Medications at the Emergency Department After Recent Rape

Abstract

Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability.

Keywords

adult victims alcohol and drugs reporting/disclosure sexual assault

Medications at the Emergency Department After Recent Rape

Rape, or nonconsensual penetrative sex, is a widespread public health problem that impacts women and men globally. More specifically, in the United States, 21.3% of women experienced attempted or completed rape and 2.6% of men experienced attempted or completed rape and 7.1% of men were forced to penetrate in their lifetime (Smith et al., 2018). It is estimated that the lifetime costs of rape are $3.1 trillion (Peterson et al., 2017). The long-term health costs include the development of long-term health problems including sexually transmitted infections (STIs), unwanted pregnancy, and mental health symptoms (Dworkin et al., 2017). Individuals who experience a rape are able to receive a sexual assault medical forensic examination (SAMFE) free of charge in the United States since 2005 as part of the Violence Against Women Act (2005) whether it is formally or anonymously reported to the police. Given that the SAMFE typically takes place within an emergency department within 72–120 hours of the assault (U.S. Department of Justice, 2013), it is a unique opportunity to provide individuals in need with prophylaxis for STIs, unwanted pregnancy, pain, and psychological symptoms. Although the Centers for Disease Control recommend provision of Ceftriaxone 250 mg for Neisseria gonorrhoeae, azithromycin 1,000 mg for Chlamydia trachomatis, 2000 mg metronidazole for Trichomonas vaginalis for adults during the SAMFE, no studies to date have examined the medications prescribed during the same day of the SAMFE at the emergency department based on demographic factors and assault characteristics. All individuals who receive a SAMFE are offered these medications, however, not all individuals agree to receive a prescription, and therefore they are not prescribed on the same day of the SAMFE. Historically, rape characteristics have been stereotyped to include a specific set of characteristics including the perpetrator being a stranger, where victims must physically resist the assault, as well as being physically violent and without intoxication (Lonsway & Archambault, 2012). It is important to note that these characteristics are not representative of the majority of rapes, with research indicating that ascription to these stereotypes may negatively impact victim treatment and outcomes (Temkin & Krahe, 2008). Therefore, the purpose of the current study was to provide a preliminary examination of factors associated with the receipt of medications on the same day of the SAMFE including rape characteristics. The current study includes a medical record review of an emergency department in the southeastern United States to assess if there are differences in prescription of antibiotic, antiviral, emergency contraception, pain, and psychotropic medications either during the SAMFE or prescribed at the emergency department within 24 hours of the SAMFE. This is important to understand how to effectively disseminate medications after a recent rape.

Sexual Health After Rape

A primary concern of individuals who recently experienced rape is related to sexual health. The most common STIs that are transmitted during rape include trichomoniasis, gonorrhea, and chlamydial infections (CDC, 2015). Approximately three-fourths of women who experienced a recent rape reported extreme fear about contracting HIV from the sexual assault (Resnick et al., 2002). Pregnancy is also a concern. Although there are potential risk factors for contracting STIs, including HIV, it is extremely unlikely that an individual who experienced a sexual assault will know the HIV/STI status of the perpetrator even if the perpetrator was their partner. Therefore, the Centers for Disease Control (CDC, 2015) recommend routine prophylaxis or routine treatment for STIs in general; however, it is recommended that HIV prevention and treatment should be made on an individual basis. The CDC further recommends that post-exposure prophylaxis for HIV should be considered if the assault occurred within 72 hours and the perpetrator’s HIV status is unknown. Given that most individuals who experience rape do not know their perpetrator’s HIV status, including those who are perpetrated against by an intimate partner, it is important to understand if there are assault characteristics that are associated with the provision of antiviral medications at this crucial period of time. It would be expected that genital injury would be associated with an increased likelihood of antiviral and antibiotic prescriptions due to more potential open wound locations. However, other assault characteristics may influence the likelihood of antiviral and antibiotic prescriptions. There is some evidence to suggest that some demographic variables (i.e., age, race, and ethnicity) may affect antiviral prescribing practices. Older individuals and survivors whose perpetrators were of other race (Asian, Hispanic, Middle Eastern, or mixed-race) have been linked to decreased likelihoods of being offered post-exposure prophylaxis medications (Draughon et al., 2015; Merchant et al., 2008). Substance and alcohol use may also affect prescribing practice. More specifically, individuals reporting substance use, especially alcohol use, may be less likely to receive these medications due to alcohol reducing the uptake of post-exposure prophylaxis (Elst et al., 2013), with those consuming alcohol or drugs having lower treatment adherence (Azar et al., 2010), and inability to recall specific details of the assault that typically warrant prescribing these medications (Draughon, 2012). It is also essential to assess the relationship to the perpetrator, given that intimate partners perpetrating rape are more likely to have more than one sexual partner, which in turn increases a victim’s likelihood for infection (Campbell et al., 2008). These are important factors to consider given that approximately 10–50% of women who experience intimate partner violence (IPV) report sexual IPV in their relationship, and relationship partners are the most common type of reported perpetrator in sexual assault (Black et al., 2011; Coker et al., 2000; Peterson et al., 2019). Furthermore, research indicates that between one-third to one-half of women who experience sexual assault report consuming alcohol prior to the assault (Abbey et al., 2004; Ullman & Brecklin, 2000).

