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

Vulnerability of individuals on mental health medications to drug facilitated sexual assaults

Drink spiking in social settings is one of the most pervasive forms of drug-facilitated sexual assault (DFSA). There are no current data in Australia on the rates of drink spiking or their associated assaults. There is also little known about the prevalence of different substances involved and how the current substance use trends compare to sexual assault trends. To explore this, a recalculation of sexual assault trends to estimate substance related sexual assault was performed. Data about recent trends of mental health prescriptions and sexual assault were obtained from the Australian Institute of Health and Welfare (AIHW). The analysis of these datasets highlighted that females are the highest consumers of antidepressants and benzodiazepines. Results also indicated a statistically significant positive correlation between females and a higher incidence of sexual assault (r = 0.996, p < .001). This paper demonstrates that females are at most risk of drug-drug interactions (e.g., diazepam and ketamine) with their medications due to the higher rate of prescriptions amongst this population, and therefore more vulnerable to both opportunistic and proactive DFSA. While these findings are preliminary and not causal, they highlight trends in need of further study.

The prevalence of selected licit and illicit drugs in drug facilitated sexual assaults

Little is known about the prevalence of incapacitating substances present in drug facilitated sexual assaults (DFSA). Presented here is a literature review conducted to provide background information, such as symptoms, exacerbations, and drug interactions, on drugs typically implicated in DFSA, namely gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), 1,4-butanediol (1,4-BD), ketamine, diazepam, oxycodone, methamphetamine, and alcohol. Literature found through Scopus and Pubmed was reviewed to determine the current prevalence of these substances in DFSA with a focus on Australian data. The global literature revealed that there is a wide variety of substances used in DFSA and the prevalence varied by country. For example, it was found that in Northern Ireland, opioids were most prevalent whereas in France, benzodiazepines were most prevalent. In Australia the review revealed a lack of contemporary data with the most recent report in Victoria using data collected during 2011-2013. The literature also revealed there can be an important difference between self-reported substance use and substances discovered via toxicological analysis. This can be due to the challenges of biological detection, reliability of self-reporting, and the possibility of a substance being introduced to a person's food or drink without their knowledge. This review highlights the need for the collection and analysis of current data pertaining to DFSA reports and the drugs detected, and due to the constantly evolving picture of both licit and illicit drug use an assessment of the role of prescription medications in DFSA due to drug-drug interactions as well as potential to incapacitate is warranted.

Drugs in blood and urine samples from victims of suspected exposure to drink spiking: A prospective observational study from Oslo, Norway

OBJECTIVE

People regularly contact emergency medicine services concerned that they have been exposed to drink spiking, i.e., exposure to drugs without their knowledge or permission. We identified drugs in blood and urine samples from patients suspecting exposure to drink spiking, with special consideration for drugs not reported taken by the patient (unreported drugs).

METHODS

From September 2018 to May 2019, we collected blood and urine samples from patients 16 years or older presenting at an emergency clinic in Oslo, Norway, within 48 hours of suspected exposure to drink spiking. We also collected information on ethanol ingestion and drugs taken. Blood samples were analyzed for 20 classical recreational drugs using ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and an automated enzymatic method for ethanol. Urine samples were analyzed using immunoassay methods and a specific gas chromatography mass spectrometry (GCMS) method for gammahydroxybutyrate (GHB).

RESULTS

From 100 included patients (median age 24 years, 62 females), we collected 100 blood samples and 72 urine samples. Median time since exposure was 5 hours. Unreported drugs were found in 15 patients. Unreported drugs in the blood samples were clonazepam in 3, methylenedioxymethamphetamine (MDMA) in 3, amphetamine in 2, tetrahydrocannabinol (THC) in 2, tramadol in 1, cocaine in 1, and methamphetamine in 1. Unreported drugs in the urine samples were cocaine in 5, amphetamine in 4, ecstasy in 3, and cannabis in 2. Ethanol was found in 69 patients, all reporting ethanol ingestion. Median blood ethanol concentration was higher in patients with no unreported drugs detected, 1.00‰ (interquartile range (IQR) 0-1.52) vs. 0‰ (IQR 0-0.46) (p<0.001). GHB was not detected.

CONCLUSION

Unreported drugs, possibly used for drink spiking, were found in 15% of patients. Blood ethanol concentration was higher when no unreported drugs were found. GHB was not detected in any patient.

Victims of drug facilitated sexual assault aged 13-24: a cross sectional study on the pool of users of a sexual violence relief centre in Northern Italy

This cross-sectional study aimed to assess the association between drugs and alcohol intake and sexual abuse in adolescents, otherwise defined as Drug Facilitated Sexual Assault (DFSA). We considered the survivors who accessed care at the Centre "Soccorso Violenza Sessuale" (SVS - Sexual Violence Relief Centre) in Turin (Italy), between May 2003 and May 2022. We found that 973 patients aged 13-24 among which 228 were victims of DFSA. Epidemiological and anamnestic aspects of the episode of sexual violence were examined, with a specific focus on investigating the alcohol and/or drug intake as reported by the victim, along with the results of the toxicological analysis. the study further accounts for the variations caused by the COVID-19 pandemic on DFSA-related accesses. Our findings show that 23% of adolescents accessing care at SVS were subjected to DFSA. Six out ten adolescents knew their aggressor, at times a partner (10%) oran acquaintance (43%). In 12% of cases violence was perpetrated by a group of people (12%). Almost 90% of young victims described alcohol consumption, while 37% reported drug use at the time of the assault. Alcohol taken alone or in combination with other substances was the most detected drug in our sample throughout the period considered. Given the large use of psychoactive substances among adolescents, it is imperative to implement harm reduction strategies alongside educational activities aimed at fostering awareness about consent. Health personnel should be trained to manage the needs of victims of DFSA clinically and forensically.

Drug-Facilitated Sexual Assault: A Systematic Review

Since the last two decades, the scientific community has made an effort to analyze drug-facilitated sexual assault (DFSA). However, a lack of understanding remains about the DFSA problem, particularly concerning the opportunistic variant. Facing this situation, a systematic review of the term DFSA is carried out from its first appearance in the scientific databases consulted (Web of Science, Scopus, and PubMed) to the current day. The search resulted in 773 publications, reduced to a final study sample composed of 19 articles. Eligible studies for this review had to meet certain inclusion criteria, in addition to providing information on DFSA prevalence, DFSA victim profile, DFSA offender profile, involved drugs, or contextual information about the assault. The results demonstrated that the assailants are men, who mostly know victims before the assault. The victims are young women under 30 years old. Alcohol is the drug involved in most DFSA cases, prevailing a voluntary use. Most assaults occur in private spaces, particularly the aggressors' own homes. Furthermore, there is a detected need for a standard definition of DFSA to allow the different actors involved in dealing with sexual violence to work effectively together, and, at the same time, it is detected that the available studies overrepresent proactive DFSA and underestimate opportunism, the most common modus operandi involved in DFSA cases.

Pro-active drug-facilitated crimes (DFC): a study in the Department of Forensic Medicine of Paris, France

INTRODUCTION

Proactive drug facilitated crime (DFC) is the administration of psychoactive substances (PAS) for criminal purposes without the victim's knowledge or by force. In Paris, France, patients who report suspected proactive DFC to the police are examined at the Department of Forensic Medicine (DFM) of the Hôtel-Dieu Hospital. Preventively blood and urine samples are collected but not systematically analyzed by the judicial authority. We aimed to assess the proportion of probable proactive DFC in patients examined at the Hôtel-Dieu DFM following a police report for suspected proactive DFC.

METHOD

Blood and urine samples were collected from 100 patients. Toxicological analyses were performed by the toxicology laboratory of the Lariboisière Hospital. The results were correlated with the clinical data collected at the initial and follow-up consultations.

