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.

Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study

BACKGROUND

Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, their relationship is complex, as ORM is registered without considering the type of opioid (legal or illegal).

OBJECTIVE

This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulness as a surveillance tool.

METHODS

This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish general population. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agency in daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeine and tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deaths registered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute, derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be those that indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidental poisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning of undetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORM and DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatment tier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlations with 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19.

RESULTS

The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006 and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlated with the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year, although not statistically significant (all P≥.05).

CONCLUSIONS

There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-related deaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in the illegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongest opioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that not only is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths.

Gender-based differences in perceptions about sexual violence, equality and drug‑facilitated sexual assaults in nightlife contexts

Sexual violence, including drug-facilitated sexual assaults, is a serious issue that is becoming increasingly common in leisure nightlife contexts. This study provides information about the attitudes and perceptions of Spanish youths towards sexual violence within that setting. The participants were recruited by a snowball sampling scheme. A bivariate analysis was performed to identify possible sociodemographic and nightlife recreational habit factors related to gender. The statistical significance of the differences between the studied variables was assessed using the chi-squared and Fisher's exact tests. Women perceived a low level of personal security, as well as the existence of social perceptions penalizing female more than male drug use, and blaming women for the sexual violence they suffer. Women also recognised less explicit violent behaviours as violence significantly more than men did. Men were more willing to have sexual intercourse with someone unable to express consent because of drugs. In addition, they believed more strongly that sexual assaults take place because of the victim's use of alcohol or other drugs. In a leisure nightlife context, women are prone to perceive a lack of social support for themselves and the feeling of impunity for the perpetrators. Furthermore, numerous misconceptions surround drug-facilitated sexual assaults, with the majority of respondents believing that assaults happen after the surreptitious administration of substances to the victim by an unknown assailant. Moreover, the involvement of alcohol was underestimated. Our findings are useful for designing prevention efforts, demystifying the drug-facilitated sexual assaults and enhancing social support for victims.