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.

Forensic intelligence-led prevention of drug-facilitated sexual assaults.

This work explores the potentially broader contribution of forensic science to preventive public health through the proactive view promoted by forensic intelligence. For that purpose, a new working framework is applied as a strategic tool that channelizes forensic intelligence in a more understandable and didactic way for decision-makers, guiding preventive crime processes. Concretely, the implementation of this operational framework focuses on preventing drug-facilitated sexual assaults in the nightlife context. Through a two-stage research scheme, the working framework is used as a study tool for understanding this violent phenomenon and as a strategic thinking and action platform for overcoming it. Forensic intelligence-guided actions significantly enhanced institutional and direct support facing this specific form of sexual violence. Awareness messages targeting potential assailants, witnesses, and victims reached more than half a thousand students from the university and pre-university education through a preventive intervention within the educational system. Moreover, the inter-professional dialogue between forensic science and other health, security, and education disciplines shows the broader proactive role of forensic science beyond the traditional retroactive view limited to courtrooms and intelligence-led policing. This study demonstrates as forensic intelligence becomes applicable for civilians, who participate as decision-makers in intelligence-led preventive processes, anticipating the need for intervention by police and judicial authorities.

An approximation to the identification of contexts, experiences, and profiles of victims of drug-facilitated sexual assaults.

This study advances on overcoming a bias limiting the forensic cases studies of drug-facilitated sexual assaults: a narrow study focus, restricted to assaults affecting young women in leisure contexts related to nightlife, party culture, and dating. A new working framework is applied to analyse data from cases received in the National Institute of Toxicology and Forensic Sciences (Madrid, Spain) over the six years between 2012 and 2017. The work throws light on non-previously described contexts, experiences, and profiles of victims, including domestic cohabitation, labour, education, healthcare, women trafficking, and the daily life of people with intellectual disabilities.

Gender-based differences in perceptions about sexual violence, equality and drug­facilitated sexual assaults in nightlife contexts. / Diferencias de género en percepciones sobre violencia sexual, igualdad y agresiones sexuales facilitadas por drogas en ocio nocturno.

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.

La violencia sexual, incluyendo las agresiones sexuales facilitadas por drogas, es un serio problema cada vez más común en los contextos de ocio nocturno. Este trabajo estudia las actitudes y percepciones de la juventud española en torno a la violencia sexual en dicho ámbito. Los participantes se reclutaron mediante muestreo en bola de nieve. Se realizó un análisis bivariado para identificar posibles factores sociodemográficos y de ocio nocturno relacionados con género. La significación estadística de las diferencias entre estas variables se evaluó mediante las pruebas de chi-cuadrado y exacta de Fisher. Las mujeres percibieron un menor nivel de seguridad personal, así como la existencia de percepciones sociales que penalizan en mayor medida el consumo de drogas femenino que el masculino, y que culpabilizan a las mujeres por la violencia que sufren. Además, ellos mostraron mayor disposición a mantener relaciones sexuales con personas incapaces de otorgar su consentimiento debido a los efectos de las drogas. Los hombres creen en mayor medida que las agresiones sexuales ocurren debido al uso de alcohol u otras drogas por parte de las víctimas. En el contexto de ocio nocturno, las mujeres son propensas a percibir la existencia de una falta de apoyo social hacia ellas, así como un sentimiento de impunidad social hacia los agresores. Además, existen numerosas concepciones erróneas en torno a las agresiones sexuales facilitadas por drogas. La mayoría cree que las agresiones ocurren tras la administración encubierta de sustancias a la víctima por parte de un agresor desconocido. Además, se subestimó la participación del alcohol. Nuestros hallazgos son útiles para diseñar esfuerzos preventivos bien dirigidos, desmitificar el fenómeno de las agresiones sexuales facilitadas por drogas y mejorar el apoyo social a las víctimas.

Diferencias de género en percepciones sobre violencia sexual, igualdad y agresiones sexuales facilitadas por drogas en ocio nocturno / Gender-based differences in perceptions about sexual violence, equality and drug-facilitated sexual assaults in nightlife contexts

La violencia sexual, incluyendo las agresiones sexuales facilitadas pordrogas, es un serio problema cada vez más común en los contextos de ocionocturno. Este trabajo estudia las actitudes y percepciones de la juventudespañola en torno a la violencia sexual en dicho ámbito. Los participantesse reclutaron mediante muestreo en bola de nieve. Se realizó un análisisbivariado para identificar posibles factores sociodemográficos y de ocionocturno relacionados con género. La significación estadística de lasdiferencias entre estas variables se evaluó mediante las pruebas de chicuadrado y exacta de Fisher. Las mujeres percibieron un menor nivelde seguridad personal, así como la existencia de percepciones socialesque penalizan en mayor medida el consumo de drogas femenino que elmasculino, y que culpabilizan a las mujeres por la violencia que sufren.Además, ellos mostraron mayor disposición a mantener relaciones sexualescon personas incapaces de otorgar su consentimiento debido a los efectosde las drogas. Los hombres creen en mayor medida que las agresionessexuales ocurren debido al uso de alcohol u otras drogas por parte delas víctimas. En el contexto de ocio nocturno, las mujeres son propensasa percibir la existencia de una falta de apoyo social hacia ellas, así comoun sentimiento de impunidad social hacia los agresores. Además, existennumerosas concepciones erróneas en torno a las agresiones sexualesfacilitadas por drogas. La mayoría cree que las agresiones ocurren trasla administración encubierta de sustancias a la víctima por parte de unagresor desconocido. Además, se subestimó la participación del alcohol.Nuestros hallazgos son útiles para diseñar esfuerzos preventivos biendirigidos, desmitificar el fenómeno de las agresiones sexuales facilitadaspor drogas y mejorar el apoyo social a las víctimas. (AU)

