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Spiking Prevalence and Motivation

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 SPIKING PREVALENCE AND
MOTIVATION:
A REVIEW OF THE LITERATURE

Contributors:
Dr Amy Burrell
P ro fe s s o r J e s s i ca Wo o d h a m s
Pippa Gregory
Elizabeth Robinson

March 2023
CONTENTS

GLOSSARY OF TERMS 4

EXPLANATORY NOTES AND DEFINITIONS 5

INTRODUCTION 6

AIM OF THE REPORT 7

METHOD 8

RATIONALE FOR SEARCHES 9

INCLUSION/EXCLUSION CRITERIA 11

FINDINGS 14

RESEARCH QUESTION 1 14
RESEARCH QUESTION 2 17
ADDITIONAL FINDINGS 21
LIMITATIONS 23

CONCLUSIONS 25

REFERENCE LIST 28

APPENDIX A: LITERATURE REVIEW TABLE 36

GLOSSARY OF TERMS

ACPO Association of Chief Police Officers (UK)

BASHH British Association For Sexual Health And HIV

DAFR Drug Or Alcohol Facilitated Rape

DFSA Drug Facilitated Sexual Assault

DFC Drug Facilitated Crime

GHB Gamma-Hydroxybutyrate

GUM Genito-Urinary Medicine

NCA National Crime Agency

SVV Sexual Violence Victimisation

SVP Sexual Violence Perpetration

EXPLANATORY NOTES
AND DEFINITIONS
Aside from the acronyms above, there are some terms which are used in the
literature which might be useful to explain. This provides context for the report
and provides a place of reference when interpreting findings.

Spiking - the covert administration of substances (e.g., drugs, alcohol) to another

person without their knowledge or consent. This can be an action on its own or
be followed by another offence (e.g., rape or robbery).

Involuntary consumption – this is where a substance that the victim consumed

was administered involuntarily (i.e., someone else gives them the alcohol or
drugs covertly). This can co-occur with voluntary consumption (see below) – for
example, someone who has consumed alcohol voluntarily might be given a drug
covertly. Other terms used to describe involuntary consumption include
unintentional consumption, covert administration, or deliberate spiking.

Voluntary consumption – some victims of assault (e.g., rape, robbery) are

targeted when they are under the influence of substances (such as alcohol, illicit
drugs, or prescription medication) which they have taken voluntarily. Voluntary
consumption / intoxication can increase vulnerability as offenders choose to
target people who are unable to defend themselves or, in the context of sexual
offences, unable to give consent. Although a crime has been committed, these
would not be considered to be spiking as the administration of substances was
via self-administration.

Proactive DFSA - the involuntary / covert / unintentional consumption of

substances before the sexual assault.

Opportunistic DFSA – sexual assaults where the victim is intoxicated due to self-
administration.

‘Party drugs’ – some drugs are used recreationally but can render a person
susceptible to assault. Examples include amphetamines, 3,4-methylenedioxy-
methamphetamine (MDMA), lysergic acid diethylamide (LSD), and Ketamine.
These can also be administered covertly.

‘Date rape drugs’ – drugs that have been associated with spiking (via research
and/or media attention). These include gamma-hydroxybutyrate (GHB),
benzodiazepines (such as Flunitrazepam (Rohypnol)), and Ketamine. ‘Date rape
drugs’ have a sedative effect and can be hard to distinguish from alcohol
intoxication and so need to be tested for specifically (Blandamer et al., 2023).

5
 INTRODUCTION

Spiking is the covert administration of substances (e.g., drugs, alcohol) to another person without their
knowledge or consent. Methods of administration include drink spiking (i.e., adding a substance to someone’s
drink), food spiking, and injection (i.e., where a needle is injected into the person). Spiking can be used to make
someone more susceptible to crime (Blandamer et al., 2023) though motivations can vary (e.g., from sexual
assault to robbery to pranking, Donovan, 2016) and spiking is not always followed by another offence. However,
spiking and/or follow-on offences can have negative, long-term impacts for victims including mental health
and/or physical consequences (Blandamer et al., 2023).

The legislative framework in the UK can address this action under a number of different acts. The most commonly
used is ‘maliciously administering poison, &c. with intent to injure, aggrieve, or annoy any other person’ under
section 24 of the Offences Against the Persons Act 1861. Other offences under this Act where spiking might be
dealt with are ‘wounding with intent to do grievous bodily harm’ (section 18), ‘inflicting bodily injury, with or
without weapon’ (section 20), ‘maliciously administering poison, &c, so as to endanger life or inflict grievous
bodily harm’ (section 23), and ‘assault occasioning bodily harm’ (section 47). It might also be prosecuted under
‘common assault and battery’ (Criminal Justice Act 1988 section 39) or, where used to facilitate a sex offence,
under ‘Administering a substance with intent to engage in a non-consensual activity’ (Sexual Offences Act 2003
section 61).

