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Medications at the Emergency Department After Recent Rape

Gilmore, A.K., McKee, G., Flanagan, J.C., Leone, R.M., Oesterle, D.W., Kirby, C.M., Short, N., & Gill-Hopple, K. (2021).

Journal of Interpersonal Violence, 1 -19.

Expanded Abstract:

In the United States, 21.3% of women and 2.6% of men experience attempted or completed rape in their lifetimes (Smith et al., 2018). Rape is associated with numerous negative physical and mental health effects, yet little is known about medical prescribing practices 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.

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.

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. Also, racial/ethnic identity was not associated with likelihood of receiving a prescription for any type of medication.

(The expanded abstract is excerpted and adapted from the article cited above)