A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review

Increasing awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault: A new viewpoint

The victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts was studied in this work by applying a novel approximation. A multifocal analytical strategy based on an intersectional gender-sensitive approach was used to analyse the evidence coming from both forensic case studies and contextual studies about sexual interrelation and drug use. The process of victimization comprises social changes affecting consumption patterns and sexual interaction, intersecting in the hegemonic recreational nightlife model. However, victims experience a range of situations that make it difficult for them to self-acknowledge themselves as such. Widespread myths about the victimization process add to the social questioning faced by victims, stemming from gender-based double standards which condition the expected female behaviors regarding the use of drugs and sexual interaction. The victims usually experience amnesia, lack of injuries and emotional harm, which make difficult the self-acknowledgement as a victim of sexual assault and the reporting of the episode suffered. Consequently, it is an urgent public health need to implement a new viewpoint about the victimization of women by opportunistic drug-facilitated sexual assault in leisure contexts, able to increase awareness of the severity of this form of sexual violence. Society must recognize the existence of this problem within itself to help victims to acknowledge themselves as such, lodge a complaint and seek adequate help. The lack of this social support feeds the perpetuation of the victimization process, which exacerbates the risk of locking victims into spirals of cyclical re-victimization and favors both the underreporting as well as inadequate coping strategies. In addition to focusing on the need to increase awareness of the severity of female victimization by opportunistic drug-facilitated sexual assault in leisure contexts, other recommendations include the use of the term "take advantage", the development of specific criminal approaches, and the in-depth knowledge of the phenomenon via victimization surveys. These steps are necessary for developing well-targeted and evidence-based preventive measures consistent-with-reality.

Interpol review of toxicology 2016-2019

This review paper covers the forensic-relevant literature in toxicology from 2016 to 2019 as a part of the 19th Interpol International Forensic Science Managers Symposium. The review papers are also available at the Interpol website at: https://www.interpol.int/content/download/14458/file/Interpol%20Review%20.Papers%202019.pdf.

Non-Consensual Sexual Contact at Electronic Dance Music Parties

Non-consensual sexual contact in bars is common, but few studies have focused on the extent of this problem at electronic dance music (EDM) parties, which are growing in popularity. We aimed to estimate prevalence and correlates of non-consensual sexual contact among individuals who attend EDM parties in New York City (NYC). Adults (ages 18-40 years) entering EDM parties in NYC were surveyed in 2018 using time-space sampling. Participants (n = 1005) were asked whether they had experienced unwanted or uninvited sexual contact including unwanted groping, kissing, or touching at an EDM party. We estimate that 15.2% of EDM party attendees in NYC have experienced non-consensual sexual contact at such parties. The majority (62.5%) of those reported that it occurred 1-2 times and 49.1% were usually or always drunk or high during the encounter(s). Almost all women experiencing non-consensual contact (99.5%) were all or mostly touched by men; 38.6% of men were all or mostly touched by other men. Women were at more than twice the odds of reporting non-consensual sexual contact than men (aOR = 2.38, p < .05) with 21.8% of women reporting experiencing non-consensual sexual contact compared to 11.0% of men. Among women, those ages 18-24 were at over twice the odds (aOR = 2.75, p < .05) of experiencing non-consensual sexual contact than those ages 25-40. EDM party environments can increase susceptibility to non-consensual sexual contact. Prevention needs to be geared toward those at risk, and education is needed for those likely to commit non-consensual sexual contact.

Characteristics and trends of sexual assaults in Israel - A large cohort study of 3941 victims

INTRODUCTION

To improve care for victims of sexual assault, specialized assault centers have been developed globally, providing medical, psychological and legal care in one place. Our assault center serves a large population in the center of Israel. In 2010, we initiated a program aimed to prevent assaults among minors and to encourage early referral of victims to the center. The goal of the current study was to assess the impact of this program by comparing the characteristics of sexual assaults before and after the program's initiation.

MATERIAL AND METHODS

We conducted a historic cohort study of all victims of sexual assaults who were treated in our center between October 2000 and November 2017. A comparison was performed between victims treated before and after January 2010 (early vs. late study period), when the prevention program was initiated. The program mainly included lectures in middle and high schools, and workshops for police investigators.

RESULTS

Overall, 3941 victims of sexual assault were treated in our center during the study period. Most victims were females (90.5%). Mean age was 23.0 ± 11.0 years. Most victims were single (93.1%), and approximately half knew their perpetrator before the assault. Compared with the early study period, in the late study period we observed a decrease in the rate of minor victims (31.9% vs. 24.7%, respectively, P < .001) and an increase in the rate of victims who arrived to the center within 3 days of the assault (P = .001). However, we observed higher rates of multiple-perpetrator assaults (16.7% vs. 21.9%, respectively, P < .001), alcohol use (29.2% vs. 40.1%, respectively, P < .001), and drug use (7.2% vs. 9.0%, respectively, P = .04). Moreover, in the late study period, fewer victims were willing to press charges (79.5% vs. 64.4%, respectively, P < .001).

