An exploratory analysis of suspected drug-facilitated sexual assault seen in a hospital emergency department

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.

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.

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.

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.

Evaluation and Management of Female Victims of Sexual Assault

Sexual assault is characterized by any sexual contact or behavior that occurs without explicit consent. Classifications vary based on the status of the perpetrator's relationship to the victim (eg, stranger, acquaintance) and characteristics of the victim herself (eg, child, elder adult, mentally disabled adult). Regardless of the classification, sexual assault is a significant individual as well as public health issue affecting women of all ages. While the majority of sexual assault cases are not initially reported to law enforcement, the best available data suggest the lifetime prevalence of sexual assault in the United States is approximately 20% among adult women. With such a significant proportion of women affected by sexual assault, women's health care providers in both ambulatory and emergency care settings play key roles in the evaluation, management, and advocacy of these victims. Establishing standard protocols based on state laws and on victim-centered practices to avoid revictimization of the patient is critical. The primary goals of care include the assessment and treatment of physical injuries, psychological assessment and support, pregnancy assessment and prevention, and therapy for prevention of sexually transmitted infections. In addition, evidentiary collection is a critical component of the sexual assault evaluation and subsequent legal proceedings. This report focuses specifically on the immediate evaluation and management of adult female victims of sexual assault. Best practices include the utility of the Sexual Assault Nurse Examiner and Sexual Assault Forensic Examiner programs, as well as standardized treatment protocols.

The Role of “Real Rape” and “Real Victim” Stereotypes in the Police Reporting Practices of Sexually Assaulted Women

Some feminists have argued that rape myths constrain women’s reporting of sexual assault to the police. The authors investigated whether myth-associated characteristics of sexual assaults play a role in police reporting behaviors of women. A sample of 186 sexual assault cases seen at a hospital-based sexual assault care center in 1994 was analyzed using logistic regression. A positive association was found between reporting a sexual assault to the police and two overtly violent components of the “real rape” myth: the use of physical force and the occurrence of physical injury.

SIMILARITIES AND DIFFERENCES IN WOMEN'S SEXUAL ASSAULT EXPERIENCES BASED ON TACTICS USED BY THE PERPETRATOR

Only a few studies have examined the characteristics of sexual assault based on the tactics used by the perpetrator. In this study we compared the experiences of women who were forced to engage in vaginal, anal, or oral intercourse due to verbal coercion, physical force, or intoxication. Random-digit dialing was used to obtain a sample of 272 single African American and Caucasian women between the ages of 18 and 49 from the Detroit metropolitan area. Participants completed a computer-assisted self-interview that asked detailed questions about a past sexual assault and their reactions to it. Among the 139 women who were forced to engage in vaginal, anal, or oral intercourse, sexual assaults that involved physical force produced the most severe negative outcomes. Situations that involved the woman being too intoxicated to resist differed from others primarily in terms of how much alcohol the man and woman consumed. Although all types of sexual assault were perceived as being at least moderately serious, verbally coerced assaults were on average perceived as being least serious. These findings suggest that the perpetrators' tactics affect women's responses to sexual assault.

The Significant Frequency and Impact of Stealth (Nonviolent) Gender-Based Abuse Among College Women

The prevalence, incidence, and impact of the gender-based abuse (GBA) of college women have been increasingly documented since the 1980s, with growing precision in the measurements and expanding identification of tactics. Although there is an obvious class bias in focusing on college women (compared to women of similar ages not attending college), it is important to address GBA among this population as they are at serious risk of sexual abuse (particularly incapacitated rape), intimate partner abuse (IPA), and stalking. This article addresses the stealth nature of the nonviolent GBAs of college women and how these abuses frequently operate under the radar of acknowledgment by society, the abusers, campus officials, the criminal legal system, and sometimes, the survivors.

