Abstract
An estimated 11 million women in the United States have been raped while drunk or drugged. Occupational health nurses can offer education and sound advice to workers and international business travelers on how to protect themselves.
The National Intimate Partner and Sexual Violence Survey (NISVS) found that more than 11 million women have experienced alcohol or drug-facilitated sexual assault (DFSA) during their lifetime (Breiding et al., 2014). Although the term “date rape” is often used, it is incorrect because DFSA can happen to anyone, in varied situations or settings. Drugs commonly attributed to DFSA include prescription medications such as sleeping pills, anxiety medicines, muscle relaxers, tranquilizers, and street drugs. In addition, “club drugs,” like Gamma-Hydroxybutyrate (GHB), Rohypnol, Ecstasy, and Ketamine, in combination with alcohol, prevent individuals from defending against unwanted sexual contact. Although these drugs may cause a cloudy appearance when added to a drink, they typically have no color, smell, or taste, which may not be noticed in a dark bar or drink (U.S. Department of Health and Human Services, 2018). Within minutes, these drugs can cause dizziness, slurred speech, lack of muscle control, brady- or tachycardia, confusion, sleepiness, dyspnea, loss of consciousness, or death (Vagianos, 2017). Perpetrators select these drugs because they are easily obtained, cause permanent memory loss for events while in effect, and are rapidly excreted (Tabachnick, 2015).
Prevalence of DFSA is difficult to quantify. However, a systematic review of 20 years of toxicology findings in DFSA cases sought to identify the global prevalence of substances used to drug victims (Anderson et al., 2017). In this study, alcohol was the most commonly detected substance; cannabinoids and benzodiazepines were also often found, but incomplete background details made it difficult to establish the degree they contributed to suspected cases of DFSA. In a separate study, alcohol was also the most prevalent substance and was detected in 30.9% of the 1,000 alleged DFSA cases reviewed (Florentin & Logan, 2019). It is important to note that a lack of alcohol or drug findings could represent delayed or improper specimen collection, rather than a lack of drug use.
Because alcohol use significantly increases DFSA risks, occupational health nurses can promote prevention by educating workers and the public to always use alcohol judiciously and be alert to their surroundings. Prevention recommendations from the Drug Enforcement Administration (DEA, 2017) include visiting and leaving drinking establishments together with trusted friends; personally, opening bottles and observing drink preparation; declining drink offers at bars or from punch bowls; and discarding drinks left unobserved for any reason. Workers should be advised to seek immediate help from a trusted source or call 911 if feeling intoxicated after little or no alcohol. Drug-facilitated sexual assault victims should not urinate, shower, bathe, douche, or discard clothing worn during the incident but go to a hospital emergency department as soon as possible for examination and evidence collection, which includes a urine sample for drug toxicology testing by a law enforcement crime lab (DEA, 2017). The occupational health nurse should provide resources to workers including details from the National Sexual Assault Hotline at 800-656-HOPE (4673), which is available to victims at any time. Resources for help when planning DFSA prevention programs include the Rape, Abuse & Incest National Network (RAINN) at www.rainn.org and the STOP SV: A Technical Package to Prevent Sexual Violence from the Centers for Disease Control and Prevention’s Division for Violence Prevention available at https://www.cdc.gov/violenceprevention/pdf/SV-Prevention-Technical-Package.pdf.