Pain After Rape

Pain is a common symptom after rape and individuals who have experienced rape often report acute pain immediately after the assault as well as chronic pain (e.g., Chandler et al., 2006; Haskell et al., 2008; Linton, 1997). In examining general pain medication prescribing practices, it appears decisions may be affected by demographic characteristics. Data indicate that emergency department prescribing practices for opioids may be unevenly distributed among racial and age groups such that in individuals presenting for pain, older adults (compared to younger adults) and Hispanic, Black, and Asian/other racial group identifying individuals (compared to White) are less likely to be prescribed pain medication (Platts-Mills et al., 2012; Pletcher et al., 2008; Shah et al., 2015). While these findings were not post-rape pain-specific, findings could shed light on prescriber predilections that could extend into SAMFEs. Although it is clear that pain is common among those with recent rape as well as among those with a rape history, less research has focused on pain medication provided at the emergency department on the same day as the SAMFE. One study found that among women who received a SAMFE, those with a G allele (an opioid receptor gene) experienced less pain at both at the SAMFE and 6 weeks after the SAMFE (Ballina et al., 2013). Therefore, this emerging evidence suggests that endogenous opioid-mediated hyperalgesia after recent trauma may be important to consider; however, there is a lack of knowledge about the pain medication provided at the emergency department. Further, opioid misuse is common after rape with 15.6% of individuals reporting opioid misuse after a recent rape (Gilmore et al., 2019) and 21.4–40% of individuals who experienced a recent rape reporting opioid use or non-medical use of prescription medication in the year prior to the assault (Gilmore et al., 2018, 2019). Given the opioid epidemic and potential influences of endogenous opioid-mediated hyperalgesia after recent exposure to potentially traumatic events, it is important that research further assess the potential relationship between differing sexual assault characteristics and their association with same-day medications prescribed while at the emergency department, to help aid in appropriate pain management plans.

Mental Health After Rape

Despite the abundant literature suggesting that mental health symptoms are common after a sexual assault (Dworkin et al., 2017), there is limited evidence for use of psychotropic medications after exposure to a recent potentially traumatic event. Several researchers have examined the utility of different medications after a recent potentially traumatic event and there has been some evidence for the use of propranolol to prevent the development of acute stress disorder and posttraumatic stress disorder; however, findings have been mixed and a meta-analysis suggested that propranolol is not effective as a secondary prevention of posttraumatic stress disorder (Argolo et al., 2015). Other medications that have been examined as secondary prevention after recent trauma includes hydrocortisone, gabapentin, escitalopram, and temazepam and among these medications, the only one that had moderate-quality evidence for prevention of posttraumatic stress disorder was hydrocortisone (for a review, refer to Amos et al., 2014). Furthermore, it is possible that some prescription psychotropic medications may interfere with treatment outcomes. Specifically, benzodiazepines, which are routinely prescribed after experiences of acute trauma, may increase the likelihood of substance-related problems among patients (Guina et al., 2016). However, it is unclear what medications are being prescribed in clinical practice acutely after exposure to a potentially traumatic experience and more work is needed to determine the efficacy of more commonly prescribed medications at this crucial period. There are documented stratifications in emergency room psychotropic prescribing practices based on racial characteristics. While SAMFE prescribing practices have yet to be systematically examined, there is some evidence to suggest that African-American individuals are prescribed more antipsychotic medications when presenting at psychiatric emergency rooms (Segal et al., 1996). Given that it is also unclear whether specific characteristics of rape and the individuals who experience assault are related to receiving psychotropic medications post-assault, it is critical for research to understand and operationalize when these medications are prescribed.