Ethanol and drug findings in women consulting a Sexual Assault Center--associations with clinical characteristics and suspicions of drug-facilitated sexual assault

The purpose of the study was to describe toxicological findings among women seeking health care after sexual assault, and to assess the relationship with so-called proactive DFSA (drug facilitated sexual assault). We also explored associations between ethanol in blood/urine and background data, assault characteristics, and clinical findings. We conducted a retrospective, descriptive study of female patients ≥ 12 years of age consulting the Sexual Assault Center at St. Olavs University Hospital, Trondheim, Norway. They were examined between July 1, 2003 and December 31, 2010, and urine and/or blood were analyzed for ethanol and selected medicinal/recreational drugs. Among the 264 patients included, ethanol and/or drugs were detected in 155 (59%). Of the 50 patients (19%) testing positive for drugs other than ethanol, benzodiazepines/benzodiazepine-like drugs were found in 31, central stimulants in 14, cannabinoids in 13 and opioids in nine. None tested positive for gamma-hydroxybutyrate (GHB). In total, 57 patients (22%) suspected proactive DFSA, but only five had findings of sedative drugs that were not accounted for by self-reported voluntary intake. No cases could unequivocally be attributed to proactive DFSA. Among the 120 patients tested for ethanol within 12 h after the assault, 102 were positive. The median estimated blood alcohol concentration (BAC) at the time of assault was 1.87 g/L. Patients testing positive for ethanol more often reported a public place of assault and a stranger assailant. Higher estimated BAC at the time of assault was associated with higher frequency of suspecting proactive DFSA. Ethanol was the most prevalent toxicological finding in urine/blood from victims of sexual assault, and high ethanol concentrations were often detected. Among the patients suspecting proactive DFSA, very few had sedative drug findings not explained by voluntary intake. It seems like opportunistic DFSA, rather than proactive DFSA dominate among the sexually assaulted attending our SAC.

Mock juror sensitivity to forensic evidence in drug facilitated sexual assaults

Mock jurors' reactions to variations in the quality of toxicological evidence regarding the presence of drugs in a sexual assault trial were examined. In Study 1, participants received a trial summary in which a negative test result, a negative test result plus expert testimony, or no test result was presented. The time taken by the complainant to report the alleged sexual assault was manipulated. The negative test result influenced participants' judgments, but this effect was minimized by the presence of expert testimony. The complainant's delay in reporting had little impact on judgments. In Study 2, complainant time to report was again manipulated along with the outcome of the test result (negative finding and no result). Results revealed that men were less conviction prone when the negative test result was obtained early as opposed to late. In contrast, when the test result was unavailable, men were more conviction prone when the complainant reported late as oppose to early.

The problem of untested sexual assault kits: why are some kits never submitted to a crime laboratory?

Victims of sexual assault are often advised to seek postassault medical care to have a forensic exam, which includes evidence collection (termed a sexual assault kit [SAK]). After the exam, law enforcement personnel are supposed to submit the SAK to a crime laboratory for analysis. However, recent media reports suggest that in many communities throughout the United States, thousands of SAKs are left untested. Few studies have examined the rate at which law enforcement submits SAKs to crime labs or the factors that may predict them to do so. Thus, the purpose of this exploratory study is twofold: (a) to examine the percentage of SAKs law enforcement submits to crime labs in cases in which a sexual assault nurse examiner (SANE) performed the exam with adult victims and (b) to explore whether assault and law enforcement characteristics predict whether SAKs are submitted to a crime lab. This study found that only 58.6% of the SAKs were submitted to the crime lab within a large Midwestern county. Using binary logistic regression, this study found that kits were significantly as likely to be submitted when there were documented physical (nonanogenital) injuries compared with kits that did not have documented physical injuries. In addition, kits that were handled by a law enforcement agency that had a high level of engagement with the SANE program were significantly as likely to be submitted as law enforcement agencies with a low or medium level of engagement. Kits were significantly less likely to be submitted when victims cleaned themselves after the sexual assault (e.g., bathing). No association was found between kit submission and the victim-offender relationship, suspected drug-facilitated sexual assault, anogenital injury, and when the victim consumed alcohol or drugs before the assault. This article concludes with a discussion of the implications for research and practice.

Sexual Violence Victimization of Women

Sexual violence is a serious public health problem with devastating health-related consequences. In this article, the authors review the prevalence, characteristics, vulnerability factors for, and impacts of sexual violence victimization for women. Some key factors are reviewed that have been shown to increase vulnerability for victimization, including certain demographic characteristics, previous victimization, and use of drugs or alcohol. The impacts of rape and other sexual violence are described, including physical and sexual health; psychological, social, and societal impacts; as well as impact on risky health behaviors. The authors conclude with a discussion of the public health approach to sexual violence, primary prevention, the relevance of sexual violence research for health care practitioners, and recommendations for health care practice.

