Caitlin Whyte (Host): Today, we're talking to Dr. William Richardson, Prisma Health Emergency Medicine Core Faculty Physician, medical toxicologist, and Medical Director of the Palmetto Poison Center about a serious safety issue, what to do if you suspect you've been roofied or drugged. From recognizing the signs to knowing how to respond, this episode covers crucial information to help protect yourself and others in social settings.

 This is Flourish, a podcast brought to you by Prisma Health. I'm Caitlin Whyte. Well, Doctor, thank you so much for joining us today for such an important episode. To start us off, what are roofies and how do they affect the body?

Dr. William Richardson: Well, roofies is a colloquial street term that initially referred to a drug called Rohypnol, which is a strong benzodiazepine sedative, and that's where the name roofies came from. But over time, it has expanded to include other substances that can be used despite drinks, and these can include even other benzodiazepines. For example, Xanax, but also other drugs like GHB, which is gamma-hydroxybutyrate, which has been associated with, as a rape drug and sexual assault, and even drugs like ketamine.

Some of the effects on the body can be similar to just alcohol intoxication. But certainly, the signs and symptoms someone might expect would be drowsiness, maybe even to the degree of some sedation, impairment of judgment, which can include just having reduced inhibitions, memory loss, and even some disorientation and confusion.

Host: Gotcha. Well, why is it so dangerous to be roofied?

Dr. William Richardson: If you had any of these symptoms, the dangers would, of course, come from your increased vulnerability and that can include being physically or sexually assaulted. Anytime you have some disorientation or confusion, obviously, there's risk there of falling or if someone was driving, a more serious injury. And there's even the potential for overdose because other sedatives may be getting consumed like alcohol already, and then someone have their drink spiked with another sedative, like a roofie.

Host: And then, you mentioned a few in our first question, but what are some common signs that someone might have been drugged, especially from a perspective of another person? What if I'm looking at my friend or my partner or something? What could I maybe see that would tip me off?

Dr. William Richardson: Absolutely. Some of the things that a friend at a bar or restaurant might notice is a real sudden change in someone's behavior or their personality. They could be speaking differently or have an unexpected trouble with balance or moving around. A big indication would be if someone was appearing extremely intoxicated, but yet maybe they'd only had one or two drinks, so an exaggerated response or intoxication that wouldn't be necessarily expected by how much alcohol they consumed. And then, of course, there can be memory issues, unexplained memory loss that people might often call a blackout. Anything like that might be an indication or a sign that someone has been drugged or had their drink spiked.

Host: Well, if someone has been drugged, how quickly would those symptoms appear? And again, how can we distinguish those from regular intoxication?

Dr. William Richardson: Most of the symptoms from this do come on pretty rapidly, and likely within 15 to 30 minutes of ingestion, and some of these symptoms can even last for several hours. Distinguishing the difference between being roofied and consuming alcohol and being intoxicated can be challenging because there are a lot of similarities. But some of the differences would be a rapid onset of the symptoms we've talked about after minimal alcohol consumption. If all of a sudden you had exaggerated symptoms of intoxication and you'd only had one drink, that would be an indication or a concern and that kind of gets to just more effects, whether it be disorientation or other cognitive impairment than you would expect based on the amount of alcohol consumed.

And then, there can be more significant memory loss associated with roofies that can begin right at the point of drugging where someone does not remember a lot of the events or any of those events surrounding that spiking of their drink and the consumption.

Host: Well, what should someone do immediately if they suspect that they have been drugged?

Dr. William Richardson: Well, first and foremost, you want to either contact a friend or family member, or if you already have one nearby, make sure they're with you. Obviously, don't attempt to drive or leave a location alone without someone that can't be trusted. You would want to seek medical attention, and that could often include an evaluation in an emergency department. And if possible, if there was a friend or family member and there was a drink, then that could even be saved if there was high suspicion it had been contaminated for potential testing. But most importantly, I would say seeking medical attention and making sure you're with someone that is a trusted friend or family member.

Host: And if we do end up going to the ER, what can someone expect if they go in this situation? Will they be tested for sexual assault right off the bat? How do these situations typically get handled in the emergency room?

Dr. William Richardson: Sure. Well, when you get to the emergency department, you're going to have a medical evaluation and a monitoring and any symptoms that you might have are going to be treated. And you may be be monitored for a few hours or longer if necessary. There is some toxicology screening, testing that can be done that would identify some agents, but certainly not most of them that can be used to spike drinks and, in regards to if someone has been sexually assaulted after having their drink spiked, that would not be mandatory, but only if the patient requested it and if it was indicated.

Host: Well, is there a way to test for these drugs and how soon after exposure should that testing happen?

Dr. William Richardson: Ideally, the testing for date rape drugs like this, roofies, should occur as soon as possible, ideally within hours, certainly within a couple of days, because some of these drugs can be metabolized and leave the system fairly rapidly. But there are urine and blood tests that can be done to detect many of these substances.

Host: Well, when we're out and about in bars or situations where we're drinking alcohol, what steps can people take to protect themselves from being drugged in social settings?

Dr. William Richardson: There are a lot of prevention strategies to help avoid your drink being spiked, and some of them are common sense approaches. You should never leave your drink unattended to go to the restroom and come back and consume it where someone could have easily spiked your drink. Obviously, avoid accepting drinks from strangers, someone who cannot be trusted. And just in general, in restaurants and bars or parties, wherever you may be, just stay aware of your surroundings and trust your instincts. If you have a suspicion that your drink has been spiked, then you certainly should not consume that drink and throw that away. And being around groups of people, friends that you know you can trust, is also important and not being by yourself in these settings.

Host: Well, wrapping up here, Doctor, being drugged is, of course, a traumatizing experience. So if this has happened to a person, what can they do to help with their recovery after the event?

Dr. William Richardson: Well, there are certainly options for counseling and therapy to help someone process or work through an event like this. It is also important to notify the appropriate authorities so this can be investigated by police or whatever authorities would need to be involved. And then if something as serious as this and sexual assault has occurred, there are support groups for survivors and people who have had these terrible experiences.

But I would say that it's most important just to remember that this is not the victim's fault. If this happens to you, you certainly want to focus on the prevention strategies we mentioned to avoid this, but it's not the victim's fault and there is support available for those who've experienced something this traumatic.

Host: Some really, really essential information for anyone heading out to a bar or a club soon. Thank you so much, Doctor, for sharing. For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by Prisma Health. I'm Caitlin Whyte. Thank you for listening.