مرکزی صفحہ Clinical Toxicology (Informa Healthcare) Toxicological analysis of blood and urine samples from female victims of alleged sexual assault

Toxicological analysis of blood and urine samples from female victims of alleged sexual assault

, ,
آپ کو یہ کتاب کتنی پسند ہے؟
فائل کی کوالٹی کیا ہے؟
کوالٹی کا جائزہ لینے کے لیے کتاب ڈاؤن لوڈ کریں
فائل کی کوالٹی کیا ہے؟
جلد:
50
زبان:
english
رسالہ:
Clinical Toxicology
DOI:
10.3109/15563650.2012.702217
Date:
August, 2012
فائل:
PDF, 201 KB
0 comments
 

To post a review, please sign in or sign up
آپ کتاب کا معائنہ کر سکتے ہیں اور اپنے تجربات شیئر کرسکتے ہیں۔ دوسرے قارئین کتابوں کے بارے میں آپ کی رائے میں ہمیشہ دلچسپی رکھیں گے۔ چاہے آپ کو کتاب پسند ہے یا نہیں ، اگر آپ اپنے دیانتدار اور تفصیلی خیالات دیںگے تو لوگوں کو نئی کتابیں ملیںگی جو ان کے لئے صحیح ہیں۔
Clinical Toxicology (2012), 50, 555–561
Copyright © 2012 Informa Healthcare USA, Inc.
ISSN: 1556-3650 print / 1556-9519 online
DOI: 10.3109/15563650.2012.702217

CRITICAL CARE

Toxicological analysis of blood and urine samples from female
victims of alleged sexual assault
ALAN W. JONES, ANITA HOLMGREN and JOHAN AHLNER

Clinical Toxicology Downloaded from informahealthcare.com by University of Louisville on 12/27/14
For personal use only.

Department of Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.

Background. The toxicological analysis of blood and urine samples from victims of alleged sexual assault represents a crucial part of the
forensic evidence when this crime is investigated. Material and methods. We searched a national forensic toxicology database (TOXBASE)
to find cases registered as sexual assault, rape, including date-rape that the police had requested the analysis of ethanol and other drugs.
Between 2008 and 2010, N  1460 such cases met this criteria. After immunological screening of urine or blood samples, all positive
results were verified by more specific analytical methods, such as gas chromatography-mass spectrometry (GC-MS) for illicit drugs. A
large number of prescription drugs and their metabolites were determined by capillary GC with nitrogen-phosphorous (N-P) detector. GC
with flame ionization detector (FID) was used to analyze ethanol and gamma-hydroxybutyrate (GHB) in blood at limits of quantitation
(LOQ) of 0.1 g/L and 8 mg/L, respectively. Results. The average age ( standard deviation) of all victims was 24  10.3 years and
72% were between 15 and 29 years. Ethanol and other drugs were not detected in 31% of cases (N  459). Blood-ethanol was positive
in N  658 cases at mean, median and highest concentrations of 1.23 g/L, 1.22 g/L and 4.3 g/L, respectively. Ethanol plus drugs were
present in N  188 cases (13%) and one or more other drugs alone in N  210 cases (14%). Cannabis (marijuana) and amphetamines
were the major illicit drugs, whereas diaz; epam, alprazolam, zopiclone as well as newer antidepressants were the major prescription drugs
identified. Conclusions. The mean age of victims of sexual assault in Sweden, the proportion of drug positive to drug negative cases, the
predominance of ethanol positive cases as well as the types of other drugs showed a remarkably good agreement in two studies spanning
a period of 8 years.
Keywords

Alcohol; Date rape; Drug use; Ethanol; Sexual assault

zopiclone) and flunitrazepam is seldom verified.10 – 12 However, because many of these drugs have short elimination
half-lives, the concentrations in blood or urine might have
decreased below the analytical limits of quantitation by the
time specimens were collected from the victims.13
Ethanol is a legal drug, and depending on the dose
ingested, the speed of drinking, the person’s age and previous
experience with alcohol ethanol-induced effects might range
from mild euphoria to unconsciousness.14 Ethanol influences people in different ways from no discernable effects
to excitement, loss of inhibitions and dangerous behaviour,
including engaging in unplanned sexual activities.15,16 There
is often a fine dividing line between consensual sex and
sexual assault, especially when both parties are under the
influence of alcohol.17,18 Excessive binge drinking resulting
in high BAC (2.0 g/L) often leads to gross intoxication and
incapacitation in novice drinkers.8,19
This article reports the toxicological results from analysis
of blood and urine samples from female victims of alleged
sexual assault or rape that came to the attention of the police
in Sweden between 2008 and 2010. The victims of this crime
are representative of the whole country, and the toxicological
results were compared and contrasted with an earlier investigation covering the years 2003–2007.20