RESULTS

At least one PAS was detected in 86% of the cases (voluntary or involuntary intake). After correlation with clinical data, 32% of the cases were classified as probable proactive DFC. In these cases, 49% of the substances identified were illicit substances (amphetamines, MDMA, etc.); 16% were benzodiazepines and related substances; 16% were antihistamines and sedatives; 14% were opioids; and 5% were antidepressants and anti-epileptics. In 90% of the cases, patients reported a voluntary ethanol consumption in the hours prior to the suspected proactive DFC.

CONCLUSION

Toxicological analyses revealed a high proportion of both probable proactive DFC and probable opportunistic DFC. Our results indicate the need to perform systematical toxicological analysis in cases of suspected DFC.

Police-recorded adult sexual assault in the Northern Territory, Australia: Alcohol involvement and alcohol policy effects

INTRODUCTION

Between 2017 and 2018 three major alcohol policy changes were introduced in the Northern Territory (NT): the Banned Drinker Register, an individual-level ban enforced via ID scanners at takeaway outlets; a Minimum Unit Price on alcohol; and Police Auxiliary Liquor Inspectors, who monitor takeaway outlets to prevent purchase by people who do not have a legal place to consume alcohol. We aimed to: (i) describe alcohol-involved adult sexual assault in the NT; and (ii) estimate the impacts of these alcohol policies on police-recorded adult sexual assault.

METHODS

We used victim records for sexual assault where victims were aged 15 years and over. We undertook descriptive analyses for the NT from 2014 to 2020 and used interrupted time series analysis to assess policy impacts across the NT and in Greater Darwin.

RESULTS

In 2020, the NT adult victimisation rate was 105 per 100,000. A large minority (40%) of adult sexual assaults involved alcohol. Interrupted time series analyses showed no effect of the Banned Drinker Register or Minimum Unit Price on sexual assault across the NT or in Greater Darwin.

DISCUSSION AND CONCLUSIONS

The rate of adult sexual assaults in the NT is extremely high and many involve alcohol. Neither the Banned Drinker Register or Minimum Unit Price were associated with changes in police-recorded adult sexual assault in Greater Darwin or across the NT. Due to small counts, we were unable to assess policy impacts in three of the four main towns, highlighting the challenges of assessing impacts of policies on sexual assault in small population areas.

Automated enzymatic hydrolysis of urine samples for improved systematic toxicological analysis of drug-facilitated sexual assault cases

Drug-facilitated sexual assault (DFSA) is characterized by victim incapacitation due to intoxicating substances. Detection of single drug exposure from DFSA requires a systematic toxicological analysis strategy including sensitive methods covering a broad spectrum of substances. The aim of this study was to develop and validate an UHPLC-MS/MS screening method for analysis of samples from DFSA cases and incorporate an automated enzymatic pre-treatment of urine samples into a robotic sample preparation for an efficient laboratory workflow. The screening method included 144 drugs of abuse, pharmaceuticals, and metabolites relevant to DFSA. The use of a recombinant enzyme showed an efficient glucuronide hydrolysis with an average parent drug recovery of 97%. Investigation of matrix effect showed no pronounced ion enhancement or suppression for most analytes (96%), and extraction recovery was above 80% for 97% of analytes. Process efficiency ranged from 50% to 138% for most analytes. The LODs ranged from 0.0001 mg/L to 2 mg/L depending on analyte, and most analytes met the SOFT recommended minimum performance limits. The validated method was applied to authentic suspected DFSA cases (n = 38). Results showed that drugs of abuse, benzodiazepines, and antidepressants were most commonly found in suspected DFSA cases. Incorporation of an automated enzymatic hydrolysis step during sample preparation enables a fast and simple workflow for simultaneous analysis of blood and urine samples for an improved systematic toxicological analysis strategy for DFSA cases.

Measuring Electronically Shared Rape Myths: Scale Creation and Correlates

Increased access to information online (e.g., social media) provides opportunities for exposure to rape myths (i.e., false beliefs about incidents of sexual assault). Social media, in particular, may serve a critical role in shaping rape culture. Thus, it is important to identify ways to assess online exposure to rape myths, especially given the influence online exposure may have on offline behaviors. Data were analyzed from 2,609 18-25-year-old participants (mean age = 20.9 years; 46.1% male; 71.6% White) recruited in 2017 through social media to complete an online survey on experiences and perceptions of sexual violence. We used exploratory and confirmatory factor analyses (EFA, CFA) to evaluate the relatedness of nine items adapted to reflect rape myths posted by friends on social media. We split the sample into training (50%) and testing (50%) sets for the EFA and CFA, respectively, then evaluated the correlation between experiences of sexual violence, substance use, and social media use and exposure to online rape myths. Eigenvalues (1-factor: 5.509; 2-factor: 0.803; 3-factor: 0.704; 4-factor: 0.482), factor loadings, fit statistics (RMSEA: 0.03; CFI: 0.99; TLI: 0.99; SRMR: 0.057), interpretability, and existing theory supported a 1-factor solution, which was supported by CFA fit statistics (RMSEA: 0.021; CFI: 0.99; TLI: 0.99; SRMR: 0.038). Cronbach's alpha of the nine items was .77. Greater exposure to online rape myths was associated with greater likelihood of attempted rape perpetration (β = .052, SE = .016, p < .005), rape victimization (β = .045, SE = .009, p < .005), use of illicit drugs (β = .021, SE = 0.008, p < .05), being male (β = .017, SE = .008, p < .05), and being younger (β = -.008, SE = .002, p < .005). Our findings support assessing exposure to online rape myths, which may be important for informing sexual violence prevention and intervention efforts.

Combining surface-enhanced Raman spectroscopy and paper spray mass spectrometry for the identification and confirmation of psychotropic substances in alcoholic beverages

Criminal practices in which an individual becomes vulnerable and prone to sexual assault after ingesting drinks spiked with doping substances have become a social concern globally. As forensic protocols require a multi-tiered strategy for chemical evidentiary analysis, the backlog of evidence has become a significant problem in the community. Herein, a fast, sensible, and complementary dual analytical methodology was developed using a single commercial paper substrate for surface-enhanced Raman spectroscopy (SERS) and paper spray mass spectrometry (PS-MS) analysis to identify psychotropic substances added to alcoholic beverages irrefutably. To study and investigate this criminal practice, pharmaceutical formulations containing distinct psychotropic substances (zolpidem, clonazepam, diazepam, and ketamine) were added to drinks typically consumed at parties and festivals (Pilsen beer, açaí Catuaba®, gin tonic, and vodka mixed with Coca-Cola Zero®). A simple liquid-liquid extraction with a low-temperature partitioning (LLE-LTP) procedure was applied to the drinks and effectively minimized matrix effects. As a preliminary analysis, SERS spectra combined with Hierarchical Clustering Analysis (HCA) provided sufficient information to investigate the samples further. The presence of the protonated species for the psychotropic substances in the spiked drinks was readily verified in the mass spectra and confirmed by tandem mass spectrometry. Finally, the results demonstrate the potential of this methodology to be easily implemented into the routine of forensic laboratories and to be further employed at harm reduction tends at parties and festivals to detect contaminated beverages promptly and irrefutably as an efficient tool to prevent such crimes.