Drink spiking has been a concern for decades (e.g., Donovan, 2016; Slaughter, 2000), however, recent media
reports about a new phenomenon of needle spiking (see Beecham, 2022; Bond, 2022; Hockaday, 2022) has
sparked new fears about spiking risks. In particular, the use of an injection raises additional concerns for victims
– for example, victims could experience higher levels of psychological distress and the risk of blood borne
infection necessitates testing (Blandamer et al., 2023). In January 2022, Hockaday reported that 1,300 needle
spiking incidents had been reported to the UK police since September the previous year, and survey of 3,730
students found that 1% reported they knew they had been injected with a needle (National Union of Students,
2022) (2% overall reported knowing or suspecting needle spiking). Blandamer et al. (2023) report that, although
injection spiking emerged as an issue in the UK in 2021, by the summer of 2022 cases had been reported in France,
Belgium, The Netherlands, and Australia. It was also suspected as a potential cause of deaths at a music festival
in Houston (USA) in November 2021 (Blandamer et al., 2023), indicating this issue may be broader than the UK.

Reports of drink spiking are also a concern, with the NUS (2022) finding that 11% of their sample reported
knowing that they had been given alcohol or extra alcohol in their drinks without their knowledge, and 7% knew
they have been given drugs without their knowledge through an alcoholic or non-alcoholic drink. Prevalence is
higher when suspected spiking is taken into account; here the figures are 18% for being given alcohol and 14%
for being given drugs. A further 2-4% reported being spiked another way (though the methods were not listed).
A recent YouGov survey (April 2022) also reported concerning levels of drink spiking with 8% of 1,693 participants
reporting they had been spiked (11% of females and 6% of males).

Concerns about spiking have led to the House of Commons Home Affairs Committee publishing a report on
spiking in April 2022 (followed by a Government response in June 2022). Work is ongoing to gather information
on spiking, including where the method of administration is a needle, to identify the prevalence and
characteristics of spiking (including motivations to commit this action) and to support developing a strategic
response to the issue.

6
AIM OF THE REPORT
The aim of this report is to present the findings of a systematic search of the literature focusing on prevalence
of, and motivations for, spiking. The research questions are:

Res earch Question 1: What evidence is there fo r the o ccurrence

of spiking (e. g., needle, drink) using substances (e.g., drugs,
a l c o h o l ) a s a n a c t i n i t s e l f, o r t o f a c i l i t a t e t h e c o m m i s s i o n o f
crime?

Research question 2: What are the motivations for spiking? (i.e.,

f r o m t h e o f f e n d e r ’s p e r s p e c t i v e ) .

7
METHOD

Six databases (see Table 1) were searched - Web of Science - Core Collection (all editions), Ovid – APA PsycINFO,
Ovid – MEDLINE(R) ALL, Ovid – Embase, EBSCO Education databases – CINAHL Plus, and ProQuest – Social
Sciences Premium –for literature relating to the prevalence of and motivation for spiking. A seventh database
was added in the form of the National Police Library (NPL), which was also searched for relevant literature. This
was an additional search that allowed for a wider range of sources to be searched (i.e., the grey literature).

Table 1: Information about databases searched

Name of Years Subjects covered Number of Number of Types of media covered
Database covered by items peer-reviewed
records indexed journals
Web of 1900- 254 research areas – 85.9 million 21,000+ Peer-reviewed journals,
Science – Present e.g., sciences, social journal articles, books,
Core sciences, arts, and conference proceedings
Collection humanities
(All Editions)
Ovid – APA 1806- 24 research areas – 5.3 million + 2,400+ Peer-reviewed journals,
PsycINFO Present e.g., Psychology and journal articles, book
the behavioural and chapters, dissertations
social sciences
Ovid – 1946 - Biomedicine (allied 23 million+ 5,600+ 40 + publication types –
MEDLINE(R) Present health services, e.g., peer-reviewed
ALL biological and physical journals, journal articles,
sciences), humanities, books
information sciences
Ovid – 1974- Biomedical and 27 million + 8,500+ Peer-reviewed journals,
Embase Present pharmaceutical journal articles,
sciences – e.g., conferences
forensic medicine,
drug dependence and
abuse.
EBSCO 1962- Nursing and Allied Not available 3,736 Academic journals,
Education Present Health magazine, trade
databases – publications
CINAHL Plus
ProQuest – Not Social sciences – e.g., 26 million+ 4,300+ Peer-reviewed journals,
Social available- criminology, journal articles, book
Sciences Present linguistics. chapters, dissertations
Premium
National 1608- Policing – e.g., Not available 5,000 + Journals, books and theses,
Police Present criminology, crime multi-media items, reports
Library and crime prevention and other grey literature,
Police Gazette