Introduction
Drug-facilitated sexual assault (DFSA), conjures up the
image of a perpetrator adding a chemical substance to a person’s food or drink to render them incapacitated for the purpose of committing an illicit sexual act.1,2 Drug-facilitated
crimes attract a lot of attention from the news media, government agencies as well reports in scientific journals.3 When
investigating DFSA, it is obviously important to determine
whether drugs had been taken voluntarily, which is often the
case with the legal drug ethanol.4 –7 Moreover, it is important
to establish whether the victims were taking any prescription
or recreational drugs at the time the offence was committed.
In most of the previous investigations of DFSA, the principal toxicological finding has been a positive blood-alcohol
concentration (BAC).8,9 The presence of fast-acting hypnotic or knock-out drugs, as exemplified by chloral hydrate,
gamma-hydroxybutyrate, z-hypnotics (zaleplon, zolpidem,

Received 8 May 2012; accepted 4 June 2012.
Address correspondence to Professor Alan W. Jones, Department
of Forensic Toxicology, National Board of Forensic Medicine,
Artillerigatan 12, 587 58 Linköping, Sweden. Tel:  46 13 252114.
Fax: 46 13 104875. E-mail wayne.jones@LIU.se

555

556 A. W. Jones et al.

Materials and methods

Clinical Toxicology Downloaded from informahealthcare.com by University of Louisville on 12/27/14
For personal use only.

Police procedures
When the police authorities investigate crimes of a sexual
nature, they have at their disposal a so-called “rape kit”
which allows them to collect forensic evidence, including
samples of blood and urine for toxicology, and other biological fluids for DNA analysis. Venous blood is taken into
evacuated tubes (10 mL) containing sodium fluoride (100
mg) and potassium oxalate (25 mg) as preservatives. Whenever possible a specimen of urine (10 mL) is also collected
in a tube containing sodium fluoride (∼1%) as a preservative
and enzyme inhibitor.
Forensic toxicology
Blood and urine samples from victims of alleged sexual
assault or date rape in Sweden are sent by express mail
for analysis to a central forensic toxicology laboratory. On
arrival at the laboratory, the cases are registered using information written on the police report forms that accompany
blood and urine samples. This information describes the
nature of the case, whether sexual assault or rape, attempted
murder, or some other crime in which drugs and alcohol
might be involved. The analytical results and demographics
of the victims are entered into a national forensic toxicology database TOXBASE, which was used for the present
study.21
Analysis of ethanol and other drugs
The analytical methods used to determine ethanol and other
drugs were the same as those used in our earlier study, which
allows a direct comparison of the toxicological results.20
The laboratory work starts with a general screening analysis by immunoassay methods aimed at five classes of drugs
(amphetamine analogs, cannabinoids, cocaine metabolite,
opiates and benzodiazepines). This initial screening is done
on urine specimens if available, otherwise on blood samples
after precipitation of proteins.
An aliquot of blood (1 mL) is mixed with acetone (3 mL)
and then centrifuged to obtain a supernatant, which is carefully removed and used for the immunoassay. After evaporation to near-dryness, the residue is dissolved in methanol
(0.5 mL) prior to automated enzyme-multiplied immunoassay (EMIT) and cloned enzyme donor immunoassay
(CEDIA). All results from the screening analysis are verified
by more specific methods, such gas chromatography-mass
spectrometry (GC-MS) or liquid chromatography-mass
spectrometry (LC-MS) for illicit drugs and metabolites.
Because EMIT and CEDIA are not suitable for analysis of most prescription drugs and metabolites, these were
determined after solvent extraction with n-butyl acetate and
capillary GC with N-P detector. This analytical method has
been used in our laboratory for many years and allows the
identification and quantification of about 200 acidic, basic
and/or neutral drugs and metabolites, including sedativehypnotics, clonidine and ketamine.