Sexual violence, including drug-facilitated sexual assaults, is a seriousissue that is becoming increasingly common in leisure nightlife contexts.This study provides information about the attitudes and perceptionsof Spanish youths towards sexual violence within that setting. Theparticipants were recruited by a snowball sampling scheme. A bivariateanalysis was performed to identify possible sociodemographic andnightlife recreational habit factors related to gender. The statisticalsignificance of the differences between the studied variables was assessedusing the chi-squared and Fisher’s exact tests. Women perceived a lowlevel of personal security, as well as the existence of social perceptionspenalizing female more than male drug use, and blaming women for thesexual violence they suffer. Women also recognised less explicit violentbehaviours as violence significantly more than men did. Men were morewilling to have sexual intercourse with someone unable to expressconsent because of drugs. In addition, they believed more strongly thatsexual assaults take place because of the victim’s use of alcohol or otherdrugs. In a leisure nightlife context, women are prone to perceive alack of social support for themselves and the feeling of impunity for theperpetrators. Furthermore, numerous misconceptions surround drugfacilitated sexual assaults, with the majority of respondents believingthat assaults happen after the surreptitious administration of substancesto the victim by an unknown assailant. Moreover, the involvement ofalcohol was underestimated. Our findings are useful for designingprevention efforts, demystifying the drug-facilitated sexual assaults andenhancing social support for victims. (AU)

An ecological working framework as a new model for understanding and preventing the victimization of women by drug-facilitated sexual assault.

An innovative approach towards the holistic and multidisciplinary study of the victimization of women by drug-facilitated sexual assault has been developed. This phenomenon constitutes a significant problem given the narrowing of the gender gap in drug use over the last few decades and the widespread presence of psychoactive substances worldwide. As violence against women and drug misuse intersect in this phenomenon, this intersectional nature emphasizes the need for a novel approach that enables us to go beyond the studies carried out to date. Consequently, a multidimensional strategy incorporating a gender-sensitive approach has been implemented. The study was aligned with approaches recommended by international authorities concerning sustainable development, thus meeting current global challenges. Furthermore, the study was structured based on an ecological model divided into multiple influence levels and integrating the triangular theory of violence. As a result, a new ecological working framework was built as a multilevel platform useful for understanding and preventing the victimization of women by drug-facilitated sexual assault.

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.

Development and validation of a liquid chromatography tandem mass spectrometry method for the determination of cannabinoids and phase I and II metabolites in meconium.

A liquid chromatography-tandem mass spectrometry (LC-MSMS) method was developed and fully validated for the determination of Δ9-tetrahydrocannabinol (THC), 11-hydroxyTHC (OHTHC), 11-nor-9-carboxyTHC (THCCOOH), 8-ß-11-dihydroxyTHC (diOHTHC), cannabinol, cannabidiol, and THC and THCCOOH glucuronides in 0.25±0.02g meconium. Samples were homogenized in methanol and subjected to cation exchange solid-phase extraction. Chromatographic separation was performed on a Kinetex C18 column (50 mm×2.1mm, 2.6µm) at 35°C, with a gradient of 0.1% formic acid in water and acetonitrile at a flow rate of 0.3 mL/min; total run time was 10min. Two transitions per analyte were monitored in MRM mode. The method was specific and sensitive; LOD was from 1 to 2ng/g, and LOQ from 4 to 10ng/g; linearity ranged from 4 to 400 ng/g for all the analytes, except for THC glucuronide (10-400ng/g); intra-assay, inter-assay and total imprecision were <11.2%, <13.45% and <15.6%, respectively; accuracy ranged from 93.9% to 109.0% of the target concentration; matrix effect, extraction and process efficiency ranged from -26.4% to -71.4%, 49.9% to 69.5% and 14.3% to 45.0%, respectively. The inclusion of THC and THCCOOH glucuronides avoided the need for the hydrolysis process, thus facilitating sample pretreatment. Application of the method to 19 authentic meconium specimens from uncontrolled pregnancies or women suspicious of drug consumption revealed fetal cannabis exposure in 4 newborns. THCCOOH (24.1-288.8ng/g), diOHTHC (53.2-332.4ng/g), THC (4.2-7.7ng/g), CBN (30.7-93.3ng/g) and CBD (7.1-251.5ng/g) were detected in all cases; THCCOOH glucuronide (190.2-306.8ng/g) in 3 cases; and OHTHC (11.9ng/g) in the remaining one; however, THC glucuronide was not identified in any specimen.