Exploring Enzymatic Hydrolysis of Urine Samples for Investigation of Drugs Associated with Drug-Facilitated Sexual Assault

Analyzing urine is common in drug-facilitated sexual assault cases if the analysis of blood is not optimal. The efficient enzymatic pretreatment of urine is important for cleaving glucuronides and improving the detection of the parent drug. The aim was to investigate the efficiency of three β-glucuronidases on eleven glucuronides relevant to DFSA at different incubation periods and temperatures. Human drug-free urine was fortified with 11 glucuronides, hydrolyzed with either β-glucuronidase/arylsulfatase (Helix Pomatia), recombinant β-glucuronidase B-One™ or recombinant β-glucuronidase BGTurbo™ and incubated for 5, 10, 60 min, 18 h and 24 h at 20 °C/40 °C/55 °C before UHPLC-MS/MS analysis. The stability of 141 drugs and metabolites relevant to DFSA was investigated by incubating fortified urine under the same hydrolysis conditions. B-One™ showed efficient hydrolysis (>90%) of most glucuronides in 5 min at all temperatures, while BGTurbo™ showed a similar efficiency (>90%), but the optimal temperature (20-55 °C) and incubation time (5-60 min) varied among analytes. The β-glucuronidase/arylsulfatase had the lowest efficiency and required the longest incubation (24 h) at 40-55 °C. The stability of 99% of 141 drugs and metabolites was not affected by incubation at 20-55 °C for 24 h. Recombinant enzymes show promising results for the simple and efficient hydrolysis of a broad panel of glucuronides relevant for DFSA.

Uncovering forensic evidence of drug-facilitated sexual assault: Toxicological findings from Eastern Denmark from 2015-2022

In drug-facilitated sexual assault (DFSA), the victim is unable to provide consent or resists sexual activity due to substance intoxication by voluntary or covert consumption. Obtaining forensic evidence of the assault is challenged by rapid drug metabolism and late sample collection. The objective of this study was to present toxicological findings and associated demographics from police reported sexual assault cases in Eastern Denmark from 2015 to 2022. A total of 369 sexual assault cases were submitted for analysis and a subgroup of 268 cases were categorized as suspected DFSA cases. The majority of the total sexual assault victims were women at the age 15-25 and the perpetrators were often unknown or an acquaintance. Time from assault to sample collection was slightly longer for suspected DFSA cases (12-24 h) compared to non-DFSA (<12 h). Positive toxicology was observed in 86 % of cases and the most common drug groups included alcohol (45 %), drugs of abuse (38 %), antidepressants (14 %), antihistamines (12 %), and benzodiazepines (11 %). Hypnotics were detected to a smaller extent (7 %). A total of 77 drugs were detected and the most commonly observed were cocaine, tetrahydrocannabinol (THC), cetirizine, amphetamine, diazepam and sertraline. The high level of observed alcohol and drugs of abuse indicated that most DFSA cases in Eastern Denmark were of an opportunistic approach rather than proactive.

Assessment of 19 years of a prospective national survey on drug-facilitated crimes in France

Drug facilitated-crime or chemical submission (DFC/CS) is defined as the concealed or forced administration of psychoactive substances to a victim for criminal purposes. This is a national program set up in the early 2000 s in the form of a prospective multicenter survey, the results of which this manuscript presents. Over this 19-year period, 5487 cases were collected, analyzed and classified into 54 % of suspected cases, 29 % of chemical vulnerability (CV) cases and 17 % of proven DFC/CS cases. In the overall data, the most prevalent victims were female (81 %), with an average age of 27 years. Sexual assault was the most frequent aggression (77 %), followed by theft (14 %). Victims of proven DFC/CS cases were from of all ages including children and elderly. In 934 victims of DFC/CS, 100 various psychoactive substances were detected mostly represented by benzodiazepines and z-drugs (55 %), various sedatives including antihistamines (16 %) and non-therapeutic substances (16 %). Gamma-hydroxybutyric acid (GHB) was found in 4 % cases. In CV cases, alcohol (90 %) and cannabis (32 %) intake were mainly involved. In France, despite prevention messages, DFC/CS has been an epidemic for many years and has been proven by our national study. This national program has the aim to identifying the substances used but unfortunately not the goal to fight against this phenomenon. Since 2009, we observed a new modus operandi of the aggressors who pose as taxi drivers facilitating the reception of the victims leaving nightclubs. We can emphasize that GHB is not the "date rape drug" but rather the benzodiazepine class is.

Combined use of cocaine and alcohol: A violent cocktail? A systematic review

It is generally believed that the use of alcohol and cocaine alone and especially in combination elicits aggression and violent behaviour. Though there is overwhelming proof that heavy alcohol use is associated with violence, this is not the case for cocaine. Still, in the popular press and by spokesmen of the police, cocaine use is seen as a cause of violent incidents. In the current systematic review, available data from human studies on the relation between cocaine and violent behaviour is presented. In particular, we present scientific data on the acute induction of violence by cocaine alone, as well as, that by the combination of cocaine and alcohol known to be frequently used simultaneously. RESULTS: show that there is only weak scientific evidence for the acute induction of violent behaviour by cocaine, either when used alone or in combination with alcohol. Based on these data we were also able to refute misconceptions about the relation between cocaine and violence published in the popular press and governmental reports, because it appeared that there was hardly any empirical support for this widely shared opinion. Probably, contextual factors, including cocaine use disorder and personality disorder, may better explain the assumed association between cocaine and violence.

Drug-Facilitated Sexual Assault With Tetrahydrozoline (Visine): A Case Report

ABSTRACT

This is a case presentation of an 18-year-old male victim who experienced a drug-facilitated sexual assault (DFSA). The drug used to incapacitate him was tetrahydrozoline (Visine) given rectally. Tetrahydrozoline, intended for ophthalmic administration, is in the class of drugs known as imidazoline receptor agonists and has been used as an agent for DFSA since the 1940s. DFSA is increasing, particularly among young men. Care of victims of DFSA is discussed with particular attention to mental health sequelae in this patient population.

Psychoactive drugs and male fertility: impacts and mechanisms

Although psychoactive drugs have their therapeutic values, they have been implicated in the pathogenesis of male infertility. This study highlights psychoactive drugs reported to impair male fertility, their impacts, and associated mechanisms. Published data from scholarly peer-reviewed journals were used for the present study. Papers were assessed through AJOL, DOAJ, Google Scholar, PubMed/PubMed Central, and Scopus using Medical Subjects Heading (MeSH) indexes and relevant keywords. Psychoactive drugs negatively affect male reproductive functions, including sexual urge, androgen synthesis, spermatogenesis, and sperm quality. These drugs directly induce testicular toxicity by promoting ROS-dependent testicular and sperm oxidative damage, inflammation, and apoptosis, and they also suppress the hypothalamic-pituitary-testicular axis. This results in the suppression of circulating androgen, impaired spermatogenesis, and reduced sperm quality. In conclusion, psychoactive drug abuse not only harms male sexual and erectile function as well as testicular functions, viz., testosterone concentration, spermatogenesis, and sperm quality, but it also alters testicular histoarchitecture through a cascade of events via multiple pathways. Therefore, offering adequate and effective measures against psychoactive drug-induced male infertility remains pertinent.

Awareness survey on drug crime scene investigation and drug detection kits among drug-related police officers

This questionnaire-based study aimed to investigate the drug crime scene experienced by drug-related police officers and the perceptions of drug test kits by them before initiating the development of drug test kits to detect 16 types of drugs. The subjects were 57 drug-related police officers. Most of the respondents (96.5%) had <10 years of experience in drug-related work. Respondents were questioned about the drug scene investigation and perceptions of drug test kits. The questionnaire about drug test kits included the question on 'simple/rapid drug test kit' and 'electronic portable drug analyzer' regarding the disadvantages of existing kits and expecting features when a new kit is developed. First, in the on-site survey, the drug-related crime occurred at the suspect's house (47.8%), and methamphetamine (35.0%) and γ-hydroxybutyric acid (19.5%) were mainly found. In the awareness survey on drug test kits, most respondents (67.2%) had an experience of using 'simple/rapid drug test kits', whereas 17.5% for the 'electronic portable drug analyzer'. In the case of 'simple/rapid drug test kit', the false-positive rate reached 53.8% by a misinterpretation due to ambiguous color change (47.6%). The inaccuracy of the result (33.3%) was the most concern in 'electronic portable drug analyzer'. Respondents most favored pipette type for sample collector when a new kit is developed. In addition, they preferred the smaller kit with short detection times in both kit types. This survey could be applied to the development of efficient and practical kits for police officers working in drug-related fields.