Gamma-hydroxybutyrate (GHB) was determined in blood
and/or urine by GC and FID detector after conversion into
the gamma-butyrolactone (GBL) derivative by acidification.
The limit of quantitation (LOQ) for GHB was 8 mg/L.22 The
concentrations of ethanol in blood and urine were determined by automated headspace analysis with GC-FID and a
method LOQ of 0.1 g/L for reporting positive results.20
Data selection and statistical analysis
All requests for toxicological analysis are entered into a
national forensic database (TOXBASE). We searched TOXBASE for information on the police request forms indicating that the crime being investigated was of a sexual nature,
such as sexual assault, date-rape or DFSA. The search of
TOXBASE was restricted to female victims, in part because
there are so few male victims and the fact that females were
included in our earlier study.20 This furnished results from
8 years of forensic blood and urine samples, 2008–2010
(N  1406) and 2003–2007 (N  1806).
Mean, median and highest concentration of ethanol and
other drugs were used as descriptive statistics. The mean age
of victims was compared by Student t-test and median concentrations of ethanol by Mann–Whitney test. The association between a victim’s age and blood-alcohol concentration
was established by calculating the Pearson correlation coefficient. Two percentages, for example, percent drug positive
to negative cases were compared by a chi-squared test.

Results
Trends over time
Fig. 1 shows month-by-month changes in the number of
alleged sexual assault or date rape cases submitted by the
police for toxicological analysis. There were N  538 cases
(37%) in 2008, N  470 (32%) in 2009, and N  452 (31%)
in 2010. There was an increase in number of cases from May
(N  108) to June (N  145), but otherwise monthly variations
were unremarkable. Fig. 1 also shows the change in mean age
of victims per month, which varied from 23 to 25 years as well
as the mean BAC, which ranged from 1.09 g/L (April) to 1.38
g/L (August) with an overall mean of 1.23 g/L.
Age distribution of victims
Fig. 2 compares the relative frequency distributions of age
of sexual assault victims in Sweden in the studies spanning a total of 8 years. The mean ages of 24  10.0 years
(2003–2007) and 24  10.3 years (2008–2010) were virtually identical (p  0.05). Moreover, the frequency distributions of age showed remarkably good agreement, both were
skewed to the right with 72% of victims aged 15–29 years
(2003–2007) compared with 73% within this age range for
the period 2008–2010.
In 458 of 1460 cases (31%), ethanol and other drugs were
negative in blood or urine and the mean age of these victims
(23  10.0 years) was not significantly different from the age
of drug-positive cases (25  10.4 years) (p  0.05).
Clinical Toxicology vol. 50 no. 7 2012

Date-rape drugs 557
1.5

250
Mean
BAC

1.0
23 y

150
24 y
23 y 25 y

24 y

24 y 24 y

25 y 24 y

24 y

24 y 25 y

100
0.5

Blood Alcohol Conc., g/L

Number of Cases

200

0.0

0
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Month

Fig. 1. Month-by-month variation in number of sexual assault or date rape cases (2008–2010) sent by the police for toxicological analysis. Above
each bar the average age of victims is shown along with monthly mean blood-alcohol concentration (BAC).

Distribution of blood-ethanol concentration
Relative frequency distributions of blood-ethanol concentration (LOQ  0.1 g/L) for the two study periods are compared
in Fig. 3. The results show a good agreement, and median
BAC of 1.19 g/L (2003–2007) and 1.22 mg/L (2008–2010)
were not statistically different (p  0.05). During the period
2003–2007, N  134 cases (11%) had a BAC  2.0 g/L compared with N  83 cases (9%) during the years 2008–2010.
The blood-ethanol concentration was positively correlated
with victims age r  0.25 (p  0.001), although this association was not as strong as in the earlier study 2003–2007
(r  0.37) (p  0.001).