Current Study

The current study described and compared medications prescribed at the emergency department within 24 hours of the SAMFE. It was decided to examine both medications given during the SAMFE and within 24 hours because if psychiatric or pain medications are needed, they must be prescribed by a physician and are typically done within 24 hours if prescribed in conjunction with the SAMFE. Specifically, we examined the following medications: antibiotic and antiviral, emergency contraception, pain, and psychotropic medications. It was hypothesized that individuals experiencing sexual assaults that are outside of the stereotypical rape experience (i.e., victims reporting alcohol or drug use during the assault who may not be able to accurately report on their assault or may be perceived to be unlikely to adhere to medications; Elst et al., 2013; Azar et al., 2010; Draughon & Sheridan, 2012, intimate partner perpetrator because victim may assume their perpetrator is in a monogamous relationship, no genital or non-genital injury as this would lessen the risk of transmission due to lack of open wounds, male victim) would be less likely to be offered medications during the SAMFE. It was hypothesized that there would be different demographic predictors of each type of medication (e.g., age, race/ethnicity, and sex) and indicators of physical violence (i.e., genital injury, non-genital injury, and strangulation) would be significant predictors of pain medications. No specific directional hypotheses were made as this is the first investigation of medications prescribed within the same day of a SAMFE.

Participants

We conducted a retrospective cohort study examining electronic medical records for patient visits during a five-year period, between July 1, 2014, to May 15, 2019, within this dataset. Participants included 939 individuals who received a SAMFE from a large, southeastern, academic medical emergency room who consented to the release of their medical records for research. The majority of participants identified as female (93.9%, n = 882), with the remaining identifying as male (6.1%, n = 57). Participant ages ranged from 18 to 81 years old, with the mean age of participants being 28.92 years of age (SD = 10.72). According to their medical records, participants were Non-Hispanic White (70.5%, n = 662), African-American (23.3%, n = 219), Hispanic/Latinx (3.3%, n = 31), Other (1.8%, n = 17), Asian (.8%, n = 8), and American Indian or Alaska Native (.2%, n = 2). In regards to marital status, participants were single (80.3%, n = 754) married (10.4%, n = 98), divorced (4.7%, n = 44), legally separated (2.1%, n = 20), widowed (1.0%, n = 9), and as having a significant other (.4%, n = 4) according to their medical records. Most participants in this sample spoke English (98.7%, n = 927), with 1.1% of participants speaking Spanish (n = 10), .1% of participants using Sign Language (n = 1), and .1% of participants not reporting their language spoken (n = 1). Regarding the number of SAMFE exams a participant received over the five-year period, most participants received one exam (96.3%, n = 904), 3.0% of participants receiving two exams (n = 28), and .7% receiving between three to seven exams (n = 7). Table 1 provides sample demographic information.

Table 1.

Descriptives for Sample Characteristics.

	N (%)
Sex
Female	882 (93.9)
Male	57 (6.1)
Race/ethnicity
Non-Hispanic White	662 (70.5)
African-American	219 (23.3)
Hispanic/Latino	31 (3.3)
Other	17 (1.8)
Asian	8 (.8)
American Indian or Alaska Native	2 (.2)
Marital status
Single	754 (80.3)
Married	98 (10.4)
Significant other	4 (.4)
Divorced/legally separated	64 (6.8)
Widowed	9 (1.0)
Not reported	10 (1.1)
Language
English	927 (98.7)
Sign language	1 (.1)
Spanish	10 (1.1)
Not reported	1 (.1)
Number of SANE visits
1	904 (96.3)
2	28 (3.0)
3–7	7 (.7)

Measures

Demographics.