Institution of Higher Education Substance Use Amnesty Policies and Sexual Violence Reporting

Sexual violence (SV) is common among college students, but the vast majority of these experiences are not formally reported to institutions of higher education (IHEs). While it is well known that alcohol and drug use is highly associated with SV, little is known about whether policies and procedures regarding substance use (SU) at IHEs may contribute to low rates of reporting. This study describes the association between SU violations and SV reporting at IHE campuses in the US and examines whether SU amnesty policies are associated with more SV reporting. Linear regression was used to estimate the association between SU violations and SV reporting and assess differences between IHE campuses by amnesty policy status. Around 50% of campuses between 2001 and 2018 document neither SV reports nor SU violations. IHE campuses with amnesty policies have more SV reports. On average, IHEs with amnesty policies have 2.7 SV reports per 1000 students and an additional 0.02 SV reports for each SU violation per 1000 students. Amnesty policies that reduce the potential costs of reporting like facing disciplinary action for alcohol or drug use are positively associated with both the level and rate of SV reporting. Institutions of higher education administrators interested in making reporting an option for more SV survivors should examine how their policies, especially those related to alcohol, may play in creating barriers to SV reporting.

Detection and discrimination of sedative-hypnotics in spiked beverage dry residues using attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy combined with chemometrics

Drugs-facilitated crimes (DFCs) involve the incapacitation of victims under the influence of drugs. Conventionally, a drug administration act is often determined through the examination of biological samples; however, dry residues from any surface, such as drinking glass if related to a DFC could be a potential source of evidence. This study was aimed to establish an attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy coupled with chemometrics for the determination of spiked sedative-hypnotics from dry residues of a drug-spiked beverage. In this study, four sedative-hypnotics, namely diazepam, ketamine, nimetazepam, and xylazine were examined using ATR-FTIR spectroscopy. Subsequently, the ATR-FTIR profiles were compared and decomposed by principal component analysis (PCA) followed by linear discriminant analysis (LDA) for their detection and discrimination. Visual comparison of ATR-FTIR profiles revealed distinct spectra among the tested drugs. An initial unsupervised exploratory PCA model indicated the separation of four main sedative-hypnotics clusters, and the proposed PCA score-LDA model had allowed for a 100% accurate classification. Discrimination of sedative-hypnotics from a dry beverage previously spiked with these drugs was also possible upon an additional extraction procedure. In conclusion, ATR-FTIR coupled with PCA score-LDA model was useful in detecting and discriminating sedative-hypnotics, including those that had been previously spiked into a beverage.

The Use of Volatile Substances in Drug-Facilitated Sexual Assault: A Systematic Review

Drug-facilitated sexual assault (DFSA) is a significant crime that is increasing in incidence. The employment of volatile substances such as chloroform and aromatic petroleum hydrocarbons in DFSAs is quite an unusual choice. The objective of this review is to explore the use of volatile substances in DFSAs. Using the PubMed database, a systematic review of the literature was conducted. Thereafter, citation searching was carried out within the included studies from the primary search. A total of five studies were eligible for inclusion. Chloroform was the drug used in the DFSA in three of the included studies, and aromatic hydrocarbons in the remaining two. Two of the offenders who employed chloroform possessed a unique way to access the drug: their degrees. The evidence found in the DFSA cases included a chloroform-scented scarf and a solvent-immersed cloth. Headspace gas chromatography-mass spectrometry, liquid chromatography-electrospray coupled tandem mass spectrometry, toxicology assays of blood and urine, and solvent or hydrocarbon gas chromatography flame-ionization detection followed by gas chromatography-mass spectrometry were among the investigations performed to detect the volatile substances. The implementation of stricter regulations on chloroform for employees in chemical industries and laboratories is recommended. In cases where the autopsy is unclear and there are conspicuous facial and airway injuries, it is prudent to collect an early sample for volatile substance analysis.

Sexual Harassments Related to Alcohol and Drugs Intake: The Experience of the Rape Centre of Turin

A cross-sectional study was conducted that describes the characteristics of sexual violence episodes related to the intake of alcohol and drugs observed among women that turned to the "Centro Soccorso Violenza Sessuale" (SVS) of the Sant'Anna Hospital in Turin between 1 January 2008, and 31 December 2017. Two hundred twenty-two patients were enrolled, 25 of which were minors, 141 were Italians, and most of them knew their aggressor and were raped in a private home. One hundred and fifty-five of them declared to the healthcare personnel to have taken alcoholic substances and/or drugs in conjunction with the event (86 reported having drunk alcohol, 36 having taken drugs and 33 disclosed both alcohol and drug abuse). If the woman knew her abuser, alcohol consumption was described as voluntary in more than 80% of cases, while in relation to drugs the consumption was equally voluntary or fraudulent. About 73% of women who reported having drunk alcohol just had amnesia or amnesia related to other symptoms, while amnesia was present in about 63% of women who reported only drug use. Physicians observed physical injuries on 156 women. Patients who reported to have assumed alcohol presented a significantly higher risk to suffer any physical injury and have a significantly increased risk to suffer injuries to their head and/or neck. The results obtained underline how even in Northern Italy alcohol intake represents the most widespread psychoactive substance in case of drug-facilitated sexual assault. There is therefore a need to promote education and prevention campaigns among citizens, especially among the youngest.

Male Victims of Rape: An Observational Study over Four Years in Paris, France

Sexual violence is a common and under-reported form of violence that affects all categories of individuals. We sought to provide epidemiological data on men aged 15 years and over, victims of rape or suspecting a rape, and who reported it to the police. We conducted a retrospective study at the Department of Forensic Medicine of Hôtel-Dieu, Paris, France, between 2018 and 2021. Two-hundred men were included in the study, with an average age of 28.8 years. A vulnerability was mentioned for 17.5% of them. Most of the patients reported anal penetration, committed by a single male assailant, whom they met on the day of the assault. More than 60% of the patients reported the voluntary consumption of alcohol and/or illicit substances prior to the assault. Most patients were examined shortly after the assault (median 1 day). Anal lesions were found on examination in 37.0% of patients reporting anal penetration regardless of the time frame. The presence of anal lesions was statistically higher when patients were examined within 48 h. Our results reinforce the data in the literature on the risk factors associated with sexual violence among men, notably the consumption of alcohol and illicit substances, and psychological, economic, and social vulnerability.

Evaluation of suspected drug-facilitated sexual assault cases in the city of Houston from 2014 to 2020

Drug-facilitated sexual assault is a form of sexual violence against an individual incapacitated by alcohol and/or drugs consumed voluntarily or covertly administered. The purpose of this study was to evaluate toxicological results and the associated demographics of sexual assault-related cases submitted to Houston Forensic Science Center from 2014 to 2020. In total, 1240 samples (1230 cases) were tested during the six-year period that consisted of blood, urine, or both specimens. Blood was analyzed for ethanol by dual-column headspace gas chromatography with flame ionization detection. Drug screen analysis was performed preferably on urine specimens using enzyme-linked immunosorbent assay. Positive screening results were confirmed upon request only due to laboratory policy. A total of 22% (n = 176) of requested samples were confirmed positive. Ethanol was the most prevalent substance detected, present in 17% of the samples (n = 212), followed by 11-nor-9-carboxy-delta-9-tetrahydrocannabinol (THC-COOH) (n = 118). The combination of ethanol and THC-COOH was the most frequent one found (n = 17) in cases positive for two or more drugs (n = 101). Demographic data showed the majority of DFSA victims were white (25%) females (72%) with an average age of 27 years old (n = 348). Almost 90% of cases where the presence of drugs was confirmed resulted in no charges being made, either due to lack of suspect information or unknown reasons by the laboratory.