Drug-facilitated crimes: definitions, prevalence, difficulties and recommendations. A review

Drug-facilitated crimes are not a new phenomenon but rather an age-old practice. However, reports of drug-facilitated crimes have significantly increased since the mid-1990s. Victims of these crimes or offences report that they were robbed or assaulted while incapacitated by a drug. Most often, these cases have involved strong central nervous system depressant drugs, which have the capability of preventing individuals from consenting to the action of the perpetrator of fighting off their attackers. For all intents and purposes, the drug acts as the offender's weapon, therefore many jurisdictions require analytical proof of its presence, which helps substantiate the alleged victim's claim. This review was undertaken to identify the evolutionary process in the current understanding of allegations of these crimes or offences, so that whoever works in this field may gain a better understanding of the complexities involved in such cases. This review provides several definitions of drug-facilitated crimes, their prevalence in European and English-speaking countries, a list of intoxicating substances, which have so far been incriminated or been suspected to be involved in these crimes or offences, some of the more common difficulties encountered in the investigation, and recommendations to improve detection of the drugs through toxicological analyses.

Factors associated with suspected drug-facilitated sexual assault

BACKGROUND

There has been little systematic investigation of widespread reports of drugging and sexual assault. We sought to determine the prevalence of and factors associated with suspected drug-facilitated sexual assault.

METHODS

Between June 2005 and March 2007, a total of 977 consecutive sexual assault victims underwent screening for suspected drugging at 7 hospital-based sexual assault treatment centres. We defined victims of drug-facilitated sexual assault as those who presented to a centre within about 72 hours of being assaulted and who provided at least 1 valid reason for suspecting that she or he had been drugged and sexually assaulted. We used logistic regression modelling to compare victims of suspected drug-facilitated sexual assault with other sexual assault victims, controlling for covariates.

RESULTS

In total, 882 victims were eligible for inclusion in the study. Of these, 855 (96.9%) were women, and 184 (20.9%) met the criteria for suspected drug-facilitated sexual assault. Compared with other victims, victims of drug-facilitated sexual assault were more likely to have presented to a large urban centre for care (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.47-3.65), to be employed (OR 1.92, 95% CI 1.34-2.76), to have consumed over-the-counter medications (OR 3.97, 95% CI 2.47-6.38) and street drugs (OR 1.71, 95% CI 1.12-2.62) in the 72 hours before being examined and to have used alcohol before the assault (OR 4.00, 95% CI 2.53-6.32).

INTERPRETATION

Suspected drug-facilitated sexual assault is a common problem. Sexual assault services should be tailored to meet the needs of those experiencing this type of victimization.

Rape: when the exam is normal

In this case report we present the sexual assault of a stuporous victim by a suspect who videotaped their encounter. We review the role of substance use and exam findings and discuss both victim and suspect factors that may lead to a negative examination of the victim.

Guidance for improved detection of drugs used to facilitate crimes

Reports of drug-facilitated crimes have significantly increased since the mid-1990s. When individuals report that they were robbed or assaulted while incapacitated by a drug, toxicologic testing may be needed to help substantiate the alleged victim's claims. Most often, these cases have involved strong central nervous system depressant drugs, which have the capability of preventing individuals from consenting to the action of the perpetrator or fighting off their attackers. For all intents and purposes, the drug acts as the offender's weapon, so many jurisdictions require analytical proof of its presence for criminal charges of the drug-facilitated crime to be filed. This article provides information on the manner in which drug-facilitated crimes occur, the drugs that are used to commit these crimes, and recommendations to improve the detection of these drugs through toxicologic analyses.

The impact of negative forensic evidence on mock jurors' perceptions of a trial of drug-facilitated sexual assault

Legal concerns with regard to the adverse impact of a negative toxicological screening for date-rape drugs in a case of drug-facilitated sexual assault (DFSA) were the focus of a recent Canadian case (R. v. Alouache, 2003). To assess the impact of a negative forensic report, as well as the impact of expert testimony explaining the many factors that may contribute to a negative outcome, participants (N=171) received a written trial stimulus in which the forensic evidence (negative report, negative report plus expert testimony, no negative report and no expert testimony control) and the complainant's beverage consumption (alcohol, cola) were systematically varied. Results indicate that a negative finding in the absence of expert testimony produced greater verdict leniency and more favourable evaluations of the defendant's case. In contrast, no differences were found between the case in which the expert testified and a case in which the negative report and expert testimony were omitted.

