Cosby Trial: Cold medicine in an alleged drugging case is … nothing to sniff at.

Bill Cosby is currently on trial for an alleged sexual assault on Andrea Constand in his home near Philadelphia in 2004. Last year, a previous court case ended in mistrial. In the interim, of course, the world learned of many more allegations against the entertainer over the decades.

At various times, Bill Cosby has claimed to have given women cold or allergy medicine. This was, I’m sure, intended to sound more benign than the Quaaludes (methaqualone) that he admitted purchasing, during a deposition in the civil case Constand brought against him in 2005.  He said then that he got Quaaludes to give to women he wanted to have sex with, and also admitted that he didn’t take that drug himself, as it made him sleepy.

But the “cold medicine” pivot doesn’t point to a lack of predatory intent. A little primer about the potentially big effects of diphenhydramine is order.

We commonly know diphenhydramine as an over-the-counter remedy, in the form of a little pink antihistamine; the most well-known brand name of this drug is Benadryl. It can make people drowsy, and in fact many people informally use it on themselves (or even their pets) to coax sleep on an otherwise agitated situation. This is a relatively safe practice if no alcohol is involved, and the dose is kept low. But at doses above the recommended 25-50 mg level, there have been reports of blackouts, feelings of heavy limbs or paralysis, and disorientation. There are also methaqualone and diphenhydramine combination pills; some formulations of these are blue tablets. Higher doses of diphenhydramine alone have been made in blue tablets, as well.

Recently, concern has emerged about nightlife welcoming the “Benadryl cocktail.” For the record, this is an ill-advised mixture. People have been mixing heavier drugs, like tranquilizers, with alcohol for a long time; in the 1950s, the Miltown Martini was much in vogue. I can remember a particularly notorious dorm party at college that involved NyQuil and vodka. Most people’s interest in these concoctions is also voluntary, recreational, and for self-dosing; nonetheless, diphenhydramine can and has been used in a predatory way. Nearly any substance can be pressed into predatory service under the right circumstances. Playing armchair toxicologist, by simply guessing on the basis of a victim’s symptoms, is not wise. To use legalistic language even outside a court setting: you’re piling on additional burdens of proof that are unnecessary if you simplimage of pills falling out of a bottley take a broader view of the total circumstances. The question really is: did someone suffer exploitation or assault, in part because they could not consent or resist?

The 2015 criminal complaint against Cosby takes diphenhydramine seriously – and it should. At a high enough dose, Benadryl absolutely could produce the symptoms that Constand described.  She said that he gave her three blue pills represented to her as herbal supplements, after she mentioned feeling out of sorts. Quickly, heavy symptoms emerged – dizziness, disorientation, and difficulty moving and staying conscious. She says she was also aware of a great deal of sexual touching during this time but was unable to resist or move away.

The prosecution this time around has a refreshing approach to the drugs aspects of the case — refreshing for being circumspect. It’s an approach, I think, with the practical goal of withstanding limitations the court might have (and did previously) place upon evidence about Cosby’s alleged pattern of behavior over the decades. But the role of drugs in the complaint keeps its sights on the underlying offenses. It takes a notably different tack than previous drugging allegation cases in some state courts and before college disciplinary boards. In my 2016 book Drink Spiking and Predatory Drugging: A Modern History, I identified a common, but often perilous, temptation to make drugs that central issue in assault cases, rather than the assault itself.

The key thing here, for establishing the non-consensual nature of the encounter, is the fact of Constand’s incapacity. The specific charge related to Cosby’s drugging behavior relates to facilitation of sexual assault, that he knowingly offered drugs that would lead to the incapacity and thus could not then argue that the encounter was consensual.

In this way, Cosby’s disassembling is the issue, not whether or not Constand took narcotics, high-dose diphenhydramine, or “herbal” supplements from Cosby. She took something from him, as they both agree, and became disoriented, weak, and only sporadically conscious afterward. This criminal complaint keeps it simple, in other words: Constand was in no state to consent, and the defendant’s behavior with whatever he may have given her strongly suggests consciousness of guilt and intent.

