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A study of patients presenting to an emergency
department having had a "spiked drink"
Hywel Hughes, Rachael Peters, Gareth Davies and Keith Griffiths Emerg. Med. J.
doi:10.1136/emj.2006.040360 Updated information and services can be found at: References
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Emerg Med J 2007;24:89–91. doi: 10.1136/emj.2006.040360 Objectives: To assess the scale of drink spiking in our area and identify which drugs are being used to spike . . . . . . . . . . . . . . . . . . . . . . . .
drinks and also to assess whether there is a problem with drink spiking in any particular establishment.
Methods: A prospective study of all patients presenting to an emergency department with alleged drink spiking over a 12-month period. Samples were analysed for levels of alcohol and drugs of misuse.
Information was collected as to where the alleged spiking took place and the involvement of the police.
Results: 75 patients attended with alleged drink spiking over the period of 12 months. 42 samples were analysed and tested positive for drugs of misuse in 8 (19%) cases. 65% of those tested had alcohol concentrations .160 mg%. The alleged spiking took place in 23 different locations, with 2 locations accounting for 31% of responses. Only 14% of those questioned had informed the police.
Conclusions: Most patients allegedly having had a spiked drink test negative for drugs of misuse. The . . . . . . . . . . . . . . . . . . . . . . . .
symptoms are more likely to be a result of excess alcohol.
Theuseofalcoholandsedatingsubstancesbyrapistsisa Thelocalresearchethicscommitteegrantedethicalapproval.
centuries-old practice. Today, numerous legal and illegal The patient was provided with details of the study and its drugs can be misused and covertly added to beverages in a aims. Samples of blood (for blood alcohol level) and urine (for social setting. Many of these substances when combined with analysis of drugs of misuse) were obtained. These were sent for alcohol will have their effects magnified.
analysis with the patients’ informed consent given either at the There has been a lot of media coverage in recent years, time of presentation or at the time of the follow-up telephone mainly focusing on just a few substances, including the central nervous system depressants, flunitrazepam (rohypnol) and c- A follow-up telephone questionnaire was performed a few hydroxybutyrate (GHB). As a result, there has been a public days later. Information was collected as to where the alleged perception that drink spiking is a widespread practice. Elliott1 spiking took place, whether the police had been informed and reported on a series of 27 non-fatal instances of suspected GHB their use of medication or drugs at the time in question or on a intoxication in the UK between 1998 and 2003.
In a UK study of more than 1000 women who claimed drug- The samples were analysed for blood alcohol level and the assisted sexual assault, only 2% were identified as deliberate presence of any of the following: cocaine, amphetamine, spiking cases with sedative drugs.2 The most common drug cannabinoid, opiates, methadone, benzodiazepines, ketamine, detected was alcohol in 46% of samples, with illicit drugs Wrexham County Borough comprising a mixed urban/rural population of approximately 130 000 is being actively promoted A total of 75 patients presented during the 12-month period as a weekend leisure venue and attracts evening visitors from with 68% (n = 51) being female. Figure 1 shows the age range outlying areas. The emergency department receives about 61 000 new cases per annum and has no observation ward.
The females outnumbered the males in every age group.
As with most emergency departments, alcohol-related Most patients (82%) attended the department on a weekend, attendances increase dramatically at the weekend, and in with 50 (66%) attending between 10 pm and 3 am.
common with others, we have noticed an increasing number of After being seen by the doctor, 66 of the patients were patients presenting, claiming that their drinks have been discharged from the department, 6 were admitted and 3 self- ‘‘spiked’’. However, there are no published studies looking at discharged before assessment. The 6 patients were admitted this group of patients in the emergency department setting.
because of the degree of intoxication/agitation (n = 4), social The aim of this study was to identify the drugs being used to reasons (n = 1) and per vaginal bleeding (n = 1).
spike drinks in this area and whether there seemed to be a A total of 42 urine samples were obtained and analysed (56% of study group) and tested positive for drugs of misuse in only 8(19%) cases (box 1). No one tested positive for rohypnol or A prospective study was performed over a 12-month period A total of 34 blood samples were obtained and analysed for starting from October 2004. All patients .16 years of age who the presence of alcohol, with a limit of detection of 10 mg/dl, presented to the emergency department alleging that their and tested positive in 32 (94%) cases. The results confirmed drink had been spiked were entered into the study. The entry (table 1) that a large number of those tested had a high blood into the study was based purely on the patients’ opinion that alcohol level. It also shows that the patients who tested positive their drink had been spiked, not on the opinion of the health for drugs of misuse had alcohol levels distributed across the professionals looking after the patient or the presentation of thepatient.