Criminal poisoning: drug-facilitated sexual assault

Drug-facilitated sexual assault (DFSA) is a complex and ever-prevalent problem presenting to emergency departments. Emergency personnel should consider DFSA in patients who are amnestic to the specific details of the event following a reported sexual assault. The presence of ethanol or a positive routine drug screen in a sexual assault victim does not exclude the potential of a surreptitious drug being present. In addition, a negative routine drug screen does not exclude all potential agents that are used in DFSA. This article discusses agents reported in DFSA. It is imperative for emergency personnel to clearly document the history and the presenting signs and symptoms to assist laboratory personnel to hone in and detect the correct agent used in a DFSA.

Toxicological investigation of drug-facilitated sexual assaults

Drug-facilitated sexual assaults have drawn a lot of attention during the last years. The role of the non-forensic doctors in the early recognition and management of such cases is crucial. Diagnosis assisted by samplings must be ascertained without delay, in victims initially brought to the emergency room for a sleepy state, a suspected abuse of drug or a pseudo-alcoholic clinical state. Further, where amnesia is present, it may be prudent to assume that sexual activity has occurred and offer pregnancy and sexually transmitted disease prophylaxis. Forensic doctors should entertain the possibility of poisoning in any presentation involving amnesia. Forensic toxicological laboratories should develop sensitive and specific methods to assure a low threshold of detection of the drugs. The awareness of a delinquent or criminal use of alcohol and/or drugs could permit a better medical recognition, so that proper and timely forensic examination is achieved, and adequate evidence is collected for the establishment of an effective investigation and prosecution.

A case in south-eastern France: A review of drug facilitated sexual assault in European and English-speaking countries

Drug facilitated sexual assaults (DFSA) have been increasingly reported in the medical literature since the 1980s but their legal recognition is more recent, at least in Europe. From a case treated in south-eastern France, whose judicial consequences were known, it seemed of interest to carry out an international study of jurisprudence concerning this type of rape. While from the medical viewpoint the drugs used are well-known and their presence can be clinically verified, the legal consequences of their use in subsequent criminal prosecution is less clear-cut. Some European countries have no jurisprudence in this area, while others consider the use of drugs as an aggravating circumstance. In France, it was only in 2003 that the first case of DFSA was truly punished by the judicial system, with considerable media attention. By contrast, in English-speaking countries, particularly the United States, the use of drugs to facilitate sexual assault has frequently been recognized in legislation and in criminal prosecutions. Prevention is fundamental and is recognised as demonstrated by campaigns in various countries.

Development of immunoaffinity solid phase microextraction probes for analysis of sub ng/mL concentrations of 7-aminoflunitrazepam in urine

We report on the development of solid phase microextraction probes for drug analysis, prepared with antibodies specific for benzodiazepines covalently immobilized to the surface. In the technique, immobilized antibody probes are exposed to a sample containing the drug for 30 min. Extracted drugs are subsequently desorbed from the probes in 500 microL of methanolic desorption solution, which is dried, reconstituted in a small volume of injection solution and analysed by LC-MS/MS. The antibodies were characterized both before and after immobilization, to facilitate the rational selection of antibodies for such analyses. Polyclonal and monoclonal antibodies were compared as was the impact of affinity purification of the polyclonal antibody to isolate the drug-specific fraction. The probes were evaluated for utility in analyzing 7-aminoflunitrazepam at sub ng/mL concentrations in urine, which is expected to be found several days after a single oral dose of 2 mg of flunitrazepam. Such analyses are required in monitoring for abuse of this drug, both in terms of 'club drug' use and in cases of drug-facilitated sexual assault. In these cases drug concentrations in blood and urine are much lower than in chronic abuse cases and are difficult to analyse by conventional methods. The method developed has a limit of detection of 0.02 ng/mL, with accuracy ranging from 1% to 27% and precision (% R.S.D.) ranging from 2% to 10% between the lower and upper limits of quantitation for the analysis of 7-aminoflunitrazepam in urine. The dynamic range of the method is from 0.02 ng/mL, which is limited by the instrument sensitivity, to 0.5 ng/mL, which is approaching the capacity of the probes. This would allow for quantitative analysis of samples at concentrations below that measurable by many other methods for general benzodiazepines analysis from urine, and a highly selective screen for samples at higher concentrations. The method has similar limits of detection to the most sensitive literature methods specifically designed for such analysis but with the advantage of significantly simplified sample preparation. This simplification makes the technique more amenable for use by both professionals and non-professionals.