Demographic information including gender, age at time of visit, race, ethnicity, marital status, and language spoken, were directly pulled from each of the participant’s electronic medical records.

Rape characteristics.

Rape characteristics were recorded by the Sexual Assault Nurse Examiner in the emergency department. These included the presence of genital injury (anal or vaginal injury), non-genital injury, alcohol or drug use at the time of the assault, report of strangulation during the assault, and relationship to perpetrator (intimate partner vs not).

Outcome variables.

Outcome variables, which included the prescribing of prescription pain medication (e.g., hydrocodone, oxycodone), over-the-counter pain medications (acetaminophen, naproxen), emergency contraceptives (levonorgestrel), antiviral agents (emtricitabine/tenofovir disoproxil fumarate), antibiotics (Azithromycin), and psychiatric medications (e.g., antidepressants, benzodiazepines, mood stabilizers, etc.) were also pulled from the patient’s electronic medical record. These categories of medications were specifically analyzed given that they are routinely prescribed as part of a SAMFE, and were included in this study regardless of whether the patient accepted or refused it. Table 2 details information about the types of medications prescribed during SAMFE visits.

Table 2.

Medications Prescribed During SAMFE Visit.

	N (%)
Over-the-counter pain medications
Yes	226 (24.1)
No	713 (75.9)
Prescription pain medications
Yes	32 (3.4)
No	907 (96.6)
Psychiatric medications
Yes	31 (3.3)
No	908 (96.7)
Emergency contraception
Yes	425 (45.3)
No	514 (54.7)
Antibiotics
Yes	661 (70.4)
No	278 (29.6)
Antivirals
Yes	25 (2.6)
No	914 (97.3)

Procedure

All study procedures were approved by the Institutional Review Board prior to any data collection. After receiving the information requested from all SAMFE exams and electronic medical records, individual medical record numbers (MRNs) were removed and replaced with random personal identification numbers (PINs) and stored in a password protected data sheet on a secure network. As described above, demographic variables and outcome variables were pulled directly from the patient’s electronic medical record. Sexual assault characteristics were analyzed using the Sexual Assault Nurse Examiner notes for each participant. Regarding the outcome variables (i.e., prescribed medications), 781 distinct types of medications were prescribed over the 5-year period. To categorize these medications, two trained research assistants manually coded these medications to one of the six categories generated through the commonly prescribed medication list provided as part of the SAMFE.

Analysis Plan

We used a series of logistic regressions to evaluate the likelihood of prescriptions on the same day as the SANE visit based on assault characteristics. Models were estimated in Mplus using maximum likelihood estimation and Monte Carlo integration. Maximum likelihood is the estimation procedure used in logistic regression, where the goal is to find the combination of predictors that maximizes the likelihood of the observed data (Hox, 2002; Tabachnick & Fidell, 2013). The Monte Carlo integration method is used in conjunction with maximum likelihood (Muthén & Muthén, 2012) by simulating the distribution found in the data and then using samples from this distribution to calculate the regression estimates. For those patients who had more than one SANE visit, we only used data from their first visit. For each medication type, we created a dichotomous dependent variable reflecting whether the patient was prescribed the medication (0 = not prescribed, 1 = prescribed). Each of these dependent variables was then regressed on the assault characteristic predictor variables (genital injury, non-genital injury, report of alcohol or drug use, strangulation, and report of IPV), which were also coded to be dichotomous (0 = not reported, 1 = reported); we excluded men from the model predicting emergency contraception. In each model, we also examined demographic factors associated with prescription medications including racial/ethnic identity, marital status, sex (when possible), and age. Racial/ethnic identity was dummy coded to reflect non-Hispanic White versus other races and Hispanic/Latinx ethnicity.

Results

Antibiotic and Antiviral Medications.