Concentrations of drugs in blood
Table 1 shows the frequency of drug positive and drug negative cases in the two studies. There were 31% of cases negative for alcohol and drugs in both time periods. Ethanol was
by far the most frequently identified substance and positive
results were found in 41–43% of all cases (0.1 g/L). The
co-administration of ethanol and other drugs, both licit and
illicit, were also common findings (Table 1). Table 1 also
attempts to classify the drugs identified, whether illicit or
licit (prescription), as shown by the footnotes to the table.
Table 2 shows that many more drug-positive cases were
identified based on analysis of urine than blood, such as

50

2003-2007, N = 1804

40
Relative Frequency, %

Clinical Toxicology Downloaded from informahealthcare.com by University of Louisville on 12/27/14
For personal use only.

50

2008-2010, N = 1460
30

20

10

0
10

20

30

40
Age, y

50

60

70

Fig. 2. Relative frequency distribution of age of female victims of alleged sexual assault in two study periods covering years 2003–2007 and
2008–2010.
Copyright © Informa Healthcare USA, Inc. 2012

558 A. W. Jones et al.
15
2003-2007, N = 806
Relative Frequency, %

2008-2010, N = 658
10

5

Clinical Toxicology Downloaded from informahealthcare.com by University of Louisville on 12/27/14
For personal use only.

0
0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Blood Alcohol Conc., g/L

Fig. 3. Relative frequency distribution of blood-ethanol concentration in female victims of sexual assault in two studies covering years 2003–2007
and 2008–2010.

791 ethanol positives compared with 658 positives in blood.
The individual drugs are also listed in Table 2 and if there
were ten or more occurrences the mean, median and highest
concentrations in blood are reported.
The two principal illicit drugs used by victims of sexual
crimes were cannabis (marijuana) and amphetamine, which
ranked fourth and fifth, respectively (Table 2). Among prescription medication, sedative-hypnotics, such as diazepam,
alprazolam and zopiclone, were common as were the newer
antidepressants, exemplified by citalopram, fluoxetine and
venlafaxine. The types of drugs and their rank ordering
Table 1. Toxicological results from analysis of ethanol and other
drugs in blood and/or urine samples from female victims of sexual
assault or date rape during two study periods over 8 years.
Drugs and drug combinations
Ethanol only drug detected
Ethanol  benzodiazepines*
Ethanol  prescription drugs
(non-sedatives)†
Ethanol  illicit drugs‡
Ethanol  illicit drugs‡ 
benzodiazepines*
Ethanol  opiates/opioids¶
Ethanol  other drug combinations
Benzodiazepines* only
Illicit drugs‡  benzodiazepines*
Illicit drugs only‡
All other drug combinations†
Legal drugs in all combinations
No drugs identified ( LOQ)

2003–2007
N  1806

2008–2010
N  1406

772 (43%)
49 (2.7%)
56 (3.1%)

603 (41%)
30 (2.0%)
54 (3.7%)

41 (2.2%)
23 (1.3%)

40 (2.7%)
8 (0.5%)

11 (0.6%)
33 (1.8%)
47 (2.6%)
28 (1.6%)
58 (3.2%)
75 (4.2%)
54 (3.0%)
559 (31%)

10 (0.7%)
46 (3.2%)
29 (2.0%)
13 (0.9%)
36 (2.5%)
81 (5.5%)
51 (3.5%)
459 (31%)

LOQ  limit of quantification.
*Alprazolam, diazepam, clonazepam, nitrazepam, flunitrazepam etc, including
zopiclone, zolpidem and zaleplon.
†Mainly antidepressants, paracetamol, caffeine, antihistamines and muscle
relaxants (non-sedative-hypnotics but excluding opiates).
‡Amphetamine, methamphetamine, ecstasy (MDMA), cocaine and benzoylecgonine, GHB, cannabis (THC and carboxy-THC), 6-acetyl morphine.
¶Buprenorphine, propoxyphene, ethyl morphine, codeine, morphine, methadone, tramadol, oxycodone.

showed good agreement between the two studies,20 with two
exceptions; fluoxetine replaced sertraline as the 9th most
common drug in 2008–2010 and codeine replaced tramadol
as the 10th most common drug.
The results in Table 2 also suggest that victims with ethanol, fluoxetine and/or THC positive in blood were younger
(mean 23–25 years) than those with codeine, zopiclone and/
or amphetamine (mean 34–39 years). The median concentrations of the various prescription drugs in blood were in the
therapeutic interval for valid use of this medication.
Trends in drug positive cases over time
The results from the two study periods 2003–2007 (N  1806)
and 2008–2010 (N  1460) are compared and contrasted in
Table 3. The annual number of cases increased from 361 per
year (2003–2007) to 486 per year (2008–2010) an increase
of 36% per year. Otherwise, the mean and median age of
victims, the percentage of alcohol and/or drugs positive to
negative cases as well as the mean and median BAC agreed
well between the two studies.