8
Two search strings were constructed. Search terms included keywords relating to spiking (e.g., drink, needle),
drug and/or alcohol facilitated crimes (as spiking falls under this umbrella of offences), and legal terms (e.g.,
administering a substance with intent). Boolean operators (AND and OR) and wildcards (*) were used to refine
searches. Outputs from search 1 and search 2 were exported into Rayyan (https://www.rayyan.ai/), which helps
researchers view, organise, and categorise their outputs. This facilitated screening and application of the
inclusion/exclusion criteria.

RATIONALE FOR SEARCHES

Preliminary reading and discussions with NCA colleagues indicated that not all spiking incidents are followed by a
secondary offence (e.g., robbery, rape, sexual assault). The word spike/spiked/spiking is associated with many
medical terms (e.g., spike proteins) which are irrelevant to the topic here. Therefore, a bespoke search string was
designed to capture all papers/sources where the word spike (or any of its iterations) was present (to capture all
spiking related papers) but limited to the word being within 2 words of other relevant keywords (e.g., drink, drug,
alcohol, needle) to minimise non-relevant returns. The legal term for the offence (administering with intent) was
added to ensure relevant papers which used this term were not missed. A decision was made not to search by
offence type as there are instances where spiking occurs without a follow-on offence and the terms used were
expected to capture such papers without the addition of crime types.

Search 1 was run on 13th December 2022 for the time period 1 Jan 2000 – 30 Nov 2022 (see Table 2 for details of
how the search string was input into databases). The search string was: Spik* near/2 (needle or drug or alcohol or
drink* or incident or offen* or act) OR Administer* substance with intent.

Table 2: Search terms and databases used for search 1

Database Search string Format
Web of Science Spik* near/2 (needle or drug or alcohol or drink* Split across two lines separated by the
Core Collection or incident or offen* or act) OR Administer* capitalised OR function
substance with intent Topic field
Ovid (for Spik* adj2 (needle or drug or alcohol or drink* or Input as one search string
PsycInfo, incident or offen* or act) OR Administer* Each database (PsycINFO, MEDLINE(R)
MEDLINE(R) substance with intent ALL, and Embase) searched individually
ALL, and Topic field
Embase)
EBSCO Spik* near/2 (needle or drug or alcohol or drink* Split across two lines separated by the
Education or incident or offen* or act) OR Administer* AND function
databases (for substance with intent TX all text (keyword search in full text)
CINAHL)
ProQuest Social Spik* near/2 (needle or drug or alcohol or drink* Split across two lines separated by the
Sciences or incident or offen* or act) OR Administer* AND function
Premium substance with intent Title and Abstract fields searched
separately then results combined (to
remove duplicates)
note: adj2 replaced near/2 for some databases where they use different search operators

9
To check the functionality of the first search, the inclusions (see next section for criteria used) were reviewed against
a list of relevant papers identified by the initial scoping of the topic area (i.e., preliminary scoping search done to
assess if there was a literature to review). Two relevant papers were identified by the scoping search that did not
appear in search 1 or the search of the NPL. Upon further examination, it was determined that this was because they
did not use the terms searched for in search 1. Therefore, a second search was conducted which incorporated the
terms used by these papers and other associated keywords (e.g., synonyms).

The same databases and timeframes were utilised. Run on 27 January 2023. The new search string was “Drug
facilitated” OR “alcohol facilitated” OR “Drug assisted” OR “alcohol assisted” OR “drug aided” OR “alcohol aided”
AND Crime* or robber* or rape* or “sex* offen*” or “sex* violen*” or theft or Drug-rape (see Table 3 for details)

