Experts say alcohol is the most commonly used drug in Tennessee sexual assaults.
Date rape drugs. Roofies. Liquid ecstasy. Special K.
Odorless, colorless, tasteless predators that leave prey weak, confused and vulnerable.
They are part of the standard plotline in many television thrillers, and a mythology has built around their pervasiveness.
But the drugs most frequently associated with drug-facilitated sexual assault — known chemically as Rohypnol, gamma hydroxybutyric (GHB) and ketamine — may not be the most common assailant.
"Quite honestly, alcohol is the No. 1 date rape drug," said Mike Lyttle, regional supervisor for the Tennessee Bureau of Investigation's Nashville crime lab. "… Roofies are very rarely — if ever — seen in real life."
That does not discount the threat of drink-spiking and drug-facilitated sexual assault. The number of cases involving date rape drugs may be deceiving as a vast majority of rapes go unreported, and those that are reported often are done so after a drug has left the victim's system, which limits gathering evidence through blood or urine sample testing.
"We really don't know for sure what the actual numbers are," said Dr. Susan R.B. Weiss, associate director for scientific affairs for the National Institute on Drug Abuse at the National Institutes of Health. But, she said, "drugs that are sedating drugs or incapacitating drugs probably are not that common in sexual assault.
"We really don't know the true prevalence, but we know for sure alcohol is much more common than other drugs."
And, experts note, awareness that alcohol alone may be just as debilitating can help change the conversation surrounding the dangers and the precautions needed to protect a potential victim of sexual assault.
"It's a time that, I believe, all of us need to be careful," said Dr. Corey Slovis, chair of emergency medicine at Vanderbilt University Medical Center. "The concept of trust, especially with people we don't know very well, is something that can't be counted on — especially when alcohol is involved."
The social acceptance and accessibility of alcohol seems to reduce its recognition as a potential date rape drug. Its effects, however, demonstrate how it functions as one.
At first, alcohol may initiate relaxation and "a little bit of euphoria," Slovis said.
But as a person's blood-alcohol level rises with continued consumption, the physiological effects of alcohol — confusion, sedation and potential loss of consciousness — cause lowered inhibitions and may incapacitate a person, rendering him or her incapable of consenting to any sexual act, Slovis said.
It also may reduce the capacity of potential victims to physically resist a sexual attack, said Kathy Walsh, executive director at Tennessee Coalition Against Domestic and Sexual Violence.
"There are date rape drugs in circulation, and innocent women have been raped due solely to a date rape drug or a date rape drug and alcohol," Slovis said. "However, the majority, it appears, of rapes that occur with non-consenting women occur because they have been either intoxicated more than they believe or they have been given higher quantities of alcohol than they thought they had been given."
In the toxicology unit of the TBI crime lab, special agent forensic scientists analyze vials of blood and specialize in blood alcohol, breath alcohol and toxicological drug screens.
Of the approximately 1,000 cases that come through the TBI toxicology lab monthly, most are samples from DUI and motor vehicle crashes. Those are tested first for alcohol to see if they are over the legal limit of intoxication, Lyttle said.
The remaining approximately 35 percent of cases — which includes all rape cases — are tested for drugs and alcohol, Lyttle said.
If indicated, drugs are extracted and identified. Quantitative information is gathered. Findings are logged as agents prepare to testify in court.
Tennessee does not have any legal statutes specifically targeting date rape drugs. Charges and sentencing for these offenses depends on the substance, what was done or intended to be done with it, and the amount possessed.
Rape in Tennessee is a Class B felony. If a perpetrator is armed with a weapon, causes bodily injury or is aided by others, then it is aggravated rape and a Class A felony.
"Using (date rape drugs) to commit a rape is not any different than any other rape," said Kathy Morante, an assistant district attorney in Nashville.
But in rape cases, drugs — specifically those considered date rape drugs — are rarely found.
There may be several contributing factors.
First, use of these drugs may not be as prevalent as media and entertainment suggest.
Data from a 2007 study for the National Institute of Justice on drug-facilitated, incapacitated and forcible rape indicate that only a small fraction (0.6 percent) of female undergraduate students who were sexually assaulted when they were incapacitated were certain they had been victims of drug-facilitated sexual assault.
Another 1.7 percent suspected they were incapacitated after having been given a drug without their knowledge.
That same study, however, indicated that the vast majority of incapacitated sexual assault victims (89 percent) reported drinking alcohol and being drunk (82 percent) before their victimization.