Individuals who were assaulted by an intimate partner, exp(b) = .39, SE = .28, p = .001, and individuals who were older, exp(b) = .98, SE = .01, p = .029, were less likely to receive antibiotic prescriptions. These results indicated that when the assault was perpetrated by an intimate partner, the odds of being prescribed an antibiotic decreased by 71%. Moreover, the odds of being prescribed an antibiotic decreased by approximately 2% for each increased year of age at the SAMFE. Genital injury, exp(b) = 10.55, SE = .58, p < .001, and male victim sex, exp(b) = 5.19, SE = .74, p = .025, were positively associated with receiving a prescription for antiviral medications. These results suggested that when genital injury was present, the odds of accepting an antiviral increased by 1,055% and that the odds of accepting an antiviral increased by 519% for male patients. This is likely because the criteria of an antiviral prescription is a laceration or significant abrasion.

Emergency Contraception.

Individuals who were assaulted by an intimate partner, exp(b) = .48, SE = .30, p = .014, and individuals who were older, exp(b) = .94, SE = .01, p < .001, were less likely to receive emergency contraception prescriptions. These results indicate that when the patient reported that IPV occurred during the assault, the odds of accepting emergency contraception decreased by 48%. The odds of accepting emergency contraception decreased by approximately 6% for each increased year of age at the SAMFE.

Pain Medications.

Non-genital injury was positively associated with over-the-counter pain medication prescriptions, exp(b) = 1.88, SE = .19, p = .001, as well as prescription pain medication, exp(b) = 4.40, SE = .50, p = .003, indicating that when patients had non-genital injury, the likelihood of accepting an over-the-counter pain medication or a prescription pain medication increased by 188% and 440%, respectively. Presence of strangulation was also positively associated with over-the-counter pain medication prescriptions, exp(b) = 1.89, SE = .27, p = .018, but not prescription pain medication. When strangulation was present, the odds of over-the counter pain medication prescriptions increased by 189%.

Psychiatric Medication.

Accepting at least one psychiatric medication was positively associated with assaults perpetrated by an intimate partner, exp(b) = 3.87, SE = .52, p = .010, and the presence of strangulation, exp(b) = 2.83, SE = .50, p = .039. These results indicated that when assaults were perpetrated by an intimate partner and involved strangulation, the likelihood of accepting a psychiatric medication increased by 387% and 283%, respectively. All findings are presented in Table 3.

Table 3.

Logistic Models Examining the Effects of Sexual Assault Characteristics on Medications Prescribed.

	Over-the-counter Pain OR (SE)	Prescription Pain OR (SE)	Psychiatric OR (SE)	Emergency Contraception OR (SE)	Antibiotics OR (SE)	Antivirals OR (SE)
Genital injury	1.36 (.19)	.82 (.47)	.62 (.52)	1.02 (.17)	1.41 (.20)	10.55 (.58)***
Non-genital injury	1.88 (.19)***	4.40 (.50)**	2.25 (.54)	1.12 (.17)	1.29 (.19)	1.48 (.49)
Alcohol or drug use	1.14 (.20)	.56 (.45)	2.10 (.55)	1.34 (.18)	1.42 (.19)	1.77 (.55)
Intimate partner violence	.86 (.30)	1.99 (.54)	3.87 (.52)**	.48 (.30)*	.39 (.28)***	.45 (1.11)
Strangulation	1.89 (.27)*	1.66 (.53)	2.83 (.50)*	.73 (.28)	.63 (.29)	.49 (1.06)
Age	1.00 (.01)	1.01 (.02)	1.03 (.02)	.94 (.01)***	.98 (.01)*	.97 (.03)
Sex	.48 (.45)	.66 (1.06)	.00 (55.55)	–	.67 (.30)	5.19 (.74)*
Non-White race/Hispanic ethnicity	1.40 (.18)	1.35 (.42)	.78 (.50)	1.14 (.17)	1.1 (.17)	.81 (.54)

Note. ***p < .001, **p < .01, *p < .05.

OR = Odds ratio, or exp(b). SE = Standard error.