Table 1: Search terms and databases used for search 2

Database Search string Format
Web of Science “Drug facilitated” OR “alcohol facilitated” OR Split across two lines separated by the
Core Collection “Drug assisted” OR “alcohol assisted” OR “drug AND function
aided” OR “alcohol aided” AND Crime* or robber*
or rape* or “sex* offen*” or “sex* violen*” or Topic field
theft or Drug-rape
Ovid (for (Drug facilitated OR alcohol facilitated OR Drug Input as one search string
PsycInfo, assisted OR alcohol assisted OR drug aided OR
MEDLINE(R) alcohol aided) AND (Crime* or robber* or rape* Each database (PsycINFO, MEDLINE(R)
ALL, and or sex* offen* or sex* violen* or theft or Drug- ALL, and Embase) searched individually
Embase) rape)
Topic field
EBSCO “Drug facilitated” OR “alcohol facilitated” OR Split across two lines separated by the
Education “Drug assisted” OR “alcohol assisted” OR “drug AND function
databases (for aided” OR “alcohol aided” AND Crime* or robber*
CINAHL) or rape* or “sex* offen*” or “sex* violen*” or TX all text (keyword search in full text)
theft or Drug-rape
ProQuest Social “Drug facilitated” OR “alcohol facilitated” OR Split across two lines separated by the
Sciences “Drug assisted” OR “alcohol assisted” OR “drug AND function
Premium aided” OR “alcohol aided” AND Crime* or robber*
or rape* or “sex* offen*” or “sex* violen*” or Title and Abstract fields searched
theft or Drug-rape separately then results combined (to
remove duplicates)
note: adj2 replaced near/2 for some databases where they use different search operators

10
 INCLUSION/EXCLUSION CRITERIA

Included in the review were empirical papers that report the prevalence of spiking within samples of crime data, or
within studies of the general population/student samples, or within forensic samples (e.g., blood results). This would
include reports that spiking occurred/was suspected to have occurred (including by the victim or third
party/witness). In addition, papers were included where they reported on the offender’s motivation for spiking.
Victim perceptions of motivations for spiking are included in the review where they were available, but they are
clearly identified as such in the findings.

The search was limited to peer-reviewed journal articles, book chapters, books, reports, conference
papers/proceedings, government reports, and dissertations/theses published in the English language. The timescale
covered was the years 2000 to 2022. The review includes research from the UK and from other countries where the
paper was published in the English language. This constraint was imposed due to the time restraints for the review
precluding opportunity for translation of papers in other languages.

Papers were excluded if the research did not report prevalence or motivation, for example, if it focused on victim
experience of impact, how the victim felt about reporting (e.g., to police or a support service), and/or what they
thought about the investigation process. Empirical work that focused on perceptions or attitudes towards spiking
(rather than actual experience) were excluded. Toxicological papers focusing on test methods were also excluded1,
as were reports which only included voluntary ingestion of substances. Source types excluded were
literature/systematic reviews and meta-analyses (since the focus is on empirical studies rather than their synthesis),
media/news articles, and case studies. Papers not published in the English language and/or published before year
2000 were also excluded.

Application of the inclusion/exclusion criteria

Search 1 returned 1,906 articles. This decreased to 1,245 unique articles once 661 duplicates were removed.
Screening was completed using the inclusion and exclusion criteria and an additional 1,228 entries were removed.
Reasons for exclusions were that the document did not relate to spiking (n=1,132), was in a foreign language (n= 2),
was a media report (n=22), focused on test methods for spiking (n=44), was a literature or book review (n= 6), or
was a case example/case study (n=5). An additional 17 articles were removed as, although they related to spiking,
they did not report on prevalence/ incidence of spiking (e.g., evaluations of prevention programmes, surveys on
views on spiking, etc.). The final number of papers which were identified as inclusions was 17.

Search 2 returned 1,407 articles. This fell to 608 unique articles once 799 duplicates had been removed. Screening
was completed using the inclusion and exclusion criteria and an additional 538 entries were removed. Reasons for
exclusions were that the document did not relate to spiking (n=150), were in a foreign language (n=18), focused on
test methods for spiking (n=207), was a literature or book review (n=60), or was a case example (n=35). Thirty-one
were excluded as they focused on victim impact, experience, and/or care. Others were excluded as they related to
investigation or prevention (n=10), focused on voluntary ingestion of substances by victims (n=4), or were on
attitudes / perceptions (n=10). The remaining 14 articles were removed for another reason (e.g., they were letters
or editorials, the paper had been withdrawn or retracted). The final number of inclusions from this search was 69.

1 Papers which appeared to demonstrate innovative testing methods were, however, highlighted to the NPCC Op Lester policing and forensic leads.

11
Six of the papers were found by both search 1 and 2. Therefore, the final number of inclusions from searches 1 and
2 was 80.

A short inter-rater exercise was conducted to help quality assure the application of the inclusion/exclusion criteria
to the title/abstract of sources returned by searches. Two researchers independently applied the criteria to a sub-
sample of the returns. A total of 125 entries were reviewed. Raters agreed on inclusion/exclusion status in 122 out
of 125 cases (98%). Where discrepancies were found (n=3), rater 1 re-assessed the eligibility (resulting in one
inclusion by rater 1 being taken out and one inclusion by rater 2 being added in). The final outcomes of decisions
are already captured in the description of applying inclusion/exclusion above.

