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Laboratory : Toxicology Testing

Toxicology screens often do not result in information that affects acute treatment but may be valuable in building a case of abuse or neglect and for the determination of ongoing emotional, social, or psychiatric treatment needs. These tests should be considered in children/adolescents with unexplained neurological signs or symptoms or if there is a symptom complex strongly suggestive of a particular toxidrome. A toxicology screen usually consists of urine, blood, and/or gastric contents.

When ordering a toxicology screen, be aware of what the healthcare facility/lab includes on the general screen. Order specialized testing as needed. If there is suspicion of a particular drug ingestion and testing is available for that drug, order that specific drug level.

Do not delay treatment while awaiting results. Emergent treatment of a poisoning can usually be guided by the history and physical.

For a listing of Poison Control Centers in NYS and more information on poisoning in children, see: https://www.health.ny.gov/professionals/poison_control/centers.htm.


Drug Facilitated Sexual Assault (DFSA)

A wide variety of substances are used with criminal intent to induce depression of consciousness, reduced resistance, and/or submission with suggestibility, disinhibition, and anterograde amnesia. Substances are usually odorless, tasteless, and can be easily dissolved into drinks (alcoholic and non-alcoholic).

After alcohol (ethanol), the most commonly used substances are benzodiazepines (BZD) and designer benzodiazepines (DBZD). The latter represent newer psychoactive substances that have a slight alteration to their chemical structure that enhances affinity to nerve receptors, increasing strong sedation and amnesia as well as risk of respiratory depression. DBZD are currently not authorized for medical use in the US (Brunetti et al 2021). The medical use of BZD includes treatment for anxiety, phobias, aggression, panic attacks, sleep disorders, epilepsy, muscle-relaxants during surgery.

Commonly used date-rape or knock-out drugs include many of the BDZ and DBDZs, and the list of DBDZ’s is growing. Note that street names may differ depending on country and local. An incomplete list of commonly used drugs includes:

  • Flunitrazepam (Rohypnol), a BDZ, is sold with street names of Roofies, Circles, Forget Me Pill, La Rocha, Lunch Money Drug, Mexican Valium, Pingus, R2, Roach 2, Ruffies, Rophies, Wolfies. Rohypnol is manufactured in tablet form and can be crushed and dissolved in liquid. It is sold illegally in the US and often used as a “club-drug” at raves and parties. The manufacturers reformulated it so that it cannot be dissolved colorlessly in clear drinks. However, the greenish blue color can be hidden in dark colored drinks. It is tasteless and odorless and can be slipped into a drink without the person knowing it. A single dose of Rohypnol as small as 0.5 to 1 mg can produce effects within 15 minutes and that last for 2 to 6 hours after ingestion, depending on individual factors such as weight, age and metabolism. It enhances the effects of alcohol by decreasing inhibition and causing sleepiness and memory loss. Recipients are left open to suggestions, physically weak, and without memory of events that transpire after the drug takes effect. For more information see: https://www.justice.gov/archive/ndic/pubs6/6074/index.htm and https://www.dea.gov/factsheets/rohypnol.
  • Gamma Hydroxybutyric acid (GHB) is sometimes used to treat narcolepsy and is illegally sold with street names such as Easy Lay, G, Georgia Home Boy, GHB, Goop, Grievous Bodily Harm, Liquid Ecstasy, Liquid X, Scoop. Analogs are produced and legally sold as industrial agents and can be bought as solvents. GHB is usually abused either for its intoxicating/sedative/euphoria properties or for its growth hormone-releasing effects, which can build muscles. GHB is a central nervous system depressant that can relax or sedate the body. At higher doses it can slow breathing and heart rate to dangerous levels. Overdose of GHB can occur quickly and the signs are similar to those of other sedatives: drowsiness, nausea, vomiting, headache, loss of consciousness, loss of reflexes, impaired breathing, and death. See: https://www.dea.gov/factsheets/ghb-gamma-hydroxybutyric-acid and https://pmc.ncbi.nlm.nih.gov/articles/PMC4462042/.

Other drugs include:

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