CONCLUSION

Our prevention program might have contributed to reducing the rate of sexual assaults among minors and shortened the time interval between the assault and victim's arrival to the center. Nonetheless, more efforts should be taken to reduce the involvement of alcohol and drugs in sexual assaults and to encourage victims to press charges.

[Knockout Drugs: Diagnostics in the Emergency Unit and Clinical Practice]

Knockout Drugs: Diagnostics in the Emergency Unit and Clinical Practice Abstract. Every now and then, physicians are challenged with date rape drugs. If there is a suspicion of substance administration, the question of involving forensic medicine is commonly raised. In obscure situations or questionable offences, however, patients may wish for an initial diagnosis in the emergency department or the private practice. The physicians are often greatly challenged by the variety of substances, the limited analytical methods and difficulties with the interpretion of results. The major goal of this article is to present diagnostic options including their limitations. An overview of frequently involved substances is provided. Particular focus will be placed on practical aspects, including questions regarding pre-analytics and health insurance coverage.

Application of a molecular networking approach for clinical and forensic toxicology exemplified in three cases involving 3-MeO-PCP, doxylamine, and chlormequat

Untargeted toxicological screening is an analytical challenge, given the high number of molecules and metabolites to be detected and the constant appearance of new psychoactive substances (NPS). The combination of liquid chromatography with high-resolution tandem mass spectrometry (HRMS/MS) in a data-dependent acquisition mode generates a large volume of high quality spectral data. Commercial software for processing MS data acquired during untargeted screening experiments usually compare measured features (mass, retention time, and fragmentation spectra) against a predefined list of analytes. However, there is a lack of tools for visualizing and organizing MS data of unknown compounds. Here, we applied molecular networking to untargeted toxicological screening. This bioinformatic tool allows the exploration and organization of MS/MS data without prior knowledge of the sample's chemical composition. The organization of spectral data is based on spectral similarity. Hence, important information can be obtained even before the annotation step. The link established between molecules enables the propagation of structural information. We applied this approach to three clinical and forensic cases with various matrices: (a) blood and a syringe content in a forensic case of death by self-injection, (b) hair segments in a case of drug-facilitated assault, and (c) urine and blood samples in a case of 3-methoxyphencyclidine intoxication. Data preprocessing with MZmine allows sample-to-sample comparison and generation of multisample molecular networks. Our present study shows that molecular networking can be a useful complement to conventional approaches for untargeted screening interpretation, for example for xenobiotics identification or NPS metabolism elucidation.

Analysis of Benzodiazepines for Drug-Facilitated Assaults and Abuse Settings (Urine)

An overview of the detection of benzodiazepines and their respective metabolites and target analytes in urine by LC-MS/MS is described. This overview shows substantial differences in the approach to detection using this technique including optional use of β-glucuronidase to hydrolyze conjugates present in urine. There are also significant variations in the extraction method employed from the use of direct injection, liquid-liquid extraction to solid-phase extraction options, with little apparent difference in limits of detection. Chromatography was largely based on the use of C18-bonded columns; however both C8- and phenyl-bonded columns were used to affect separation. Modern-day tandem mass spectrometers are capable of exceptional sensitivity enabling detection of sub-nanogram per milliliter amounts in urine, which provide for longer detection times in the urine of suspected drug-facilitated assaults. A method employed in the laboratory of the authors is provided by way of an example for readers wishing to establish a method in their own laboratory.

Factors Influencing the Filing of Complaints, Their Investigation, and Subsequent Legal Judgment in Cases of Sexual Assault

In Geneva, examination of victims of sexual assault is performed by a gynecologist and a medical examiner. 48% of the victims file a complaint and we wanted to investigate the factors leading to file a complaint, those leading the Prosecutor to go to trial, and those influencing a conviction. Between 2006 and 2012, 676 victims of sexual assault were investigated (averaged age 26 year, mean 22). Information on injuries, perpetrators, and circumstances of the assault was collected and analyzed. The attacker being the ex-spouse or a friend and the presence of semen were factors leading to file a complaint. The assailant being a family member or ex-spouse and the presence of genital/anal lesions were factors influencing the Prosecutor. The presence of nongenital lesions, the assailant being known by the victim, influenced conviction. This study shows that the medical examiner plays a vital role in the investigation of cases of sexual assault.

Development of a high-throughput screening analysis for 288 drugs and poisons in human blood using Orbitrap technology with gas chromatography-high resolution accurate mass spectrometry

