Drug‐Facilitated Sexual Assault Using Tetrahydrozoline

Abstract

Drug-facilitated sexual assault (DFSA) has been defined as the use of a chemical agent to facilitate a sexual assault. We report two cases of the use of tetrahydrozoline for DFSA. We believe this is the first report with urinary quantification of tetrahydrozoline levels postassault. Blood and urine were obtained c. 20 h postexposure in two cases of reported DFSA. Tetrahydrozoline was not detected in blood but was identified in urine in both victims. After initial identification in the urine using the 2010 update to the AAFS mass spectrometry database library, tetrahydrozoline was quantified at 114 and 150 ng/mL, respectively, using GC/MS. Two unique clinical features reported in these cases were intermittent periods of consciousness and postexposure vomiting. Use of GC/MS was successful in identifying tetrahydrozoline in the 100 ng/mL range up to 20 h postexposure. For victims with late presentation, urine may be a better sample for evaluation for tetrahydrozoline.

Unintentional Pediatric Ophthalmic Tetrahydrozoline Ingestion: Case Files of the Medical Toxicology Fellowship at the University of California, San Francisco

“…Previous authors reported three cases of pediatric THZ ingestion with plasma concentrations ranging from 23.6 to 41.4 ng/ mL and urine concentrations of 9.2 to 49.5 μg/ml (9,200-49,500 ng/mL) [47]. A forensic case report showed that THZ may not be detected in blood after 16-22 h, and checking urine may be better in late presentations [29].…”

“…Respiratory depression, hypotension, miosis, and hypothermia have been reported with variable frequency [14]. Vomiting has been reported as well [18,28,29]. Convulsion-like episodes have been reported in two case reports [17,30].…”

Drug-Facilitated Sexual Assault With Tetrahydrozoline (Visine)

“…Blood and urine were collected approximately 20 hours after the assault and was identifiable in the urine, but not the blood, of both victims. Stillwell and Saady (2012) reported on two sexual assault patients who ingested THZ orally in alcoholic beverages. Both reported no symptoms, and despite the difference in the time since ingestion (7 hours and 23 hours), the substance was still identifiable in their urine.…”

“…This case presents a peculiar instance of DFSA with alcohol and THZ eye drops. The synergistic effects of these medications have been reported in case reports to have profound effects leading to marked central nervous system (CNS) depression (Stillwell & Saady, 2012). This medication is easily attainable in most pharmacies and grocery stores, is cheap, and is a colorless liquid with a rapid onset of action after oral ingestion.…”

“…Spiller et al (2007) described a case of a male adult using THZ in beverages to incapacitate an adult woman and four children for the purposes of sexual assault. Spiller and Siewert (2012) described two cases of the use of THZ for DFSA. Blood and urine were collected approximately 20 hours after the assault and was identifiable in the urine, but not the blood, of both victims.…”