Sexual Assault: Approach to Reality in the Area of Santiago de Compostela (Galicia, Spain) through a 12-Year Retrospective Study

Sexual assault constitutes a severely traumatic experience that impacts the lives of far too many victims each year. The underlying behaviors of the offenders are often associated with psychological, physical and social distress, and the use of psychotropic substances was found in a good number of cases. A descriptive and retrospective review of sexual assault cases has been undertaken to identify trends in the toxicology findings in Drug-Facilitated Sexual Assault in Santiago de Compostela over the past 12 years. During this period, a total of 69 cases were referred to the Forensic Toxicology Service as sexual assault cases. The sex and age distribution of the cases showed that females between the ages of 14 and 65 years constituted the group most frequently submitted to sexual assault, with a peak of 55.1% in the 18- to 30-year age group. Alcohol consumption was positive in 77.1% of positive cases determined, followed by drugs (34.4%) and illicit drugs (26.2%). Our results showed a high percentage of alcohol consumption in sexual assault cases.

Traumatic Injuries in Sexual Assault Patients in the Emergency Department

Introduction

The emergency department (ED) is at the forefront for treatment of sexual assault patients. Many require treatment for injuries sustained during the assault, ranging from mild to severe. Our objective in this study was to characterize types of injuries associated with sexual assault and identify associated factors.

Methods

We reviewed ED charts from an inner-city trauma center and nearby community hospital from 2019–2020 for patients age ≥13 years with a chief complaint of sexual assault. We used descriptive statistics, chi square, and logistic regression to characterize demographics and identify factors associated with trauma.

Results

A total of 157 patients met inclusion criteria. The mean age was 27.9 years old (range 13–79 years) and 92.4% were female. Adult patients (age >18 years) comprised 77.5% of assaults vs adolescents (age 13–18 years) at 22.3%. Most patients presented to the trauma center compared to the community hospital (69.4% vs 30.6%). The assailants were reported as 61.2% acquaintance, 22.9% stranger, and 15.9% intimate partner. A forensic rape kit was performed in 92 (58.6%) cases. The patient was intoxicated with alcohol in 39 (24.8%) cases, and 22 (14%) patients reported drug-facilitated assault where an unknown substance was given to them. Alcohol (P = 0.95) and drug-facilitated assault (P = 0.64) did not change the occurrence of injuries. Fifty-seven (36.3%) patients exhibited physical trauma on presentation. Forty-five (28.6%) patients had minor injuries of abrasions, lacerations, or contusions. Major trauma was defined as fracture, brain injury, hemorrhage, strangulation, or injury requiring surgical consultation. There were 12 patients with major trauma consisting of fracture injury or nonfatal strangulation. None of the patients required admission. Sexual assault by an intimate partner (odds ratio [OR] 2.6; 95% CI: 1.1–6.5) and being an adult patient compared to adolescent (OR 3.0; 95% CI, 1.1–7.7) was significantly associated with physical trauma. Sexual assault by an intimate partner was also associated with nonfatal strangulation (OR 4.0; 95% CI, 1.1–15.4).

Conclusion

Physical injuries that resulted from sexual assault were mostly minor and occurred in 36% of rape victims. Intimate partner violence was found to be associated with physical trauma as well as nonfatal strangulation. Overall, this study helps us to understand key factors associated with sexual violence.

Statement of the DGGG - Recommendations on the Care and Support of Female Minors Suspected of Having Been Subjected to Acute Sexual Violence or Rape

Ziele Die vorgelegten Empfehlungen sollen zur weiteren Verbesserung und Standardisierung der ärztlichen Versorgung von Betroffenen sexualisierter Gewalt, insbes. von einer Vergewaltigung betroffenen weiblichen Minderjährigen in Deutschland beitragen. Sie wendet sich vor allem an Frauenärztinnen und Frauenärzte in der Klinik und in der Niederlassung und ergänzt die umfangreiche Kinderschutzleitlinie der Bundesrepublik Deutschland. Methoden Unter Einbeziehung der Ergebnisse einer umfassenden selektiven Literaturrecherche wurden von einer interdisziplinär besetzten Gruppe von Expertinnen und Experten in einem 3-stufigen Verfahren im Auftrag des Vorstands der DGGG diese Empfehlungen erarbeitet und im Konsens verabschiedet. Zusammenfassung Diese DGGG-Stellungnahme ist entsprechend dem Alter der Betroffenen (ca. 14 bis 17 Jahre/pubertär; 0 bis ca. 13 Jahre/präpubertär) zweigeteilt. Dies hat medizinische, strukturelle und forensische Gründe. Es werden zahlreiche Empfehlungen zum Umgang mit den mutmaßlich von akuter sexualisierter Gewalt bzw. einer Vergewaltigung betroffenen Minderjährigen, zur Erstversorgung, zu Versorgungsformen (z. B. Vertrauliche Spurensicherung), zur Anamneseerhebung, zur medizinisch-forensischen Untersuchung, zur medizinischen, psychischen und psychosozialen Versorgung sowie zur Nachbetreuung gegeben.

Analysis of conventional and nonconventional forensic specimens in drug-facilitated sexual assault by liquid chromatography and tandem mass spectrometry

The incidence of drug-facilitated sexual assault (DFSA) has dramatically increased in the last decades. Forensic analytical scientists continuously seek new methods and specimens to prove the incidence of intoxication for the judiciary system. Factors influencing sample selection include the ease of obtaining the samples and the window of detection of the drugs, among others. Both conventional (blood, urine) and non-conventional specimens (hair, nails, fluids) have been proposed as suitable in DFSA cases. Reported sample treatments include a variety of liquid-liquid and solid-phase extraction as well as dilute-and-shoot procedures and microextraction techniques. Regarding analysis, liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) has emerged as the preferred confirmatory technique, due to its sensitivity, selectivity, and wide-scope applicability. In this review, we critically discuss the most common specimens and sample treatments/analysis procedures (related to LC-MS/MS) that have been reported during the last ten years. As a final goal, we intend to provide a critical overview and suggest analytical recommendations for the establishment of suitable analytical strategies in DFSA cases.

Impact of the Covid-19 lockdown on sexual assault cases in Eastern Denmark - a retrospective clinical forensic study

To explore if the shutdown of Danish nightlife during the Covid-19 pandemic caused a decrease in the number of clinical forensic examinations of victims of sexual assault in Eastern Denmark. Secondarily, to investigate, if there was a change in criminological characteristics, e.g. scene and time of crime, relation to the perpetrator and the proportion of possible drug-facilitated sexual assaults. 130 case files from clinical forensic examinations of individuals of alleged sexual assault in the period 1st of April to 30th of June in both 2019 and 2020 were included. 67 and 63 examinations were performed in 2019 and 2020, respectively. 125 cases were female and five were male. Approximately 70% were 15-25 years of age. Pre- and post-lockdown victim profiles were similar regarding assailant relation, location of crime and time of assault. Voluntary intake of alcohol prior to the assault was registered with 46.3% in 2019 and 62% in 2020. The ratio of possible drug-facilitated sexual assault (DFSA) was approximately 50% each year. The lockdown did not seem to change the overall number of examinations or the demographic and criminological characteristics of the sexual assault victims. No decrease in cases of possible DFSA was found despite the lockdown of nightlife venues.