A recent study made by the Regional Laboratory for Toxicologyat Birmingham reported an increasing number of requests received for toxicological analysis of individuals presenting to their general practitioner or hospital after self-reported or suspected surreptitious drug administration.3 Of the 169 samples analysed between 2002 and 2004, only 73 (43%) testedpositive for drugs or alcohol, with 29 testing positive for alcohol alone. Where drugs were detected, the most involved commondrugs of misuse. Neither GHB nor flunitrazepam was detected The results of our study also show that most patients presenting to the emergency department, claiming that theirdrink has been spiked, will test negative for drugs of misuse.
Our study showed a much higher detection rate of alcohol,which is likely owing to the timing of the sample taken. The patients’ symptoms may well have been the result of excessalcohol. A number of these patients probably had their drinks Figure 1 Number of patients in each age group.
spiked with alcohol, but this is difficult to determine. Claimingthat their drink has been spiked may also be used as an excuseby patients who have become incapacitated after the voluntaryconsumption of excess alcohol.
Table 1 Blood alcohol concentrations of the Most of the patients presented on the night of the alleged incident so even drugs with a short detection window (18 h for GHB) should still have been detected. A few patients who presented after this time period may have tested negative despite their drinks having been spiked.
The patients with positive results did not differ from those who tested negative as regards the clinical findings and symptoms. All the patients with positive results were dis- charged from the department, as the decision to admit wasmade on clinical grounds rather than on a positive test, whichwas returned much later.
The drugs of misuse detected in our study were opiates (codeine and morphine), amphetamines, ecstasy and cocaine.
range. All except one patient admitted to having drunk alcohol No ketamine, GHB or rohypnol was found in the samples, which suggests that they are not commonly used in this area to A total of 49 (65%) patients completed the telephone spike drinks. On questioning, none of the patients with positive questionnaire (42 had provided samples for analysis, 7 had results admitted knowingly taking drugs of misuse before presentation or being on any regular medication.
The alleged spiking took place in 23 different places. Only Only 14% of patients in our study had informed the police about four places were mentioned on more than two occasions, with their alleged spiked drink. In 2005, the police in northeast Wales two nightclubs mentioned eight and seven times each.
had recorded only three cases of alleged spiked drinks (personnel The eight patients with positive results gave seven different communication). So it is likely that the police are unaware of the locations at which the spiking took place.
scale of the problem. The numbers in this study are likely to be an Five patients had friends who had allegedly been spiked at under-representation of the true scale of the problem in the the same time but had not attended the department.
community as many may not seek medical help or may seek Seven patients (14%) had informed the police. Three had alternative forms of advice and support. This is evidenced by five experienced an alleged episode of spiking in the past (one had of the patients having friends also affected at the same time but successfully prosecuted the person responsible).
The places identified as being a particular problem for suspected drink spiking are also the busiest establishments inthe town centre on a weekend. The positive results did notimply any particular establishment as having a problem. Thismay be because of our low numbers. Departments receiving larger numbers of patients with suspected drink spiking mightidentify establishments in their area as having a problem.
Patient 1— amphetamine (methylenedioxymethamphetamine), Collecting data like this could help the police target their resources on those establishments which seem to have a Patient 2— amphetamine (methylenedioxymethamphetamine, There have been a number of publicity campaigns in recent years to raise the awareness of drink spiking. Emphasis should also be laid on how excess alcohol consumption makes people more vulnerable to assaults and injury.
In conclusion, this study confirmed our suspicion that most of the patients presenting with suspected drink spiking would test negative for drugs of misuse. We could also pass on A study of patients presenting to an emergency department having had a spiked drink anonymous information to the police as to the scale of the Keith Griffiths, Biochemistry Department, Ysbyty Gwynedd, Bangor, problem as we see it. We were also able to highlight possible establishments, that may have a problem with alleged drink Ethical committee approval for this study was granted by the North EastWales Local Research Ethics Committee (application reference number 04/ We thank the staff of the emergency department in Wrexham for thecollection of samples and the biochemistry departments of Wrexhamand Ysbyty Gwynedd for the handling and processing of samples.
1 Elliott SP. Nonfatal instances of intoxication with gamma-hydroxybutyrate in the . . . . . . . . . . . . . . . . . . . . . . .
United Kingdom. Ther Drug Monit 2004;26:432–40.
2 Scott-Ham M, Burton FC. Toxicological findings in cases of alleged drug- Hywel Hughes, Rachael Peters, Emergency Department, Wrexham Maelor facilitated sexual assault in the United Kingdom over a 3-year period. J ClinForensic Med 2005;12:175–86.
3 Elliott SP, Burgess V. Clinical urinalysis of drugs and alcohol in instances of Gareth Davies, Biochemistry Department, Wrexham Maelor Hospital, suspected surreptitious administration (‘‘spiked drinks’’). Sci Justice

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