"When it comes to date rape drugs, in the vast majority of the cases, once we start talking to an officer or we look at the case, it's going to be alcohol," Lyttle said. "You may have things that exacerbate that, but we really don't have a smoking gun."
But there is another factor to consider: Most victims don't remember being drugged or assaulted and may not become aware of an attack until hours after it occurs. Many drugs associated with rape leave the bloodstream within hours.
Victims may also choose not to report a crime. The study for the National Institute of Justice found that only 16 percent of all rapes were reported to law enforcement. Notably, victims of drug-facilitated or incapacitated rape were somewhat less likely to report to the authorities than victims of forcible rape, the study found.
Major barriers to reporting rape include not wanting others to know about it, fear of retaliation, perception of insufficient evidence, uncertainty about how to report, and uncertainty about whether a crime was committed or whether harm was intended.
In cases where drug-facilitated assault is suspected, each toxicology screen must be done during a certain time period after the drug has been ingested in order to detect it. Victims do not have to undergo a medical exam if they do not want to report the rape to authorities.
In Tennessee, a person can get a sexual assault exam free of charge without notifying law enforcement. The law states the health-care provider does not have to report the crime unless there is a gun, knife, strangulation or serious bodily injury involved, said Debbie Curtis, a member of Sexual Assault Nurse Examiners (SANE) and president of the sexual assault team in Murfreesboro.
If the crime is reported, samples collected during a forensic medical examination of the victim are given to the crime lab for analysis.
During the examination, a blood sample is taken up to 24 hours after the assault; a urine specimen may be taken up to five days later, Curtis said.
Urine has a longer drug detection period than blood, but if a victim urinates before being examined, traces of the drug may be gone, narrowing the chance of a positive test even when drugs are involved.
Said Lyttle: "It's extremely rare that we get a case in (the TBI Nashville lab) with a sample that you actually think you have a shot."
'No way to know'
Those results carry through to court.
For the last three years, Morante has reviewed all of the rape cases that involve adult victims sent to the Nashville district attorney's office.
In that time period, the number that implicated use of a date rape drug: "None."
Victims will come in describing incidents that suggest they may have been drugged, but, Morante said, without the positive test, "It really is just sort of people talking ... there's no way to really know."
Still, simply going into a bar and having drinks should not put a person at risk for being sexually assaulted, Curtis said.
"There are people who are drinking in bars every single day and every single night," she said. "It's not against the law to drink and it's not against the law to be drunk, but it is against the law" to have sex with someone without his or her consent.
"People don't get raped because they have been drinking, because they are passed out or because they are drunk. People get raped because there is a perpetrator there — someone who wants to take advantage of them."
To protect against that, the community needs more education about bystander awareness and intervention, Curtis said. If you see someone who is vulnerable and possibly intoxicated, and you see someone who might be taking advantage of another person, step up and intervene.
"That's how we help each other," Curtis said.
More education also is needed about sexual violence — with focus on the people who use drugs and alcohol to facilitate sexual assaults, said Walsh, who works closely with victims at the Tennessee Coalition to End Domestic and Sexual Violence.
Alcohol should be part of that conversation at an early age, she said. The standard warnings about not leaving a drink unattended in a bar should also include information about the effects of drinking.
A body's physiological reaction to alcohol depends greatly on how often a person drinks, his or her weight and metabolic rate, among other factors, so there is no standard amount that should serve as a cutoff, Slovis said. But, he said, "unfortunately, if you want to be an adult, you need to drink responsibly."
Alcohol not only incapacitates a victim, it may also lower the inhibitions of a potential assailant, Slovis said. About 40 percent of female victims of sexual violence believed the offender had been drinking or using drugs before the victimization, according to the Bureau of Justice Statistics' 1994-2010 national crime victimization survey.
Equally as important is awareness that even if they aren't the traditional "date rape drugs," more readily available drugs like Valium (diazepam) and Xanax (alprazolam) also can incapacitate a person both when taken alone and when mixed with alcohol.
And, Walsh said, "just because you have been to a bar and you have been drinking and maybe you have even consumed drugs, it shouldn't keep you from reporting (a sexual assault) and it shouldn't keep law enforcement from responding."
For some victims it may be too late for a forensic exam, Walsh said, but they may need counseling even weeks later.
"I have never known a victim who wanted to be victimized," Walsh said. "That simply does not exist."