Contrast this approach with the one used in prosecuting and confirming convictions against Jeffery Marsalis, another Philadelphia-area case where the defendant was accused of multiple serial rapes and druggings:

But in trying to establish the likelihood of drugging, the press and the courts seemed at times, disturbingly, to rest their accusations of assault on it. It was a successful gambit for them, but risky. And it once again deferred the question of what right women had to bodily integrity when voluntarily intoxicated, as many of the women also were. So much emphasis was placed on the drugs that Marsalis’ violence—his decision to rape and exploit—seemed like some mechanistically simple and inevitable outcome of his drugging scheme. For instance, the courts belabored how he could have obtained drugs through his nursing and emergency medical technician (EMT) work. But by the time of the Marsalis allegations, in the early 2000s, obtaining drugs for such a purpose was hardly difficult. Benzodiazepines were everywhere. GHB was a popular club drug. Diphenhydramine (which was brought up as a possibility) is available over the counter. Basically, anyone who wanted to drug anyone else would not find many obstacles of a chemical sort. There basically are no barriers to means, nor have there been for a very long time. [p193]

The prosecution made the same mistake when they prosecuted Marsalis for a similar case in Idaho, developing a deep expert witness roster based on a theory of GHB drugging. Toxicology evidence was negative, and was misrepresented by a detective initially, although that wasn’t the only evidence that suggested drugging. But the drugs preoccupation put the conviction in jeopardy during appeal, where Marsalis’ lawyers argued, convincingly to at least some of the appellate judges, who dissented from affirmation of conviction, that the prosecution had made a particular drug scenario the centerpiece of its case, misrepresented the evidence, and then tried to argue that it wasn’t central. Once again, however, the appellate court majority did decide that the central issue was the complainant’s lack of capacity to consent, not an intricate and well-documented road map of chemical predation. A close call, and an example of how a drug-centric shaping of a case, can jeopardize the centrality of assault upon an incapacitated person.

The Cosby complaint takes its unknowns in stride, rather than running from them, headlong into phantom evidence that then weighs down the accuser with absences. It remains to be seen whether this broader-view approach makes a difference.

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New Excerpt: What’s in your Halloween Cache?

Here’s an excerpt from the book, Drink Spiking and Predatory Drugging: A Modern History, about the attractions of drug scarelore, especially involuntary drug ingestion as a “problem solver” for frightened parents. It almost always rears its head around Halloween, but never really goes away completely. – PD

Like Many Things, the Promise of Light and Portable Drug Testing Depends Entirely on Context

images-pills-modern-cover-photo-fbI noted in my last blog entry on the dubious technology “drink spiking detection” devices — such as coasters, test cards, and other reagent-coated bar ware — that both false positives and false negatives are too high to make the technology useful. I also suggested that if such user-end technology — thus far deployed without much real consumer interest — were to become more popular, the imprecision associated with such products could instill a dangerous reassurance to people situationally suspicious enough to test their drinks, while creating undue fear, accusations, and other kinds of serious ramifications in the case of false positives.

But in another realm, there’s already a darker side to false positives in quick field tests. Nationwide concern in the US is beginning to pick up about the sometimes life-altering problems associated with inaccurate or inconclusive field tests used by law enforcement agencies. Field testing technology for drugs on the scene (say, at a vehicle stop) hasn’t developed much since its inception in the 1970s; it appears that what is new is the recognition that cross-reactions with any number of other ordinary chemicals and compounds produce unacceptably high levels of false positives. The New York Times Magazine reported in July that widely deployed reagent field tests have routinely produced false positives for methamphetamine and cocaine. But enter “field drug test” or “drink detector” into a search engine on line, and you’ll find little recognition of the cross-reaction problems that have been known for years.

Furthermore, the necessary visual interpretation of chemical testing results (it turned blue, it turned sort of blue, it turned light blue…) remains a key moment in decision-making in forensic detection and is fraught with the tendency to over-certainty and over-confidence.  This problem has been well-known since the most rudimentary lab techniques were developed in the early 1900s, and remains a problem for cheap, easy field deployables. The cobalt thiocyanate tests used to test for cocaine, for instance, will also turn blue with a number of over-the-counter medicines and cleaning products.