Vortex-assisted dispersive liquid-liquid microextraction-gas chromatography (VADLLME-GC) determination of residual ketamine, nimetazepam, and xylazine from drug-spiked beverages appearing in liquid, droplet, and dry forms

Presently, investigations of drug-facilitated crimes (DFCs) rely on the detection of substances extracted from biological samples following intake by the victim. However, such detection requires rapid sampling and analysis prior to metabolism and elimination of the drugs from the body. In cases of suspected DFCs, drug-spiked beverage samples, whether in liquid, droplet, or even dried form, can be tested for the presence of spike drugs and used as evidence for the occurrence of DFCs. This study aimed to quantitatively determine three sedative-hypnotics (ketamine, nimetazepam, and xylazine) from drug-spiked beverages using a vortex-assisted dispersive liquid-liquid microextraction-gas chromatography (VADLLME-GC) approach. In this study, a GC method was first developed and validated, followed by the optimization of the VADLLME protocol, which was then applied to quantify the target substances in simulated forensic case scenarios. The developed GC method was selective, sensitive (limit of detection: 0.08 μg/ml [ketamine]; 0.16 μg/ml [nimetazepam]; 0.08 μg/ml [xylazine]), linear (R²  > 0.99), precise (%RSD <7.2%), and accurate (% recovery: 92.8%-103.5%). Higher recoveries were achieved for the three drugs from beverage samples in liquid form (51%-97%) as compared to droplet (48%-96%) and dried (44%-93%) residues. The recovery was not hindered by very low volumes of spiked beverage and dried residues. In conclusion, the developed VADLLME-GC method successfully recovered ketamine, nimetazepam, and xylazine from spiked beverages that are likely to be encountered during forensic investigation of DFCs.

Recommendations for Care and Support of Female Rape Victims

Introduction According to prevalence studies, at least 5% of all women in the Federal Republic of Germany experience rape during their lifetime. While the effects vary according to the individual, rape has serious consequences for the somatic, psychological, and psychosocial health of the victim. The medical care that is provided to presumed rape victims is of special importance, as this care can have a positive influence on the patient's ability to process their experience and engage in healing following such a traumatic event. Furthermore, doctors are the professionals whose help is most often sought in this context. Primary care following rape consists of three aspects: the forensic medical examination, medical care, and psychological care. In this position paper, each of these aspects are discussed in detail. Recommendations for follow-up care are also provided. Methods In a multi-tiered process, a selective literature review was performed and a consensus among representative experts from different areas of specialization was formulated. Goals The goal of this paper is to contribute to the further improvement and standardization of the medical care provided to women who are presumed rape victims.

The Evolution Toward Designer Benzodiazepines in Drug-Facilitated Sexual Assault Cases

Drug-facilitated sexual assault (DFSA) is a crime where the victim is unable to provide sexual consent due to incapacitation resulting from alcohol or drug consumption. Due to the large number of substances possibly used in DFSA, including illicit, prescription and over-the-counter drugs, DFSA faces many toxicological challenges. Benzodiazepines (BZDs) are ideal candidates for DFSA, as they are active at low doses, have a fast onset of action and can be easily administered orally. The last decade has seen the emergence of designer benzodiazepines (DBZDs), which show slight modifications compared with BZDs and similar pharmacological effects but are not controlled under the international drug control system. DBZDs represent an additional challenge due to the number of new entities regularly appearing in the market, their possibly higher potency and the limited knowledge available on their pharmacokinetic and pharmacodynamics properties. Many BZDs and DBZDs have a short half-life, leading to rapid metabolism and excretion. The low concentrations and short time windows for the detection of BZD in body fluids require the use of highly sensitive analysis methods to enable the detection of drugs and their respective metabolites. This review discusses the current state of the toxicological analysis of BZDs and DBZDs in forensic casework and their pharmacokinetic properties (i.e., absorption, distribution, metabolism, and elimination), as well as their analysis in biosamples typically encountered in DFSA (i.e., blood, urine and hair).

Sexual Violence Suffered by Women in Early and Late Adolescence: Care Provided and Follow-Up

OBJECTIVE

 To compare the sexual violence suffered by women in early and late adolescence, the reactions triggered after the aggression, and the care provided.

METHODS

 A retrospective study in which we reviewed the medical records of 521 female adolescents treated by a multidisciplinary team at a reference hospital in the city of Campinas, state of São Paulo, Brazil. We analyzed sociodemographic variables, and those pertainin to the characteristics of the episodes of violence, the emergency care, and the physical and psychological reactions observed during the follow-up. For the analysis, the sample was divided into groups of early (10 to 14 years) and late (15 to 18 years) adolescence. We used the Chi-squared/Fisher Exact, Mann-Whitney, and Kruskal-Wallis tests to compare the groups; the level of significance adopted was 5%.

RESULTS

 The early group (n = 242) contained more adolescents who were enrolled in school (p < 0.001), suffered more daytime aggressions (p = 0.031), in their residences (p < 0.001), by an aggressor with whom they were acquainted (p < 0.001), had greater need of legal protection (p = 0.001), and took longer to seek care (p = 0.048). Feelings of guilt, shame, and the perception of violence were similar between the groups. In the late group (n = 279), there was greater consumption of alcohol during the aggression (p = 0,005); they received significantly more prophylaxis treatments; reported more physical symptoms (p = 0.033), sleep disorders (p = 0.003), symptoms of anxiety (p = 0.045), and feelings of anguish (p = 0.011); and had more prescriptions of psychotropics (p = 0.005). Only 52% completed the 6-month follow-up, with no differences between the groups.

CONCLUSION

 The age groups showed differences in the characteristics of the episodes of violence; early adolescents took longer to seek help, and the late group presented more intense symptoms and psychological worsening during the follow-up. Measures of prevention and specific care aimed at this population are needed.

Factors Associated With Law Enforcement Reporting in Patients Presenting for Medical Forensic Examinations

Law enforcement reporting following sexual assault is lower than for other violent crimes. Sexual assault nurse examiners (SANEs) provide care for patients in the acute period following sexual assault and are well-positioned to identify and address barriers to reporting. We examined data from medical forensic examination records documented by SANEs for a 5-year period (2011-2015). We examined 347 records of women 18 and older to identify factors associated with law enforcement reporting at the time of the exam using binomial logistic regression to construct odds ratios (OR). A total of 56.5% of patients in the sample reported to law enforcement. Patients who did not voluntarily consume alcohol were more likely to report than those who did (OR = 4.45; p = .001). Patients who were not students were more likely to report than students (OR = 3.24; p = .002). Patients who had a medical forensic exam within 32 hr of the assault were more likely to report than those having exams after 32 hr (OR = 2.68; p = .007). Patients who had anogenital and/or bodily injuries were more likely to report than those who had no injuries (OR = 2.50; p = .008). Patients who were penetrated (vaginally, orally, and/or anally) were more likely to report than those who were not penetrated (OR = 2.50; p = .056). Knowing the assailant, having multiple assailants, and patient and assailant race/ethnicity were not associated with different likelihood of reporting to law enforcement. SANEs and others who work with victims of sexual assault can use data to understand and address barriers to reporting.

Prepartying and incapacitated rape: Is drinking a risk factor or an outcome?

BACKGROUND

Incapacitated rape (IR) is common in college and has been linked to heavier post-assault drinking and consequences, including blackouts. Following IR, college students may adjust their drinking in ways meant to increase perceived safety, such as enhancing situational control over one's drinks through prepartying, which is drinking before going out to a main social event. Although it is possible that prepartying could influence risk related to IR, it is unclear whether or how prepartying and IR are associated.

METHODS

To address these gaps, we examined prepartying as both a risk factor and a consequence of IR, including the reasons for prepartying. Across two studies (Study 1 N = 1074; Study 2 N = 1753) of college women and men, we examined associations between IR and prepartying motives, alcohol consumption, and alcohol-related blackouts.

RESULTS

Within the cross-sectional Study 1, negative binomial regressions revealed that having a history of IR was associated with more alcohol consumption and blackouts when prepartying. In a multivariate model, past-year IR was associated with preparty motives related to interpersonal enhancement, intimate pursuit, and barriers to consumption, but not situational control. Within the prospective Study 2, a path model revealed that preparty drinking was a prospective predictor of IR in the following year, but past-year IR did not predict subsequent prepartying.