Discussion
The relatively few male victims of DFSA in Sweden were
not included to allow direct comparison with our earlier
work (2003–2007), which only included female victims
of this crime.20 In both studies, spanning a total of 8 years
and a total of 3266 cases of alleged sexual assault or rape,
there was a striking predominance of alcohol positives and
elevated BAC.20 The pattern of alcohol and drug use in
these victims of sexual crimes is representative for the entire
country, which is one of the strengths of the present study.
Moreover, the same analytical toxicology was applied in all
sexual crimes and not just those cases in which the victim
claimed they had been drugged by a perpetrator.
In a recent review article, it was noted that in only 2%
of cases of alleged DFSA was there evidence of covert
Clinical Toxicology vol. 50 no. 7 2012

Date-rape drugs 559
Table 2. The drugs most often identified in blood and/or urine in N  1630 female victims of sexual assault with number of positive cases, mean
age ( standard deviation) of victims and the mean, median and highest concentrations of ethanol and drugs in blood.
Drugs*

Clinical Toxicology Downloaded from informahealthcare.com by University of Louisville on 12/27/14
For personal use only.

Ethanol
Paracetamol
Diazepam
Cannabis (THC)¶
Amphetamines
Alprazolam
Zopiclone
Citalopram
Venlafaxine
Fluoxetine
Codeine

N†
(urine)
791
88
86
85
55
33
33
26
19
18
17

Age, years
Mean  SD

N‡
(blood)

Mean drug
conc. mg/L

Median drug
conc. mg/L

Highest drug
conc. mg/L

25  10.3
29  12.6
33  12.1
25  8.3
30  11.2
32  12.3
34  14.3
28  10.7
29  10.8
23  6.7
39  8.2

658
87
64
33
33
19
13
26
19
14
11

1230
6.5
0.24
0.001
0.35
0.06
0.10
0.11
0.25
0.28
0.07

1220
5.0
0.10
0.0007
0.24
0.04
0.05
0.10
0.10
0.20
0.08

4300
25
1.0
0.006
1.7
0.19
0.40
0.30
0.90
0.70
0.16

conc.  concentration.
*Included if there was more than ten occurrences of the same substance in blood.
†Number of drug positive cases in urine.
‡Number of drug positive cases in blood as well as mean, median and highest concentrations. ¶Cannabis verified as tetrahydrocannabinol (THC) in blood and
carboxy-THC in urine.

administration of drugs.23 During police investigations, it is
obviously important to consider any voluntary use of drugs
and/or alcohol when statistics are compiled, including any
medication being prescribed to victims. Furthermore, it
needs to be established whether alcohol or drugs had been
taken after the offence but before sampling blood for toxicology. If victims received an analgesic or an anti-anxiety agent
when being examined by a physician, this clearly needs to be
considered when analytical results are interpreted.
A limitation of the present study, as well as many other
investigations of DFSA, is the amount of time that passes
after the offence before biological specimens were obtained
for toxicological analysis. Much depends on the physical,
psychological and emotional state of the victim, the location of the attack, the advice and help given by friends and

Table 3. Comparison of toxicological results from analysis of ethanol
and/or other drugs in female victims of sexual assault 2003–2007 and
2008–2010.
Results
Number of cases
Cases per year
Mean age  SD, years
Age (median), years
Ethanol and drugs negative, N (%)
Ethanol positive in blood, N (%)1
Ethanol positive in blood or
urine, N (%)
Mean BAC  SD, g/L
Median BAC, g/L‡
Other drugs positive in blood, N (%)¶
Other drugs positive in blood or
urine, N (%)¶

Period
2003–2007

Period
2008–2010

1806
361
24  10.1
20
559 (31%)
806 (45%)
952 (53%)

1460
486*
24  10.3†
20
459 (31%)†
658 (45%)†
791 (54%)†

1.24  0.70
1.19
345 (19%)
475 (26%)

