not available. Because GHB cannot be traced in blood or urine after about 8-12 hours, even tests conducted the day after the incident are too late. The effects of GHB are such that many victims cannot recall or do not realize what happened. However, we can hazard some idea of the scale. Some estimate that drugs are used in 15-20 percent of sexual assaults.”

Considering the resources available to the federal government, especially in light of the widespread fear inflicted for the most part on young women, and the potential for dire consequences for the lives and freedom of men, saying “we don’t know” in the place of data is remarkably irresponsible.

In 2004, there actually was some pertinent data available . Results of a study initiated to collect evidence of the presence of Rohypnol use to facilitate rape were published in 1999. During 24 months during 1996-1998, police, emergency rooms and rape crisis centers forwarded urine samples associated with allegations of sexual misconduct involving misuse of a drug. This was less than one sample per state per month.

Samples were tested for 20 drugs and alcohol by Gas Chromatograph Mass Spectrometer. The most common result was found in 422 samples: a negative for all the drugs and alcohol. Second most common was a positive for alcohol (some had other drugs as well). GHB, which became a Schedule 1 drug in 2000, was in 45 samples. Rohypnol, the initial focus of the study, appeared in 6 samples, of which 4 were positive for at least one other drug and/or alcohol.

According to the researchers, “These data clearly indicate that there is no evidence of widespread misuse of flunitrazepam in sexual assault. Alcohol remains the substance most frequently associated with this type of crime.” Also, the study states that, “Despite the widespread media interest, there has been little proven evidence and no systematic investigation of the incidence of drug use in the crime of sexual assault.” This used, “a highly specific and sensitive GC-MS analysis which has a detection limit of less than 1 ng/ml. This procedure can confirm the presence of flunitrazepan metabolites in the urine at least 72 hours after ingestion of a 1 mg dose of the drug.” Almost all of the samples were processed within the first 24 hours after the drug was ingested, and only a tiny fraction of the samples were tested after 72 hours.

In the discussion section, the researchers also note, “Despite media reports, these results do not support the labelling of flunitrazepam as a `date rape drug’. The incidence of samples positive for flunitrazepam was very low, and the trend for detection, if any, decreased over time.” The paper closes with a mention the usefulness of this particular drug for patients with sleep or anxiety disorders. “For these legitimate users of the drug, flunitrazepam remains a valuable, safe and effective hypnotic.”

According to a 2006 paper on GHB submitted to the World Health Organization, effects of intravenous GHB can begin within 5 minutes, unconsciousness lasting 1-2 hours or more, “….after which there is a sudden awakening.” This doesn’t work for the narrative.

The most common internet search results I saw while preparing this essay were consistent with the date rape drug narrative, and incompatible with what actual data collected that does not conform to the narrative.

It’s not impossible for a man to go to a public place, choose one woman among numerous strangers, slip something into her drink and propel her from the scene without being noticed by anyone, have sex with her and arrange for her to be in a situation where she will be unable to recall enough information to identify the perpetrator.

Even if a woman initiates a police report like reports that have led to prosecutions in the past, including a lack of memory, belief she was drugged and raped, a urine test is for Rohypnol or GHB is positive, and his DNA on her person or clothing, it’s not case closed.

Perhaps this woman is suffering a medical condition causing amnesia. Her testimony would be unreliable. Shortly after she and the man engaged consensual sex and drugs, an unrelated medical emergency damages her memory. It might be nice if police acted on the potential for serious health problems as vigorously as they seek a warrant.

Another cause for reasonable doubt is that a woman who willingly engaged in sex and drugs woke up with a patchy memory of the sex, but no memory of when she did say, “Yes, please,” to GHB or Rohypnol. If the authorities are willing to believe that one of these drugs can completely blot out awareness and ability to refuse consent, they should be willing to entertain the possibility that her memories, while compatible with the popular narrative, are not what actually happened.

Reported memories could be colored by embarrassment. The 2016 study of benzodiazepine-users mentioned feeling that their behavior under the influence, described to them by others, was incompatible with their normal behavior and self-image, causing distress, shame and embarrassment. Suppose a woman is feeling out-of-sorts in the morning, with blurry memories, and familiarity with the date rape drug narrative. Suppose she gave him her phone number, and he didn’t call her. Suppose she ruminates, or discusses her feelings with friends familiar with the narrative. It’s a short trip from “not like me” to “I could never.”

It’s because of the murkiness of human experience (that can be exemplified by not just the narrative, but that events driven by this narrative that have put real men in prison for decades), that the elements of due process are so very important. Innocent until proven guilty, scientifically sound evidence, appeals, and especially reasonable doubt are very serviceable as a counter to mob emotions and demands for quick action. But most of all, any case that springs from a narrative like date rape drugs, is a case in which the most important job of the jury is to make their ruling based on the explanation of events that is consistent with innocence.
Sources

Rohypnol
https://www.drugs.com/illicit/rohypnol.htmlrohypnol – Flunitrazepam

2016 study of 41 benzodiazepine users, prominent mention of Rohypnol
http://jaapl.org/content/44/3/328

Characteristics
https://medical-dictionary.thefreedictionary.com/Rohipnol

Blue dye since 1997
https://www.dea.gov/druginfo/drug_data_sheets/Rohypnol.pdf

GHB
http://www.who.int/medicines/areas/quality_safety/5GHBPreReview.pdf

GHB rep for sexual pleasure
https://www.journeycenters.com/treatment-programs/addiction-treatment/ghb-abuse/

Study of users reports and brain scans
https://www.researchgate.net/publication/

314718362_Neural_underpinnings_of_prosexual_effects_induced_by_gamma-hydroxybutyrate_in_healthy_male_humans

GHB Sex, prosocial behaviors study
http://pptypo3.univie.ac.at/fileadmin/usermounts/eisenec3/1-s2.0-S0306453015004011-main.pdf

Testimony to Dept. of Justice Regarding GHB, includes mention of lack of data
https://www.ussc.gov/sites/default/files/pdf/amendment-process/public-hearings-and-meetings/20040317-19/Avergun-DOJ.pdf

GHB timing of ingestion, effect, max effect, waking
http://www.who.int/medicines/areas/quality_safety/5GHBPreReview.pdf

Amnesia
https://www.medicalnewstoday.com/articles/9673.php