CONCLUSIONS

Findings revealed a robust link between recent history of IR and prepartying regardless of gender. Prepartying was a prospective risk factor for subsequent IR. Although more research in this area is needed, addressing prepartying in alcohol interventions may contribute to the prevention of negative outcomes, including sexual assault.

Evidentiary discrepancies in sexual assault casework within the US

In recent years, a significant number of investigations have discovered up to 200 000 unsubmitted sexual assault kits (SAKs) in the US. While the public outcry was largely directed towards DNA analysis, the SAKs also contained biological specimens specifically designated for toxicological analysis. Due to the sensitivity of analytes in potential drug facilitated sexual assaults, the preservation and maintenance of the specimens is crucial in providing accurate toxicological measurements. The investigations into the unsubmitted SAKs have identified subjective law enforcement officer (LEO) rationale for the unsubmitted kits, however the impact on toxicological specimens has not been examined. This brief review of policies and guidelines with respect to forensic specimens has identified potential sources of evidentiary degradation, despite the use of chemical preservatives. With respect to temperature-controlled environments, the variation in SAK submission policies established throughout the US are potentially detrimental to the preservation of toxicological evidence. Degradation as a result of time-delayed collection and poorly maintained storage temperatures plays a crucial role for/in the interpretation of qualitative and quantitative toxicological results. This review finds these delays can be addressed through modernisation of facilities; electronic tracking of unsubmitted SAKs; mandated transfer of biological evidence within 72 h; and documentation of temperature within the chain of custody or other records. Without identifying the range of temperatures in which the evidence was exposed, forensic toxicologists may unintentionally provide erroneous interpretations of toxicological analyses – potentially casting doubt on the survivor’s recall of events and negatively impacting future sexual assault investigations.

Comparing Transgender and Cisgender Experiences of Being Taken Advantage of Sexually While Under the Influence of Alcohol and/or Other Drugs

A small body of literature suggests that transgender people are more frequently exposed to sexual violence while they are under the influence of alcohol than cisgender counterparts. The goal of this study was to report any differences between transgender (n = 1,136) and cisgender (n = 74,277) respondents to the Global Drug Survey on their experiences of being taken advantage of sexually while under the influence of alcohol and/or other drugs. We found that transgender people were more likely than cisgender people to have experienced being taken advantage of in the last year (9.3% vs 4.2%) and more than 12 months preceding the survey (24.9% vs 14.3%). Non-binary participants were more likely than binary transgender participants (27.7% vs 17.8%) to report being taken advantage of sexually more than a year preceding the survey. Similarly, trans respondents assigned female at birth were more likely than trans respondents assigned male at birth to report this (30.0% vs 19.7%). Nonspecialist services for survivors of sexual violence should be adequately prepared for and accommodating toward transgender clients. Future research should explore their unique needs. Moreover, clinicians who assess transgender people should remain mindful of their increased likelihood of being taken advantage of sexually while under the influence of alcohol and other drugs and consider trauma-informed interventions.

Care of women and girls after sexual assault in Geneva: A descriptive study between 2005 and 2014

BACKGROUND AND PURPOSE

We aimed to examine epidemiological data and identify risk factors for sexual assault. This study included women seeking care at the Geneva University Hospitals emergency obstetrics and gynaecological unit.

METHOD

Retrospective, sociodemographic, and clinical data were collected from the medical reports.

RESULTS

We reviewed 836 medical charts and registered 92.8 women and girls per year who consulted the emergency department after sexual assault. The average age was 26 (±12) years, with a median of 23 years. Body lesions were reported in 525 patients (63%) and genital traumatic lesions were reported in 230 (28%) patients. Sexual assault by a stranger was reported in 436 cases (52%). Thirty percent of patients knew their aggressor. Aggressions were predominantly committed on the weekend, accounting for 367 cases (46%), with nearly two-thirds (65%, n = 474) occurring between 10 pm and 6 am. In total, 399 (48%) patients who were sexually assaulted reported having consumed alcohol and 102 (12%) reported having taken drugs prior to the aggression; 80 (10%) patients had consumed both and 286 (34%) had amnesia. Half of the sample sought and received medical care within 24 h from the time the aggression took place.

CONCLUSION

Sexual assault risk factors in our study population in Geneva included use of drugs and alcohol, with amnesia. Future prevention and education interventions should target these areas.

Geographies of Sexual Assault: A Spatial Analyses to Identify Neighborhoods Affected by Sexual and Gender-Based Violence

Emergency departments are a common access point for survivors of sexual and gender-based violence (SGBV), but very little is known about where survivors live and the neighborhoods they return to. The objectives of this study were to describe the patient population that present for a sexual or partner-based assault and explore the geographic distribution of cases across the Ottawa-Gatineau area. Data for this study were extracted from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (January 1 to December 31, 2015) at The Ottawa Hospital. Spatial analyses were conducted using six-digit postal codes converted into Canadian Census Tract units to identify geographic areas with concentrated cases of SGBV. Concentrated areas were defined as Census Tracts with seven or more SGBV cases within a single calendar year. In 2015, there were 406 patients seen at the SAPACP and 348 had valid postal codes and were included in the analyses. More than 90% of patients were female and 152 (43.68%) were below 24 years of age. More than 70% knew their assailant and the most common locations of the assault were at the survivors' home (31.03%), assailants' home (27.01%), or outdoors (10.92%). Eight concentrated areas were identified including three in the downtown entertainment district, three lower income areas, one high-income neighborhood, and one suburb more than 20 km from downtown. The findings from this study describe the typical clinical presentation of sexual and domestic assault survivors and also challenge geographic stereotypes of where survivors live and what areas of the city are most affected by SGBV. Using residential information provides a survivor-centric approach that highlights the widespread nature of SGBV and supports the need for population-based approaches to improve care for survivors.

The impact of sociocultural contexts on mental health following sexual violence: A conceptual model

OBJECTIVE

Sexual violence has substantial mental health effects on survivors around the globe. Although there has been increasing attention to the ways that sociocultural environments can affect survivors' recovery, there has been no review to our knowledge of the specific factors within sociocultural environments that offer risk or protection, or the mechanisms by which these factors affect recovery.

METHOD

To address this gap, we present a conceptual model supported by a theoretical and empirical review that prioritizes research conducted with ethnic minority and global samples.

RESULTS

We identify three components of global sociocultural settings-norms, structures, and environmental stressors-that may affect mental health following sexual violence. We propose that these components may affect survivors' mental health by (1) influencing how survivors themselves, survivors' social contexts, and the systems with which survivors come into contact think about and respond to sexual violence, and (2) creating additional sources of stress, burden, or protection for survivors.

CONCLUSIONS

We argue that future research, practice, and policy could have a greater effect on survivors by attending to sociocultural factors in recovery.

GHB related acids are useful in routine casework of suspected GHB intoxication cases

GHB related acids (3,4-dihydroxy butyric acid, 2,4-dihydroxy butyric acid and glycolic acid) are produced through oxidative GHB metabolism. These analytes could be potential biomarkers to ensure the diagnosis of a GHB intoxication and even prolong the detection window. Within this study, forensic routine cases were measured to consider the potential of additional gas chromatographic mass spectrometric analysis on these acids. 17 GHB positive real cases (10 serum samples and 7 urine samples) and 40 cases with suspicion of drugging in DFC cases and negative GHB results (21 serum samples and 19 urine samples) were evaluated. Increased GHB related acid concentrations were detected in all serum and most urine samples positive on GHB. In some GHB negative cases, especially in serum samples, concentrations of GHB related acids gave hints that GHB actually was taken. We recommend to use the following cut-offs for a more reliable interpretation of potential GHB intoxication cases: 3,4-OH-BA:>3 mg/L in serum and>50 mg/L in urine; 2,4-OH-BA:>2 mg/L in serum and>25 mg/L in urine; GA:>5 mg/L in serum and>400 mg/L in urine.