Discussion

The present study examined, for the first time, medications prescribed to patients at the emergency department within 24 hours of a SAMFE as identified through the electronic medical record. Specifically, we examined characteristics of the rape event and associations with receiving prescriptions for antibiotic and antiviral, emergency contraception, pain, and psychotropic medications. Genital injury was associated with increased likelihood of prescriptions for antiviral medication; non-genital injury was associated with both over-the-counter and prescription pain medication prescriptions. Individuals with assaults perpetrated by an intimate partner had a decreased likelihood of antibiotic and emergency contraception prescription, and an increased likelihood of psychiatric prescriptions. Strangulation was associated with greater likelihood of prescription for over-the-counter pain and psychiatric medication. Sex was a significant predictor of antiviral prescriptions with males more likely to be prescribed antiviral medication as compared to females. Contrary to previous findings related to some medications (i.e., post-exposure prophylaxis), alcohol or drug use during the event did not increase the likelihood of any prescriptions examined in the current study. Moreover, racial/ethnic identity was not associated with differential likelihood of receiving a prescription for any type of medication.

Results suggest that sexual assault characteristics may differentially predict medications prescribed at a SAMFE. It may be that both survivors and SAMFE medical providers are affected by rape characteristics, such that certain medications may be more or less likely to be requested or prescribed. For example, individuals whose assaults were perpetrated by an intimate partner may believe that they are more aware of whether the perpetrator is infected by an STI, and thus less likely to be prescribed antibiotics. However, because prescribing decision-making processes are not recorded in one’s medical record, future research is needed to better understand the prescribing process. Further, it is not known if survivors actually received or used the medications. Nevertheless, these findings are a novel contribution and provide valuable information regarding SAMFE related medical care and recommendations. Despite this addition, there remains a growing need for data regarding prescribing practices and recommendations to improve medication care of survivors.

By describing characteristics of rape events associated with prescriptions received, the current study can quantify aspects of the medical encounter relevant to improving future medical care for survivors. Notably and contrary to expectations, prescription pain medications were only associated with non-genital injury. Given the vast and highly visible negative sequelae associated with prescription pain medication misuse, diversion, and dependence (Kolodny et al., 2015; Lovegrove et al., 2019), and data indicating increasing prescriber judiciousness for pain medication (Hawk et al., 2018; Lin et al., 2018), it is possible national initiatives influenced this outcome. Additional research is needed to explicate this outcome and to determine whether it is a pattern that exists in other sexual assault populations.

Another notable outcome is that partner-perpetrated assaults yielded lower chances of receiving emergency contraception and antibiotic medications and higher chances of receiving psychiatric medication. Medical care associated with IPV annually ranges up to $7 billion and IPV survivors utilize 20% more health care than women without IPV exposure (Bonomi et al., 2009; Peterson et al., 2018). Given the high prevalence of lifetime sexual IPV nationally (Black et al., 2011) and that perpetrators of sexual assault incidents are most commonly identified as intimate partners, future research should closely examine the role that dynamic plays in prescribers’ evaluations of patients’ medical needs and the consequent impacts on medical care utilization and costs.

Limitations and Future Directions

Several considerations are important to interpret the current findings and to inform future research. While a strength of the current study is that it leverages a large regional patient population and, thus, generalizability in this context, it is necessary to replicate these findings in similar samples in order to determine whether these correlates are consistent across different populations, geographic regions, and nations. In particular, medications prescribed in the emergency department may vary from those prescribed when the SAMFE is conducted in another setting (e.g., advocacy center). One limitation to consider is that this study targets a narrow timeframe in the immediate aftermath of a sexual assault. Although a very small proportion of the sample had presented for three or more SAMFE visits, 3% of the sample were presenting for their second. It is possible that prescriptions received might change over time or following multiple victimizations. It is also unknown whether other sexual assaults had taken place in which the patient did not present for a SAMFE, or might have received care in another setting. The study is also limited in that the nature of the data does not allow us to characterize pre-existing mental or physical health problems that might have influenced prescriptions issued or not issued. An important area for future research might include qualitative and quantitative data from prescribers and patients regarding medications requested or declined, and the rationale underlying mutual or independent decisions regarding which medications are employed. Finally, while these data examined prescriptions that were issued, they did not examine whether the prescriptions were filled, whether patients initiated or ceased various medications, or whether patients were compliant in following prescription instructions. This is an important area for future research to determine whether greater attention is needed specific to medication utilization following SAMFE. It is also important to note that this analysis assessed a snapshot of the care provided to patients focused on medications addressing physical health care after assault. A more comprehensive review of SAMFEs in the future should integrate investigations of prescribing practices in addition to mental health care referrals and utilizations.

