title: A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review.
abstract: OBJECTIVE
  A systematic review was undertaken to determine the current global prevalence of drug-facilitated sexual assault (DFSA) reported in adults in order to identify trends in the toxicology findings in DFSA around the world over the past 20 years.
  
  
  METHODS
  Databases PubMed, PsycINFO and Scopus were systematically searched using the terms: "drug-facilitated sexual assault", "chemical submission", "date rape", "rape drugs" and "drink-spiking" to identify relevant studies for inclusion in the review. This study focused on adult victims of suspected DFSA aged 16 years and above in which toxicology results were reported.
  
  
  RESULTS
  The majority of studies included were published in the United States, followed by the United Kingdom, with only a single study dedicated to this area in both Australia and Europe. Epidemiology, prevalence rates, and toxicology for DFSA appear broadly commensurate across different continents, although there are some differences in how "drug-facilitated sexual assault" is defined, as well as differences in the sensitivity of toxicological analyses. Nonetheless, alcohol is the most commonly detected substance and co-occurrence with other drugs is common. Aside from alcohol there was no other specific drug category associated with DFSA. Cannabinoids and benzodiazepines were frequently detected, but a lack of contextual information made it difficult to establish the extent that these substances contributed to suspected cases of DFSA.
  
  
  CONCLUSIONS
  This comprehensive review suggests that alcohol intoxication combined with voluntary drug consumption presents the greatest risk factor for DFSA, despite populist perceptions that covert drink-spiking is a common occurrence. There is a need to develop policies that encourage early responders to suspected DFSA (e.g., law enforcement agencies, medical staff, support agencies, etc), to collect detailed information about the individual's licit and illicit drug consumption history, in order to assist in providing appropriate and more thorough contextual information.
authors.affiliation: Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Victoria, Australia. Electronic address: laura.j.anderson@monash.edu.
authors.forename: Laura Jane
authors.initials: LJ
authors.lastname: Anderson
authors.affiliation: Criminology, School of Social Sciences, Monash University, Wellington Road, Clayton, Victoria 3800, Australia.
authors.forename: Asher
authors.initials: A
authors.lastname: Flynn
authors.affiliation: Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, 3006 Victoria, Australia.
authors.forename: Jennifer Lucinda
authors.initials: JL
authors.lastname: Pilgrim
mesh_terms: D000435:Alcoholic Intoxication / Q000453:epidemiology; D019548:Crime Victims; D053593:Forensic Toxicology; D006197:Hair / Q000737:chemistry; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects / Q000032:analysis; D012742:Sex Offenses; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000453:epidemiology*
chemical_list: D013287:Illicit Drugs
keywords: Chemical submission; Covert drug administration; Drink-spiking; Drug facilitated sexual assault; Sexual assault; Toxicology