Additional searches

Reference lists
To ensure the literature review is as complete as possible, the reference lists of all inclusions (n=80) were checked
to identify any additional potentially relevant sources. Upon reviewing the reference lists, an additional nine sources
were identified and added to the list of inclusions bringing the total up to 89.

Search of National Police Library database

A research assistant on secondment to the National Crime Agency searched the National Police Library (NPL)
database using the search string spik* N2 (needle or drug or alcohol or drink* of incident or offen* or act) Or
Administer* substance with intent. Duplicates were automatically removed by the search engine leaving 163 articles
for screening. Two further duplicates were identified during the screening process and were removed, eight were
excluded as they were not in English, and 16 pre-dated 2000. The researcher identified that 88 were not related to
spiking and removed 36 as they did not relate to the research question (e.g., they did not relate to prevalence or
motivation). One was removed because it was a literature review and four as they were not empirical papers. One
paper was not accessible to the research team and had to be excluded. Overall, seven sources from the NPL search
met the inclusion criteria. However, all six had been found already in search 1 and/or search 2 (n=4), or they had
been identified via our reference list search (outlined above) (n=2). The remaining source was a short item which,
upon review, appeared to relate to Hurley et al. (2006); this was, therefore, also excluded as the full paper is already
included in the review.

Full text screening

As outlined above, results from the database searches (n=3,313), and the search of the National Police Library
(n=163) were screened to (1) remove duplicates, and (2) review the title and abstract against the inclusion/exclusion
criteria. Once crossovers (i.e., papers which were identified by more than one search) were accounted for, and
reference lists were reviewed, 89 papers were identified as meeting the inclusion criteria at this stage. Full texts
were sourced (using inter-library loans where possible) for the 89 sources and all were screened. Two further papers
were removed from the analysis after the screening stage as the additional information provided by the full text
indicated they did not meet the inclusion criteria, leaving the final number of papers in the review as 87.

This review of the existing literature was carried out by adapting the Preferred Reporting Items for Systematic
Reviews and Meta-Analysis (PRISMA) flowchart (Moher et al., 2009) using a template provided by Page et al. (2021).
The process for the search is presented in Figure 1.

12
Figure 1: PRISMA outlining inclusion/exclusion decisions

The remaining 87 sources each was reviewed to (1) identify statistics or estimates of prevalence of spiking, and (2)
motivations for spiking. Papers were read and key information extracted and inserted into a table to summarise
and compare findings (see Literature Review Table in Appendix A).

13
 FINDINGS

The 87 sources were mostly journal articles (n=70) but also included conference abstracts (n=11), reports (n=4), a
thesis (n=1), and a book chapter (n=1).

Most research was from the United States of America (USA) (n=20 papers) and the United Kingdom (UK) (n=11),
along with Australia (n=6), Italy (n=6), Spain (n=5), and Canada (n=5). However, a wide range of countries were also
represented, namely: Denmark (n=4), Bangladesh (n=3), France (n=2), Belgium (n=2), Germany (n=2), Norway (n=2),
Costa Rica (n=1), Cyprus (n=1), Hungary (n=1), India (n=1), Iran (n=2), Netherlands (n=1), New Zealand (n=1),
Northern Ireland (n=1), Pakistan (n=2), Poland (n=1), Scotland (n=2), South Africa (n=2), Sweden (n=2), and Wales
(n=1). Most papers clearly stated the country, although the origin of a few papers had to be inferred from the place
the data were collected (e.g., name of city or hospital that was stated as the site of data collection). Sometimes an
inference was made based on author location and/or how introduction to the study were framed within the paper
(e.g., which country is discussed in the opening to the paper). Where inferences have been made, this is highlighted
in the literature review table.

RESEARCH QUESTION 1

What evidence is there for the occurrence of spiking (e.g.,

needle, drink) using substances (e. g., drugs, alcohol) as an act in
i t s e l f, o r t o f a c i l i t a t e t h e c o m m i s s i o n o f c r i m e ?

No studies on needle spiking

There were no studies specifically on needle spiking. However, one study did report a case of forced injection as the
means of spiking (McGregor et al., 2003) and another reported ‘tablet injected’ (Hurley et al., 2006). Unfortunately,
there is no additional information about what ‘tablet-injected’ refers to (though a cursory internet search indicates
that some people crush tablets up and dissolve them so that they can be injected. There are some harm reduction
advice articles on this topic2).

Prevalence of being spiked

It was hard to determine levels of genuine spiking. Even if drugs and/or ethanol are found in blood or urine it is not
always possible to determine if this is a result of spiking. In particular, this can sometimes be explained by voluntary
consumption and some authors express concerns that patients are not always correct in their recollection of their
own substance ingestion. To make things even more complicated, some papers do not separate out voluntary versus
involuntary ingestion when reporting their results.