1.23  0.65
1.22†
313 (21%)†
412 (28%)†

BAC  blood-alcohol concentration.
*Significantly more cases per year 2008–2010 (p  0.001).
†No significant differences for the two study periods (p  0.05).
‡Blood-ethanol  0.1 g/L with or without other drugs present.
¶With or without ethanol present.
Copyright © Informa Healthcare USA, Inc. 2012

relatives and transport to a location where a medical examination and sampling of body fluids is possible. Drugs with
short elimination half-lives, such as z-hypnotics and GHB,
might become eliminated from the body by the time blood
and/or urine was taken for analysis. Accordingly, a negative
toxicology report for these substances, does not rule out that
they had been administered or used by a victim. This is evidenced by zopiclone, with 33 positive findings in urine but
only 13 in blood (Table 2).
The victims BAC at time of sampling blood will also be
lower than the BAC when the crime was committed, although
knowledge of ethanol’s pharmacokinetics permits making a
back calculation. The elimination kinetics of ethanol from
blood is a zero-order process provided BAC exceeds 0.1–0.2
g/L.24 If and when a back calculation is done in DFSA cases,
then a good strategy is to use a range of ethanol elimination
rates, such as 0.10–0.20 g/L/h or an average of 0.15 g/L/h
for moderate drinkers.8,25 Interpreting the BAC in relation
to the degree of impairment or incapacitation of the victim
is much more difficult and much depends on the person’s
age, the dose of ethanol, the speed of drinking and the person’s tolerance to ethanol. The combined effects of alcohol
and other drugs, especially sedative-hypnotics, might cause
greater impairment than alcohol alone.26
The percentage of drug positive cases was higher in urine
than in blood (Table 2), because urine provides a wider
detection window in analytical toxicology.27 The use of
alternative specimens for toxicology, such as hair, is gaining
in importance in DFSA cases, which extends the detection
window even further.28 However, interpreting the concentrations of drugs and metabolites in urine or hair in relation
to the clinical effects on the individual, such as impairment
or incapacitation, is not possible. The presence of drugs or
their metabolites in urine verifies prior use of the substances
but when they were taken or the effects produced on the
individual cannot be determined.
Publications on DFSA from several countries confirm
that the principal psychoactive substance identified in blood

Clinical Toxicology Downloaded from informahealthcare.com by University of Louisville on 12/27/14
For personal use only.

560 A. W. Jones et al.
of victims is the legal drug ethanol.9,29 In a small case series
(N  135) of sexual assaults in the Netherlands, most victims
were women (94%) having a mean age of 25 years and most
had consumed ethanol before they were attacked.30 The presence of alcohol and other drugs was negative in 27% of cases
and proportion of negative cases increased with longer times
before sampling blood and urine for toxicology. The mean
BAC in this Dutch study was 1.21 g/L, which is in good
agreement with results from Sweden (1.23 g/L). Other common drugs identified in the Dutch study besides ethanol were
non-opiate analgesics, illicit drugs and benzodiazepines.30
Cannabis (marijuana) and amphetamine are popular illicit
recreational drugs in Sweden, and these substances were
among the drugs verified positive in blood or urine (Table 2).
It is difficult to envisage surreptitious administration of these
drugs; however, their pharmacological effect might have
increased the propensity for unplanned sexual encounters.
The antidepressants, citalopram, venlafaxine and fluoxetine,
were common findings, and this type of medication is often
prescribed to young adults in today’s society.31 The presence
of codeine in 11 blood samples and paracetamol (acetaminophen) in 87 might have arisen from use of over-the-counter
paracetamol-codeine formulations (Table 2).
The hypnotic drug, zopiclone, was identified in N  13
blood samples (Table 2), and this substance might render
people drowsy making them more susceptible to a sexual
crime.13 A likely scenario is that zopiclone was taken as a
sleeping aid whereafter victims became vulnerable to sexual
advances from an acquaintance or perpetrator.32 The benzodiazepine anxiolytics diazepam and alprazolam were also
identified in blood samples, and this medication can alter
a person’s awareness and judgement, especially when combined with alcohol.33
The proportions of drug positive to drug negative cases,
the high prevalence of ethanol, the high median BAC as well
as average age of victims showed very good agreement in
two studies spanning a total of 8 years. Ethanol was the psychoactive substance most commonly identified, which agrees
with investigations of sexual assaults occurring in other
nations, even if drinking habits and use of alcohol as a social
drug might be different in Sweden.8,18,34 Because ethanol is
a legal drug, many victims probably met their assailant at a
bar, a pub or a party where alcohol was served.
Elevated BAC leads to excitement, loss of inhibitions,
poor judgement and sometimes an increased propensity to
take risks, which together might make some people more
vulnerable to sexual advances. However, this is a matter for
lawyers, expert witnesses and the courts to consider when
people are prosecuted for DFSA, although we have no information about how many cases actually went to trial.17,35 The
so-called date rape drugs, exemplified by GHB and flunitrazepam, were noticeably absent, which calls into question
their use in DFSA crimes in Sweden.5,10,36
The annual number of DFSA cases increased by 35%
between the two study periods 2003–2007 and 2008–2010,
which either means that date-rape is increasing in frequency
or that victims are more likely to make a police report
that a sexual crime was committed. The low age of female