Rising incidence of hospital-reported drug-facilitated sexual assault in a large urban community in Canada. Retrospective population-based study

BACKGROUND

Drug-facilitated sexual assault (DFSA) occurs when an individual has been sexually assaulted due to the surreptitious administration of drug(s) thereby rendering her/him unable to give consent. Our study aim was to calculate the age- and sex-specific annual incidence of hospital-reported DFSA and to determine whether a one-year increase in DFSA observed in 1999 in a pilot study on the same population was a significant and sustained trend.

METHODS

We identified cases of DFSA by reviewing the sexual assault examination records of all the individuals who presented to a hospital-based sexual assault care referral service in Vancouver, British Columbia during the study time period (January 1, 1993 to May 31, 2002). The annual sex- and age-specific incidence and temporal trends of drug-facilitated sexual assault were examined using population data from the British Columbia Ministry of Health.

RESULTS

The mean annual incidence of female DFSA increased from 3.4 per 100,000 (years 1993--1998) to 10.7 per 100,000 (years 1999--2002). Age-adjusted relative risks for female DFSAs were significantly higher in 1999 (2.77, 95% CI 1.85-4.15), 2000 (3.01, 95% CI 1.97-4.57), 2001 (3.14, 95% CI 2.07-4.78) and 2002 (4.88, 95% CI 2.84-8.37) compared to 1993-1998. Women aged 15-19 years had the highest DFSA incidence, with a year-adjusted relative risk of 3.89 (95% CI 2.75-5.50) compared to all other age groups.

CONCLUSION

This study demonstrates that the incidence of hospital-reported DFSA has shown a marked and sustained increase since 1999. Young women in their teens are particularly vulnerable to this form of sexual assault and further efforts are needed to develop and evaluate prevention programs for this group.

Determination of bromazepam, clonazepam and metabolites after a single intake in urine and hair by LC–MS/MS

The number of reports on drug facilitated crimes is increasing these last years. Apart from ethanol and cannabis, benzodiazepines (BZD) and analogs are the most common drugs reported to be used probably due to their amnesic and sedative properties. We have developed a rapid and sensitive method using LC-MS/MS triple stage quadrupole (TSQ) for the determination of single exposure to bromazepam (Lexomil, 6 mg) and clonazepam (Rivotril, 2 mg) in urine and hair of healthy volunteers. Chromatography was carried out on a Uptisphere ODB 5 microm, 2.1 mm x 150 mm column (Interchim) with a gradient of acetonitrile and formate 2 mM buffer, pH 3. Urine was extracted with Toxitube A (Varian) and allowed the detection of bromazepam, 3-hydroxy-bromazepam, clonazepam and 7-Aminoclonazepam for more than 6 days. Head hair, collected 1 month after the exposure, was treated by incubation with Soerensen buffer pH 7.6, followed by liquid-liquid extraction with dichloromethane for common BZD. A specific pre-treatment for amino-BZD, with an incubation of 15 min at 95 degrees C in 0.1 N NaOH before liquid-liquid extraction with dichloromethane, gave better recoveries and repeatability. After single exposure, bromazepam was present in powdered hair at 28 pg/mg and 7-Aminoclonazepam at 22 pg/mg in the first 1-cm segment, while no clonazepam was detectable. This method was applied in two forensic cases. It allowed us to determine bromazepam in urine 3 days after the alleged offense and in cut head hair at a concentration of 6.7 pg/mg only in the 2-cm proximal segment. The other case showed the presence of clonazepam and 7-Aminoclonazepam in urine a few hours after the offense and the presence of 7-Aminoclonazepam at about 3.2 pg/mg in axillary hair 4 months later.