The screening analysis for drugs and poisons always symbolizes the capabilities of a forensic laboratory. Due to the rapid emergence of new compounds in clinical and forensic intoxication cases, sensitive and specific methods are necessary for the screening of wide range of target compounds. A novel high-throughput screening method has been developed for the toxicological analysis of 288 drugs and poisons in human blood using Orbitrap technology with gas chromatography-high resolution mass spectrometry (GC-HRMS). This method allows for the fast detection and identification of high-throughput forensically important drugs and poisons, e.g., drugs of abuse (cocaine, amphetamines, synthetic cannabinoids, opiates, hallucinogen), sedative-hypnotics, antidepressants, non-steroidal anti-inflammatory drugs, pesticides (acaricides, fungicides, insecticides, nematicides), and cardiovascular agents in one single GC-Q Exactive run. After a simple extraction with ethyl ether and buffer, following centrifugation, the supernatant was injected into the system. For detection, spiked blood samples were analyzed by Orbitrap-GC-HRMS using an electrospray ionization in full scan mode with a scan range from 40 to 650 (m/z). The identification of drugs and poisons in the samples was carried out by searching the accurate molecular mass of characteristic fragment ions, ion rations and retention time (RT) against the in-house library that we developed with 70 ev electron energy. The limit of detection (LOD) for most compounds (249 in a total of 288 compounds) was below 100 ng/mL. For selectivity, no substances have been identified in drug-free blood samples from six different sources, and the method was suitable for the recovery and the carryover. The coefficient of variation (CV) of the RTs was below 0.99% in all reproducibility experiments. Mass accuracy was always better than 3 ppm, corresponding to a maximum mass error of 1.04 millimass units (mmu). The developed method was applied to 136 real samples from forensic cases, demonstrating its suitability for the sensitive and fast screening of high-throughput drugs in human blood samples.

Defining the Construct of Synthetic Androgen Intoxication: An Application of General Brain Arousal

Synthetic androgens (i. e., anabolic-androgenic steroids) are the primary component to the majority of problematic appearance and performance enhancing drug (APED) use. Despite evidence that these substances are associated with increased risk for aggression, violence, body image disturbances, and polypharmacy and can develop a pattern of chronic use consistent with drug dependence, there are no formal definitions of androgen intoxication. Consequently, the purpose of this paper is to establish a testable theory of androgen intoxication. We present evidence and theorize that synthetic androgen intoxication can be defined by a pattern of poor self-regulation characterized by increased propensity for a range of behaviors (e.g., aggression, sex, drug seeking, exercise, etc.) via androgen mediated effects on general brain arousal. This theory posits that androgens reduce threshold for emotional reactivity, motor response, and alertness to sensory stimuli and disrupt inhibitory control over the behaviors associated with synthetic androgen use. These changes result from alteration to basic neurocircuitry that amplifies limbic activation and reduces top-down cortical control. The implications for this definition are to inform APED specific hypotheses about the behavioral and psychological effects of APED use and provide a basis for establishing clinical, legal, and public health guidelines to address the use and misuse of these substances.

Simultaneous drug identification in urine of sexual assault victims by using liquid chromatography tandem mass spectrometry

According to domestic and international epidemiological investigation, the proportion of substance involved sexual assault has the trend of ascent. In the past, laboratory methods that investigated urine sample of the sexual assault victims was to screen with enzyme immunoassay and then confirmed with mass spectrometry. The objective of the study is to simultaneously identify abused drugs in 126 decoded urine samples of sexual assault victims by liquid chromatography tandem mass spectrometry. The instrument was operated in multiple-reaction monitoring with an electro-spray positive ionization mode. Chromatograms were separated with ACE5 C18 column on a gradient of acetonitrile. After liquid-liquid extraction, samples were passed through a 0.22μm PVDF filter before injection into the system. The limits of quantitation ranged from 0.2 to 10ng/mL. The precision (CV) results were below 12.9% (intraday) and 15.0% (interday). The intraday accuracy ranged from 84.8 to 121.0%, interday accuracy ranged from 72.0 to 117.3%. We found that 29 (23.0%) were positive for drugs. The most common drug identified is flunitrazepam (11.1%), followed by nimetazepam and ketamine (7.9%), some new psychoactive substances, such as 2C-B, mephedrone, methylone, PMA and PMMA were also identified. We identified abused drugs, benzodiazepines, and new psychoactive substances in urine of sexual assault victims by using liquid chromatography tandem mass spectrometry.

Vulnerability and revictimization: Victim characteristics in a Dutch assault center

Sexual and family violence are highly prevalent problems with numerous negative health consequences. Assault centres, such as the Centre for Sexual and Family Violence (CSFV) in the Netherlands, have been set up to provide optimal care to victims. We wanted to gain insight into characteristics of the population that presented to the Centre in order to customize care to their needs. File analysis was conducted of victims who attended the CSFV between 2013 and 2016. Data were analyzed in SPSS. A total of 121 victims entered the Centre, 93% of them being female. Forty-two per cent were adult victims of sexual violence, 28% minor victims of sexual violence and 30% adult victims of family violence. One-third of sexual and two-third of family violence victims had experienced prior abuse. Current use of psychosocial services and psychiatric medication was high, and a cognitive disability was present in 18% of the sexual violence victims. Half the victims reported, but when the perpetrator was a recent contact, e.g., someone met at a party, reporting rates went down. Sexual and family violence victims share characteristics that indicate vulnerability, suggesting that care for both groups might best be combined in one single assault centre. In this way, victims can make use of the same services and knowledge of gender-based violence. One of the major aims of assault centres is to provide psychosocial follow-up care and facilities for reporting. The victims' needs in these matters deserve further research.