Technically, in order for a positive field test to lead to criminal conviction, it has to be confirmed in a lab by more precise tests. But circumstances rule. Most people arrested for drugs don’t have access to private lawyers or even readily available bail or bond money, and pleas before confirmation are the norm.  Some period of incarceration may ensue anyway, just enough to disrupt the stability of more vulnerable citizens. The Times article chronicles the downfall of a Louisiana woman arrested in Houston and saddled with a felony conviction for crack cocaine, which turned out to be a fragment of the over-the-counter aspirin and caffeine pill that she insisted it was. Having lost her steady home and job as a result, she didn’t even realize that she’d been part of a wave of similar exonerations until the Times informed her, years later.

But on-site drug testing can be used by consumers of drugs, as well. In a different context, the technology, even with its flaws, can prevent harm rather than inflict it. There is a well-functioning model out there – and it comes from the rave scene. In rave and electronic music settings, there’s actually a solid network of nonprofit drug testing that can analyze drugs on the spot. The DanceSafe outfit is probably the best known of these harm reduction groups, but the technology to provide such a service is widespread. MDMA, commonly known as Molly or Ecstasy, is one of the more widely adulterated illicit drugs. On August 3, Lauren Frayer reported on NPR’s All Things Considered radio show that on-site testing had been arranged for a larger music festival in the UK. Due in great part to advocacy on the part of researcher Fiona Measham of Durham University, a legal path has been cleared for the process, to encourage event goers to subject their drugs to testing. In the process, they can discuss the results with a trained counselor. In the US, DanceSafe sells testing kits to consumers, but can’t provide on-site testing and counsel due to risk of attendees’ arrests. (This organization and others are advocating for legal and enforcement-practice reform that would enable this service in the US.)

Online drug commerce has advanced the prospect of user-initiated testing, as well. A firm called Energy Control in Barcelona tests any drug sent to it and provides a report. It now receives government support in the interest of harm reduction, although it started out with a single doctor, Fernando Caudevilla, who posted to the now-defunct Silk Road darknet platform, offering testing and advice. The testing is highly precise but not immediate – with at least a few days’ turnaround time. The company takes Bitcoin payments to enhance anonymity.

A number of drug cryptomarkets have emerged in the wake of Silk Road’s closure in 2013, when it was seized by the FBI as part of the indictment of its founder, Ross Ulbricht. The market for online illicit drug transactions is growing rapidly, according to a newly-released RAND report.

So you can assume that there is a latent demand for user-end testing products, for people that use drugs voluntarily, and have the resources to buy them discreetly. People who purchase drugs in hand-to-hand transactions aren’t the same as those who buy on line. It’s unclear whether this sort of simple re-agent technology would be used widely by those who purchase street drugs.  Energy Control reported that cocaine was much purer in online samples than street ones, suggesting that a bifurcated market remains — starkly by economic resources — and perhaps also the interest in drug content verification. In any case, having users make contact with neutral testers and advice-givers seems all to the good, in terms of enhancing public health and at the same time adding to the research body of knowledge about illicit drug trends. Increasing awareness of the fallibility of light-and-portable tests — and resisting the “gee whiz” style of reporting on technology — also seems useful to everyone.

What’s in Your Drugs? And Does it Matter if it isn’t what you think? (Part 1 of 2)

Summer Drug Testing Roundup, part 1 of 2: 

In mid-July in Yorkshire, England, ITV and other news sources reported that purchasers of “street Valium” got more than they bargained for and a number of them had sought medical attention. The first odd thing was that the drug had turned their tongues blue, and the second was that the drugs’ effects were much heavier than expected. Within weeks, police made an arrest and recovered about 40 more of the suspect tablets.