victims (mean 23–25 years), their relatively high BAC (mean
1.23 g/L), with many above 2.0 g/L, suggests that alcohol
intoxicated was an important element in the case.

Declaration of interest
There was no external funding for this study and none of the
authors consider that they have any conflicts of interest by
publishing this article. Ethical committee approval for this
study was neither applied for nor obtained because the subjects were not identifiable in the data evaluated.

References
1. Bechtel LK, Holstege CP. Criminal poisoning: drug-facilitated sexual
assault. Emerg Med Clin North Am 2007; 25:499–525.
2. Hall JA, Moore CB. Drug facilitated sexual assault–a review.
J Forensic Leg Med 2008; 15:291–297.
3. UNODC. Guidelines for the forensic analysis of drugs fascilitating
sexual assault and other criminal acts. Vienna: United Nations Office
on Drugs and Crime; 2011:1–46.
4. Scott-Ham M, Burton FC. Toxicological findings in cases of alleged
drug-facilitated sexual assault in the United Kingdom over a 3-year
period. J Clin Forensic Med 2005; 12:175–186.
5. Djezzar S, Questel F, Burin E, Dally S. Chemical submission: results
of 4-year French inquiry. Int J Legal Med 2009; 123:213–219.
6. Grossin C, Sibille I, Lorin de la Grandmaison G, Banasr A, Brion F,
Durigon M. Analysis of 418 cases of sexual assault. Forensic Sci Int
2003; 131:125–130.
7. Du Mont J, Macdonald S, Rotbard N, Asllani E, Bainbridge D, Cohen
MM. Factors associated with suspected drug-facilitated sexual assault.
CMAJ 2009; 180:513–519.
8. Scott-Ham M, Burton FC. A study of blood and urine alcohol
concentrations in cases of alleged drug-facilitated sexual assault in
the United Kingdom over a 3-year period. J Clin Forensic Med 2006;
13:107–111.
9. Papadodima SA, Athanaselis SA, Spiliopoulou C. Toxicological
investigation of drug-facilitated sexual assaults. Int J Clin Pract 2007;
61:259–264.
10. Schwartz RH, Weaver AB. Rohypnol, the date rape drug. Clin Pediatr
(Phila) 1998; 37:321.
11. Madea B, Musshoff F. Knock-out drugs: their prevalence, modes of action, and means of detection. Dtsch Arztebl Int 2009; 106:341–347.
12. Hughes H, Peters R, Davies G, Griffiths K. A study of patients
presenting to an emergency department having had a “spiked drink”.
Emerg Med J 2007; 24:89–91.
13. Stockham TL, Rohrig TP. The use of Z-drugs to facilitate sexual assault. Forensic Sci Rev 2010; 22:61–73.
14. Horvath MA, Brown J. The role of drugs and alcohol in rape. Med Sci
Law 2006; 46:219–228.
15. LeBeau MA, Montgomery MA. Challenges of drug-facilitated sexual
assault Forensic Sci Rev 2010; 22:1–6.
16. Newcomb ME, Clerkin EM, Mustanski B. Sensation seeking moderates the effects of alcohol and drug use prior to sex on sexual risk in
young men who have sex with men. AIDS Behav 2011; 15:565–575.
17. Testa M, Livingston JA. Alcohol consumption and women’s vulnerability to sexual victimization: can reducing women’s drinking prevent
rape? Subst Use Misuse 2009; 44:1349–1376.
18. Abbey A, Zawacki T, Buck PO, Clinton AM, McAuslan P. Alcohol
and sexual assault. Alcohol Res Health 2001; 25:43–51.
19. Jones AW, Holmgren P. Comparison of blood-ethanol concentration in
deaths attributed to acute alcohol poisoning and chronic alcoholism.
J Forensic Sci 2003; 48:874–879.
20. Jones AW, Kugelberg FC, Holmgren A, Ahlner J. Occurrence of ethanol and other drugs in blood and urine specimens from female victims
of alleged sexual assault. Forensic Sci Int 2008; 181:40–46.
Clinical Toxicology vol. 50 no. 7 2012