The Interest of a Systematic Toxicological Analysis Combined with Forensic Advice to Improve the Judicial Investigation and Final Judgment in Drug Facilitated Sexual Assault Cases

The conviction rate in drug facilitated sexual assault (DFSA) cases is known to be very low. In addition, the potential impact of toxicological results on the case is often not well understood by the judicial authorities. The aims of this study were (1) to obtain more knowledge concerning the prevalence of incapacitating substances in DFSA cases, (2) to create a more efficient DFSA analysis strategy taking background information into account, and (3) to evaluate the potential impact of systematic toxicological analysis (STA) on the final judicial outcome. This small-scale epidemiological study (n = 79) demonstrates that ‘commonly-used’ illicit drugs, psychoactive medicines and ethanol are more prevalent in DFSA cases in contrast to the highly mediatized date rape drugs. Additionally, via case examples, the interest of performing STA—to prove incapacitation of the victim—in judicial procedures with mutual-consent discussions has been demonstrated as it led to increased convictions. However, more attention has to be paid to ensure a short sampling delay and to get more accurate information from the medical treatment of the alleged victim. This will improve the interpretation of the toxicological analysis and thus its applicability in a DFSA case. The future is multi-disciplinary and will certainly lead to an efficient and more cost-effective DFSA approach in which STA can impact the final judgment.

Alcohol Use and Sexual and Physical Assault Victimization Among University Students: Three Years of Follow-Up

The aim of this study was to determine the incidence of sexual and physical assault among university students and its association with alcohol use. The research is part of a wider cohort study (Spit for ScienceTM) at a large public university in the United States. The follow-up data include the first two cohorts (2011, 2012; n = 5,170). The dependent variables were victim of sexual assault and victim of physical assault. The independent variables were alcohol dependence and abuse according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.), cannabis use, residence, ethnicity, sexual orientation, and previous experience of sexual assault and/or physical assault. We used multilevel logistic regression for repeated measures. All data were analyzed using generalized linear mixed models. Incidence rates of sexual and physical assault (per 100 students a year) were 15.1 and 27.6 among nonabusers/dependents versus 36.4 and 56.7 among alcohol-dependent females at the first year, and 2.8 and 4.7 versus 7.7 and 23.1 at the third year; while in males, incident rates were 6.0 and 3.1 versus 18.5 and 66.6, and 2.3 and 7.4 versus 18.9 and 15.1, respectively. Our results show that alcohol abuse and dependence constitute risk factors to be victim of sexual assault in males (odds ratio [OR] = 2.21 and OR = 2.73) and alcohol dependence in females (OR = 2.16). Similarly, alcohol abuse and dependence are risk factors to physical assault among both males (OR = 1.52 and OR = 2.03) and females (OR = 1.70 and OR = 2.88). Ethnicity, sexual orientation, and whether the individual had been victimized in the past were associated with sexual assault. Regarding physical assault, cannabis use and past victimization are also risk factors. Our study has shown that assault victimization is strongly related to alcohol abuse and dependence diagnoses in both genders. Ethnicity and sexual orientation are also associated to both assaults. Our results show that incidence rates of both types of assaults were clearly higher in the first 6 months of university, probably explained by the novel and potentially risky environment.

Forensic application of DNA barcoding in the identification of commonly occurring poisonous plants

Exposure to poisonous plants is hazardous to health; thus, reliable species identification is required to decide the most appropriate treatment. Since ingested plants are too much degraded for visual observation, DNA barcoding can be used as a molecular tool for species identification. Considering the universal primers, PCR and sequencing success rate, and diversity of the poisonous plants, the rbcL DNA marker was selected for molecular identification. A reference DNA barcode library for 100 poisonous plant species was created using rbcL DNA barcodes. For the poisonous plants represented in the library, 100% and 89% species differentiation was observed at the genus and species level, respectively. All the undifferentiated species were congeneric species. Mapping the metabolites of the poisonous plants to the DNA based phylogenetic tree indicated that the phylogenetically related species also had related toxic compounds. Therefore, genus-level identification may be sufficient in the practical application of DNA barcoding in poisoning cases. We conclude that rbcL can be used as a primary marker, and if required, ITS2 or trnH-psbA may be used as a secondary marker to identify the poisonous plants. The present study provides the foundation to develop a reliable molecular method to identify the poisonous species from the vomit samples of poisoning cases.

Single hair analysis: Validation of a screening method for over 150 analytes and application on documented single-dose cases

Hair is the matrix of choice in forensic toxicology when retrospective analysis is needed. Nonetheless, due to misalignment, different growth stages and segmentation lengths of 0.5-1 cm, resolution of time is limited. By segmental analysis of single hairs, most of these factors can be compensated and resolution of time is enhanced. A method for manually segmenting single hairs in 2-mm sections and screening for 156 analytes by liquid chromatography coupled to tandem mass spectrometry has been developed and validated. The method was applied to 15 single-dose cases concerning different pharmaceuticals by analyzing 10 hairs each, sampled 1 and 2 months after ingestion in most cases. The validation showed a lower limit of quantification of ≤1.25 pg/segment for ~90% of analytes and good accuracy. Many substances could be detected in the presented cases, whereas detection of benzodiazepines and low dosed opioids remains challenging. In positive cases, characteristic peak-shaped concentration profiles across the hairs were obtained. The segment with most coinciding peak maxima can be allocated to the time of ingestion. A method for the determination of individual hair growth rate was applied and revealed a gap between expected and actual position of peak maxima. Additionally, different localization of simultaneously administered substances was observed. These findings were tried to be explained by different routes of incorporation and may contribute to current knowledge. The presented method may directly be applied to similar questions in hair analysis, and the findings are considered important for interpreting further results in single hair analysis.

Long-Term Detection In Hair Of Zolpidem, Oxazepam And Flunitrazepam In A Case Of Drug-Facilitated Sexual Assault

Drug-facilitated sexual assault (DFSA) cases are pretty common in forensic toxicology. In this case report, a 56-year-old female tourist claimed to have been sexually assaulted by five men after having had a drug-spiked alcoholic drink. Urine samples were collected at 38, 44, and 45 hours after the alleged rape. After 7 months, hair strands (28 cm in length) were also sampled to perform the segmental hair testing. Urine and decontaminated hair segments were tested for different groups of basic, acid, and neutral substances (GHB, Z-drugs, barbiturates, benzodiazepines, hypnotics, antipsychotics, drugs of abuse). GC/MS and LC-MS/MS methods were applied for the qualitative and quantitative analyses. Toxicological analyses performed on urine samples gave inconclusive findings. Zolpidem, flunitrazepam, and oxazepam were detected in the hair segments corresponding to the time frame of the alleged assault. Endogenous levels of GHB were detected along the hair shaft. No drugs were detected in the proximal and distal hair segments or in washing solutions. This DFSA case demonstrated that the segmental toxicological analysis of hair, even when performed 7 months after the sexual assault, can provide evidence consistent in a single exposure to psychoactive drugs, at the time of the offence.

[Suspicion of chemical submission in older subjects attending a hospital emergency department]

Chemical Submission (CS) is considered a danger to health and a form of violence. There are different forms of proactive CS (involuntary consumption of psychoactive substances) and opportunistic CS (voluntary consumption), with criminal intent, usually theft, submission, or sexual assault. The objective of this work is to describe the characteristics of cases of suspected CS in adults older than 65 years treated in the Emergency Department of the San Carlos Clinical Hospital and the results of the toxicological analysis performed by the INTCF in Madrid (April 1, 2015-2019). There were 12 (8%) cases of suspected CS, with a mean age of 75 (SD 8) years, of which 8 (66.7%) men, with two different profiles, all associated with theft, and in 3 (25%) possible sexual assault. In 9 (75%) cases, benzodiazepines and / or usual drugs were identified. CS is a problem to consider in Emergency Departments and is not exclusive to the young population.