It appears that the underground compounder making the drugs mixed diazepam (known by one of its commercial names, Valium) with flunitrazepam (known as Rohypnol) or “roofies.” Swiss pharmaceutical giant Roche began blue-dye tagging Rohypnol tabs in response to spiked-drink reports in the United States in the late 1990s. Both Valium and Rohypnol are benzodiazepines, but Rohypnol is stronger. Roche makes both of the name brands, but generic versions are around, as well. Valium is mostly used as an anti-anxiety drug, whereas Rohypnol treats insomnia. (Roche was never all that aggressive in seeking to swim upstream against the negative publicity as it marketed the drug in the US. Rohypnol was too similar to other insomnia drugs anyway, and Roche focused mainly on countering the negative publicity.)

No doubt the purchasers of the illicit drug had expected a Valium-high, but experienced something more anvil-like and presumably suffered some of Rohypnol’s known side effects, such as amnesia.

The recent incident in Yorkshire points up the strangeness of continuing to use the term “date rape drugs” in any meaningful way. References to Rohypnol assume, often without sources or reference, that it is widely implicated in drugging and drink-spiking cases. In fact, Rohypnol is available by prescription in Europe and elsewhere, and it is rarely implicated in predatory drugging incidents. In the handful of cases where anything other than high blood-alcohol levels has been found, none of the commonly labeled “date rape drugs” are among the top substances. Instead, the usual street substances are found, including stimulants. But the moniker “roofie” leapt clear of its origins and took on a meaning of its own.

The Yorkshire Street Valium incident points to a more common problem — adulterated drugs in the illicit market. Up until recently, consumers of illegal or restricted substances had no way to verify that what they were buying was what they thought they were buying. Underground mid-level distributors and wholesalers sometimes employed chemists for verification of samples from larger lots they were negotiating to buy, but the street user was more or less on his or her own. In the US, there have been a number of cases in which seekers of heroin were sold heroin-fentanyl combinations, with sometimes fatal results. Fentanyl is a powerful synthetic opiate, and by weight or volume tends to be considerably stronger than heroin. Also this July, law enforcement in Long Island, NY arrested 24 people in connection with heroin and fentanyl distribution. At least one of the combinations they were distributing seems to have provoked an uptick in overdoses.

But in describing a street preparation as a deadly dose, you have to consider not only the objective effects of a particular dose, but the expectations that the buyer and user bring to the anticipated high. Fentanyl itself is now sought out, on its own or in combinations, by illicit users. Heroin users often expect their purchases to be cut with other things; toxicologists note that most of the time, the adulterants buffer rather than strengthen the effects of the drug. But the haphazard and after-the-fact investigation of the content of illicit substances, as well as a non-transparent supply chain, means that it is difficult to separate effects of the drugs themselves and the drugs’ potential substitutions and additives.

In my book on drugs associated with the “date rape drugs” scare, I noted that there was really no factual basis to label certain popular club drugs like GHB as the preferred weapons of predators. GHB, Ketamine, and Rohypnol – like many central nervous system depressants – have been implicated in specific cases, but any CNS depressant can work, and the labeled drugs are found less often than other widely available drugs (and, of course, alcohol). GHB also presents an interesting conundrum in that it is often not clear whether people who had some in their system were dosed by someone else with ill intent, or whether the GHB was a part of a popular mix of MDMA and GHB sometimes sought out in club settings.

Just to add to the confusion, GHB’s street names are myriad, including Liquid Ecstasy and Cherry Meth. and its effects are seemingly subjective enough to be mistaken for any number of knowingly ingested substances.  The underground compounder often finds that GHB is a cheap substitute for other drugs. GHB is also sought out by recreational users for its reputation as a calorie-free buzz mimicking moderate alcohol ingestion. It can be very dangerous, however, in combination with alcohol.

Voluntary drug users clearly might benefit by being able to quickly and easily test the content and potency of their drugs, but for many reasons the market hasn’t reached this potential public yet.  In my next blog, I discuss the problems with validity and reliability of home and field drug test kits, and the products that come to market to purportedly fix this problem. Depending on context, testing technology can either aid well-being and safety or undermine it.