Clinical Toxicology Downloaded from informahealthcare.com by University of Louisville on 12/27/14
For personal use only.

Date-rape drugs 561
21. Druid H, Holmgren P, Lowenhielm P. Computer-assisted systems
for forensic pathology and forensic toxicology. J Forensic Sci 1996;
41:830–836.
22. Jones AW, Holmgren A, Kugelberg FC. Driving under the influence
of gamma-hydroxybutyrate (GHB). Forensic Sci Med Pathol 2008;
4:205–211.
23. Beynon CM, McVeigh C, McVeigh J, Leavey C, Bellis MA. The involvement of drugs and alcohol in drug-facilitated sexual assault: a systematic
review of the evidence. Trauma Violence Abuse 2008; 9:178–188.
24. Jones AW. Pharmacokinetics of ethanol – issues of forensic importance. Forensic Sci Rev 2011; 23:91–136.
25. Jones AW. Evidence-based survey of the elimination rates of ethanol
from blood with applications in forensic casework. Forensic Sci Int
2010; 200:1–20.
26. Jones AW. Pharmacokinetic and pharmacodynamic interactions
between alcohol and other drugs. In: Mozayani A, Raymon L, eds.
Handbook of Drug Interactions, a Clinical and Forensic Guide. Totowa: Humana Press; 2011:87–114.
27. Verstraete AG. Detection times of drugs of abuse in blood, urine, and
oral fluid. Ther Drug Monit 2004; 26:200–205.
28. Barroso M, Gallardo E, Vieira DN, Lopez-Rivadulla M, Queiroz JA.
Hair: a complementary source of bioanalytical information in forensic
toxicology. Bioanalysis 2011; 3:67–79.

Copyright © Informa Healthcare USA, Inc. 2012

29. Hall J, Goodall EA, Moore T. Alleged drug facilitated sexual assault
(DFSA) in Northern Ireland from 1999 to 2005. A study of blood alcohol levels. J Forensic Leg Med 2008; 15:497–504.
30. Bosman IJ, Verschraagen M, Lusthof KJ. Toxicological findings
in cases of sexual assault in the Netherlands. J Forensic Sci 2011;
56:1562–1568.
31. Nguyen HV, Kaysen D, Dillworth TM, Brajcich M, Larimer ME. Incapacitated rape and alcohol use in White and Asian American college
women. Violence Against Women 2010; 16:919–933.
32. Gustavsen I, Al-Sammurraie M, Morland J, Bramness JG. Impairment related to blood drug concentrations of zopiclone and zolpidem
compared to alcohol in apprehended drivers. Accid Anal Prev 2009;
41:462–466.
33. Montgomery MA. The use of benzodiazepiones to facilitate sexual
assault. Forensic Sci Rev 2010; 22:33–40.
34. Abbey A, Zawacki T, Buck PO, Testa M, Parks K, Norris J, et al.
How does alcohol contribute to sexual assault? Explanations
from laboratory and survey data. Alcohol Clin Exp Res 2002; 26:
575–581.
35. Kerrigan S. The use of alcohol to facilitate sexual assault. Forensic Sci
Rev 2010; 22:15–32.
36. Marinetti L, LeBeau MA. The use of GHB and analogs to facilitate
sexual assault. Forensic Sci Rev 2010; 22:41–59.