2
See, for example, National Harm Reduction Coalition - https://harmreduction.org/issues/safer-drug-use/injection-safety-manual/preparing-equipment/

14
With a clear definition of spiking as the involuntary administration of a substance without the person’s knowledge
or consent, relevant information was identified in 47 out of 87 papers. These papers report varying rates of
prevalence, ranging from less than 1% to 66% depending on the type of sample being investigated.

Whilst it is possible this could be an artefact of different rates of spiking, or rates in different countries or time across
different periods, it is more likely to reflect differences in data collection methods and sampling (e.g., whole
population, people who present to hospital, people who report particular types of crime, just females/males, just
one particular age group, just students etc.). Sample sizes ranged from under 100 to over 40,000 and were drawn
from a number of different sources including medical files/hospital data, and databases of forensic institutes who
do toxicology testing. There were also studies which gathered data via surveys or interviews.

These substantial differences in samples make direct, meaningful comparisons difficult and there is no obvious way
to organise the findings. A decision has been made, therefore, to summarise by topic of the paper.

Of the 12 papers included in the review where the overarching topic was spiking, eight included some information
about prevalence. Elliott and Burgess (2006) reported 89% of their sample involved a spiked drink, though it is noted
that this paper focused on toxicological testing of people who presented at hospital suspecting they had been spiked
which would explain this high percentage. McPherson and Smith (2006) and McPherson (2007 report prevalence
rates of 25% and 26% respectively with relatively large samples (over 400 and 805). Greene et al. (2007) reported
illicit or medicinal drugs of unexplained origin were detected in 8 out of 78 participants (10%). Quigley et al. (2009)
reports 9 out of 97 (9%) of cases were deemed to be plausible cases of spiking, and Swan et al. (2017) reported that
462 (out of 6,064) students in their sample (8%) reported 539 incidents of spiking. Mortesen et al. (2016) report 4%
(23 out of 571) of their participants were suspected victims of drink spiking. This study was in Denmark (all the other
spiking papers discussed in this paragraph were from Australia or the UK) so this might indicate a lower prevalence
for a different country. However, other papers in the review from Denmark show different rates (Birkler et al. (2012)
and Bistrup et al. (2022) report 12% and 13-21% respectively (more on these below) and Larson & Hilden (2016)
don’t report prevalence) indicating this is more likely to be due to methods and data sampling than differences
across countries. Furthermore, the information in Mortesen et al. (2016) is limited as only the conference abstract
was available so it is possible there is context or factors which could explain the difference are not included in the
information reviewed.

Most of the papers (36 out of 47) were about sexual violence (e.g., DFSA, forced rape, sexual assault). Sample size
was not possible to establish in one case (an abstract from Vecchio et al., 2014) though they did report that 66% of
patients had a suspicion of covert drug administration. In research with samples under 100 cases the prevalence
varied widely. Horvath & Brown (2007) reported there were relatively few cases in which drugs had been
administered surreptitiously (5%) and no cases where victim consumed alcohol involuntarily. Wille et al. (2021)
reported the victim believed to have been administered a drug by the perpetrator in 18% of cases. Prego-Meleiro
et al. (2022) report 40% of their sample were victims of proactive DFSA though this varied by context (7% in night-
time context compared to 76% in domestic context, and 86% in other contexts). Vecchio et al. (2015a) report a
higher rate (66%) but this is reported suspicion of covert drug administration by patients which could explain the
higher levels. For example, Negrusz et al. (2005) reported that 28 out of 119 (24%) people believed that they were
given a drug surreptitiously, but they only identified 6 (4%) as proactive DFSA (i.e., evaluated as to have been victims
of DFSA through surreptitious drugging).

15
Aside from Negrusz et al. (2005), there were nine other papers on sexual violence with samples between 100-200
who reported prevalence. These found prevalence rates of 8% (Gee et al. 2006, suspected DFSA with drug was
detected and no voluntary consumption stated), 12-15% (Birkler at al., 2012 (covert DFSA); Caballero et al., 2017
(proactive DFSA); McCormack et al., 2022 (unknown substance given)) and 18% (Thompson, 2005, reports of ‘spiked
drink’). Bistrup et al. (2022) reports suspicion of spiked drink as 21% of cases in 2019 and 13% in 2020. Xifro-
Collsamata et al. (2014) (suspected DFSA criteria met) and Tiemensma & Davies (2018) (detected drugs that don’t
match reported consumption) report higher rates at 31% and 32% respectively, then up to 47% Du Mont et al. (2016)
(predatory DFSA).