Conclusions

In summary, this study addresses a persistent gap in the existing literature regarding the lack of descriptive data regarding medical prescriptions received among patients receiving SAMFE. The current findings suggest that in this sample, some characteristics of a sexual assault event were associated with the prescriptions a patient receives. These findings warrant replication in larger and more generalizable samples across geographic regions and extension to more thoroughly examine prescribing practices and patient experiences with medication utilization following rape.

Footnotes

Author’s Note

Since Dr. McKee is an employee of the U.S. Government and contributed to the manuscript “Medications Prescribed at the Emergency Department After Recent Sexual Assault” as part of her official duties, the work is not subject to U.S. copyright.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Manuscript preparation was supported by a grant from the National Institute on Drug Abuse (K23DA042935) and the National Institute on Alcohol Abuse and Alcoholism (K23AA023845). This research was also supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Medical Research Service of the Veterans Affairs Central Virginia Health Care System, and the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC).

ORCID iDs

Amanda K. Gilmore

Ruschelle M. Leone

Charli M. Kirby

Author Biographies

Amanda K. Gilmore, PhD, is an assistant professor in the Department of Health Policy & Behavioral Sciences and the Mark Chaffin Center of Healthy Development in the School of Public Health at Georgia State University. Her research focuses on prevention of alcohol use and sexual assault, as well as secondary prevention of substance use and mental health symptoms after sexual assault.

Grace McKee, PhD, is a postdoctoral fellow in the Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC) at the Central Virginia Veterans Affairs Medical Center. Her research focuses on couples and family therapy utilization and efficacy, particularly within the Veterans Affairs health care system, and on interpersonal problems including intimate partner violence and sexual assault. She also has a strong interest in quantitative analysis and methodology with a focus on large-scale electronic health record data.

Julianne C. Flanagan, PhD, is associate professor in the Department of Psychiatry & Behavioral Sciences at the Medical University of South Carolina and a Staff Psychologist at the Ralph H. Johnson VAMC. Dr. Flanagan’s program of research focuses on (1) examining the behavioral and neurobiological mechanisms linking substance use and posttraumatic stress disorder with intimate partner violence (IPV) and (2) developing novel behavioral, pharmacological, and combined treatments for mental health and substance use disorders among individuals and couples at high risk for IPV.

Ruschelle M. Leone, PhD, is a research assistant professor in the Department of Health Policy and Behavioral Sciences and the Mark Chaffin Center for Healthy Development within the School of Public Health at Georgia State University. Her research focuses on informing and developing intervention programming to reduce alcohol misuse and interpersonal violence.

Daniel W. Oesterle is a clinical psychology doctoral student and a Frederick N. Andrews Research Fellow within the Department of Psychological Sciences at Purdue University. Daniel’s work focuses on intimate partner aggression, where he is interested in examining alcohol and substance use as a primary risk factor for sexual violence.

Charli M. Kirby, BA, is a program assistant in the Department of Psychiatry & Behavioral Sciences at the Medical University of South Carolina. She is currently involved in research focused on interpersonal violence and couples-based treatments of alcohol use disorder.

Nicole Short is an assistant professor in the Department of Anesthesiology and Institute for Trauma Recovery at the University of North Carolina at Chapel Hill. Her research focuses on the etiology and prevention of posttraumatic stress and substance use after trauma, particularly sexual assault.

Kathy Gill-Hopple, PhD, MSN, BSN, RN, SANE-A, SANE-P, is the Clinical Forensics Program coordinator at the Medical University of South Carolina.

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