You've Been Spiked!

People of my age will be able to remember Saturday evenings back when there were only 4 terrestrial TV channels. The highlight of Saturday night on ITV was watching Jeremy Beadle present You’ve Been Framed!, where folk would have their misfortunes caught on home videos sent in by their friends and family in exchange for ￡250. I believe the show is still running, but it doesn’t have that universal audience it once had. Instead, today’s modus operandi is to upload videos of your friends puking up and groaning whilst lamenting that they’ve been spiked in exchange for 250 likes on TikTok.

We’ve been told that “spiking” is going to be made illegal in the King’s Speech, to much applause. Let’s put aside the question of it already being illegal, because there is a much bigger problem.

The number of patients who present as having been “spiked” has skyrocketed in the last 5 years. What used to be something relatively rare, that I might encounter a handful of times a year, is now something that I expect at least 25% of my patients to say. Usually it is preceded by the phrase, “must have been”, and this is the crux of the problem, as it has become a catch-all diagnosis of exclusion used for anything and everything.

• Feeling ill? Not expecting to feel ill? You must have been spiked!
• Took a pill? Didn’t react to it the way you did last time? You must have been spiked!

I encounter a large number of patients for whom now spiking is their assumed working diagnosis for any time they or their friends feel a bit off. In the past few weeks alone I’ve had to assess patients worried they have been spiked for a variety of bizarre and in my opinion unlikely reasons, including:

• a lady with a headache that came on suddenly
• a man who felt anxious and needed to sit down
• a lady who decided to take some MDMA and then was sick a few times

Some of the ones further back are even more unlikely, including:

• a man who was adamant he must have been spiked because he couldn’t find his phone, which subsequently turned up in the fridge at his house the next day
• a lady with some minor bruising to her ankle and lower calf that she couldn't identify a cause of
• a lady with a spot on her arm that had popped and bled a little
• a man who had decided that he had been spiked, but couldn’t really explain why he thought that, nor have any symptoms or abnormal observations, and generally felt fine.

The problem with this trend of defaulting to spiking as the catch-all for any ailment or abnormality (or normality in the last example) is that it is turning a serious criminal matter into routine small-talk that medics start to ignore. If everyone has been spiked, then no one has been spiked. When all your patients tell you they have been spiked, you start to normalise to it and it becomes a check-box question much like asking someone what they had to eat or drink today. I’ve heard patient history conversations that have gone along the lines of:

“Hello, how can I help you?”

“I’ve been spiked”

“Ok, and what have you had to eat and drink today?”

“Well I had a sandwich at lunch, and we had some wine before I came out, and then some pizza for our tea, and I had a couple of shots about an hour ago”

“And do you have any medical issues or allergies we need to know about?”

“No, can I have some water please?”

“Of course! Here’s some water. Have you enjoyed the event otherwise?”

“Yes, it’s been really good, better than I thought it would be actually.”

In fact, I hear a lot of conversations go along those kind of lines, sometimes interspersed with vomiting into a bowl, and friends loudly proclaiming, “They MUST have been spiked!”, whilst simultaneously live-streaming the poor person on their phone for the lulz. Jeremy Beadle certainly never stooped that low.

I mentioned that spiking has become a diagnosis of exclusion, but actually it’s worse than that. It has become a diagnosis of default. Large numbers of people are dragged in by so-called friends, dumped in a medical or welfare bay, with the handover of "they've been spiked, we'll come back and pick them up later". This would perhaps be mildly more acceptable if further investigations continued, but alarmingly often the friends aren't interested in further assessment. At the point someone proclaims, “They MUST have been spiked”, everything stops, including consideration of differentials that may present with very similar signs and symptoms.

Everyone knows that alcohol intoxication can present similar. But have you also considered that similar presentation could be:

• hypoglycaemia
• sepsis
• stroke.

For a diagnosis of exclusion to be made, by definition, other potential diagnoses have to be excluded. This isn’t happening. Instead, the diagnosis starts and ends with "been spiked [no further treatment required]". My worry is that someone with an unrelated time-critical illness is going to be missed.

It is important to emphasise that spiking is not itself a medical matter. Let me explain that a little. Spiking is the malicious administration of an intoxicating substance either against the victim’s wishes or without their knowledge. Intoxication can be a medical matter, but the cognitive motivation and malice behind how an intoxicating substance entered the body is generally not. Whether you choose to take GHB yourself or have it put into your drink makes minimal difference in terms of the required medical treatment pathway, much in the same way as accidental trauma vs ABH.

Now, this isn’t to say that medical care isn’t required, nor that medics shouldn’t be involved with safeguarding and signposting. But it is saying that by treating spiking as a medical matter rather than a criminal matter, we’re assigning the situation to the wrong context. The medical team have neither the expertise nor resources to perform a police investigation. That mundane patient history quote I gave earlier is a good example of this, where “I’ve been spiked” is simply logged down and moved on from.

Surely new legislation in the King’s Speech will solve this problem? I don’t believe it will, because the problem is not the lack of reporting but rather the sheer universalism of it. We find ourselves in a bizarre situation where so many reports of spiking are made that none of them will ever be actioned, because there are simply too many to be plausible. This isn’t a question of medics not believing individual people, it’s a question of normalisation to the point of it no longer being seen as a meaningful statement.

The scant research that has been done into spiking prevalence is very inconclusive, with a large amount of first-person testimony but minimal drug analysis or testing. When testing has been performed, identified substances tend to be either voluntarily taken or prescription medications. Urine and saliva testing is increasingly available at some events and venues, but victims sometimes refuse the tests in case, fearing either the test won’t corroborate the spiking, or alternatively will identify another intentionally consumed substance such as cannabis. And even when they are used, I’ve had patients dispute the test result validity when it did not confirm their expectation. This makes testing largely meaningless. It isn’t helped by the large number of media articles about first-person reported cases of spiking, which always conclude, “CCTV from the venue did not indicate that [name’s] drink had been tampered with, but [name] is still convinced they were spiked.”

All this can sound like I am trivialising and casting doubt on the whole concept of spiking. But my motivation is not to hold victims in disdain; quite the opposite. My fear is that the victims are increasingly becoming diluted in a sea of confusion, populated by people who aren’t entirely sure why they feel ill, and people who want to make social media videos of their friends as a memento of this tragedy-turned-treat.

There have been a number of patients I have treated over the years who have been in dangerous safeguarding situations due to drink spiking, and I am worried that they will increasingly be missed. Because whilst our attention is on many people throwing up into bowls, we’re forgetting to ask ourselves whether the ‘friend’ who is saying they will take this semi-conscious person home is actually perhaps the original attacker. And no beefed up anti-spiking law is going to help with that.

I do not have many solutions to this. But one idea is paradoxically the reverse of what is often said. I hear the statement made that people need to be empowered to speak up if they have been spiked and know they will be taken seriously. I think equally, and possibly more so, we need to reassure people that that they will be treated seriously with care and compassion regardless of the situation they find themselves in.

If you have been spiked, then you are a victim of a cruel criminal act. But ultimately I shouldn’t treat you any better or worse than if you come to me and say you took a pill, have a migraine, were punched in the face, are having a heart attack, or any of the other myriad of reasons a person might find themselves unwell. I say this because at the moment it feels to me like some friends of patients feel a need to justify their asking for help or treatment, not because they necessarily want signposting to how to report a crime.

So when people say to me, “How can I tell if a person has been spiked or if they are just drunk?”, my first answer is the same as it has always been: “Review the CCTV”. But increasingly, my second answer is to challenge the use of the word “just” before drunk, as if it somehow lessens the need to take the situation seriously.