Moving onto papers with sample sizes of up to 500 (n=11), again varied results were found. Rates ranged from up
to 5% (Hagemann et al., 2013 (suspected proactive DFSA); Monk & Jones, 2014 (covert or forced administration);
Saint-Martin et al., 2007 (clinical signs of drug-related submission); Kouta et al., 2013 (forced intake); Hurley et al.,
2006 (drug not reported by victim found)) to 7% (Anderson et al., 2019 (positive toxicology with no voluntary
consumption)) then 12-15% (Cerdas et al., 2014 (proactive DF rape); Lawyer et al., 2010 (involuntary incapacitation);
Mognetti et al., 2022 (forced intake)), 24% (Thompson, 2006 (suspected spiked drink)), and 29% (Richer et al., 2017
(proactive DFSA)). The remaining 10 papers had samples of at least 750. Watt et al. (2015) found sex was forced by
spiked drinks in 6% of cases in past 4 months, and 7% across the lifetime. Du Mont et al. (2010) reported 184 out of
882 cases met suspected DFSA criteria (and that in 49% of all suspected DFSA victims a drug was found that had not
been voluntarily consumed). Djezzar et al. (2014) reported that 473 out of 890 cases met the criteria of probable
chemical submission or drug-facilitated crime (53%), and that in 8% of cases victims were subject to forced ingestion.
Scott-Ham and Burton (2005) report that 2% were attributed to involuntary ingestion and McGregor et al. (2003)
found 172 out of 1,421 cases (12%) were identified as suspected DFSAs. Later work by McGregor et al. (2004) found
a slightly higher rate of 15% (246 out of 1,594 cases were identified as DFSA). McCauley et al. (2010) reported a
relatively low prevalence for drug/alcohol-facilitated rape at 3.5% as did Krebs et al. (2009) who reported certain
drug facilitated sexual assault in less than 1% of cases and suspected drug-facilitated sexual assault in 2% of cases.
The largest study with a sample of over 40,000 - Basile et al. (2021) – reports that 30% of female and 32% of male
victims of alcohol/drug-facilitated rape reported involuntary use of substances, mostly drugs. Finally, Kilpatrick et
al. (2007) estimated prevalence based on 5,000 interviews findings indicate nearly 3 million women have
experienced drug-facilitated rape (defined as involuntary ingestion) during their lifetime and nearly 200,000 in the
past year.

The three remaining papers were on other topics. Kapitány-Fövény et al. (2017) focused on GHB involved crimes
and found that 46 out of 352 (13%) were due unintentional consumption. Pragst et al. (2006) looked at poisoning
with diphenhydramine (DPH) and found 1 case (out of 68) where the drug was forcibly administered in a drug
facilitated crime (2%). Eagling et al. (2020) reported research on Methaemoglobinaemia (MetHb) (a condition
associated with exposure to drugs) and identified that 4 (out of 207 cases) could be spiking (2%). This was not certain
though as spiking was grouped with unknown for reporting and the source was a conference abstract meaning that
additional information which might have broken this down further was not available. The remaining report was from
Taylor et al. (2006) who provided an estimate of spiking prevalence in Australia reporting that there were 3,000-
4,000 suspected incidents of drink spiking between 1 July 2002 and 30 June 2003.

16
Some papers reported prevalence over time and found that cases (e.g., of DFSA or spiking) tended to increase over
time. For example, Djezzar et al. (2014) found prevalence of drug facilitated crime (DFC) generally increased over
time (less than 1% of cases in 2001/2002, increasing to 6% 2003, and was 18% by 2011). McGregor et al. (2003)
looked at all sexual assault victims who presented at a women’s sexual assault service and reported that the
proportion of suspected DFSA cases ranged from 7% to 12% between 1993 and 1998. Furthermore, they found a
statistically significant increase up to 23% in 1999. It was suggested that this could reflect a real rise in cases or an
increased awareness of spiking in the general population (leading to more people presenting for testing).

People who have, or are willing to, spike others

Two sources provided information about the proportion of people who had, or who were willing, to engage in spiking
others. In her thesis on spiking in Australia, McPherson found that 45%- 49% (of her 805 participants) admitted to
buying, or mixing, cocktails for others without detailing the contents of the cocktail to the intended consumer and
a quarter (26%) had added alcohol to punch.

Furthermore, 6-16% reported at least one occurrence of adding alcoholic shots to another person’s drink without
their knowledge or consent and 1% of participants had added a substance to a beverage under these circumstances.
She found men were more likely to report drink spiking perpetration. She also explored willingness to commit such
acts finding that 29-30% admitted a willingness to buy, or mix, cocktails for others without detailing the contents of
the cocktail to the intended consumer, 19% reported a willingness to add alcohol to punch, 7% reported their
willingness to add alcoholic shots to alcoholic drinks, 3% reported their willingness to add alcoholic shots to non-
alcoholic beverages, and 1% were willing to add a substance to any type of drink. This could suggest that, although
people engage in spiking related behaviours, they are not admitting a willingness to do this.

Swan et al. (2017) found that 1.4% of her sample of students (83 out of 6,064) reported 172 incidents of drugging
someone or knowing someone who has drugged someone. Unfortunately, the paper did not distinguish between
these two categories and so it is difficult to determine how many people admitted they had spiked someone
themselves.

It is positive to see that relevant information is available in the literature but more focused work on spiking
prevalence would be useful to explore this in more detail and gain a better overall estimate of prevalence.

RESEARCH QUESTION 2

W h a t a r e t h e m o t i v a t i o n s f o r s p i k i n g ( i . e . , f r o m t h e o f f e n d e r ’s
perspective)?

The motivation of individuals to perpetrate spiking was rarely mentioned explicitly – this is likely to be because, for
many papers, it can be inferred from the topic. For example, if the paper is on drug-facilitated sexual assault, then
it would be anticipated a drug might been administered to commit that offence. For most papers, the potential
motivation was sexual assault and/or rape (in 69 papers this was either a stated motivation or could be inferred
from the topic).

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Other offences were also listed including homicide (indicated to be a motivation in 2 papers with a further 1 case
(Marinetti & Antonides, 2013) where a homicide occurred but it is unclear if this was related to spiking), kidnapping
(4 papers mention this), and physical assault (1 paper where this could have been related to spiking). Fourteen (16%)
papers mentioned motivations of robbery, theft, and/or acquisitive crime. Non-offending motivations unrelated to
offending were also suggested, including pranks, to have fun, and to get someone to relax.

Some researchers were able to distinguish between methods of administration and reported the types of crimes
experienced by victims. In these instances, it is perhaps more reliable to infer that the motivation was for the offence
that was subsequently completed. For example, Djezzar et al. (2014) identified 473 cases (in France) that met the
criteria of probable chemical submission (a premeditated choice of substance by the offender) or drug facilitated
crime (DFC) (the perpetrator giving a substance to the victim); offence types reported include sexual assault or rape
(51%), 219 cases (46%) sexual assault, 104 cases theft (22%), 21 cases rape and theft together (4%), sedation for
purposes of homicide (37, 8%), and other (physical assault, kidnapping, mental manipulation in a context of
inheritance theft) 2% (n=9). Pelletti et al. (2018) also reported on DFC finding 6 homicides and 3 robberies could be
categorised as DFC. Gharedaghi et al. (2018) reported 77% of DFCs in their sample were robbery and 4% were rape.
Moghaddam & Rahimi’s (2021) also reported robbery (80%) and rape (12.5%) in their paper on criminal poisoning.
Taylor et al. (2004) report that 20-30% of spiking incidents involve sexual assault and 5% involve robbery though
they also note there is no follow-on victimisation in most cases. Kapitány-Fövény et al. (2017) identified 46 cases of
unintentional consumption of GHB which occurred in the context of 11 sex offences and 38 acquisitive crimes.
Furthermore, they noted that offences were only recorded where the method of administration was unintentional.

Victim perspectives were not specifically searched for in this review (as it was focused on prevalence and offender
motivations). However, some victims offered views on motive and so this is reported here. McPherson (2007) found
that, of the 207 people who reported a spiking incident, 66% (n=136) considered themselves a victim of crime. Of
these, aside from being spiked itself (which 5% of the 136 victims identified as a crime against them), other offences
included sexual assault (13%), robbery (1%), kidnapping (1%), and non-consensual substance use (8%). However,
the categories as defined by victims as may not always reflect offences recognised by law and it was noted some
also listed impacts such as violation of rights (4%), and/or reflections on what could have happened, namely that
could have been raped (9%), or killed (4%).

Swan et al. (2017) also considered non-perpetrator perspectives reporting that, of the 462 people who reported
being drugged/knowing someone who had been drugged (out of a sample of 6,064, 8%) the motives of the
perpetrators were inferred to be: to have fun (n=30), get people to loosen up (n=18), sex/sexual assault (n=57),
unknown (n=47), mistake (n=9), mean/revenge (n=6), other (n=33). Where these authors also reported data on
those who had perpetrated spiking, 51 of the 83 perpetrators explained their motivation and these were to have
fun (n=14), to have sex with/sexually assault someone (n=12), unknown (n=6), calm someone down/make them
sleep (n=5), to observe effects of drugs (n=3), to be mean to the victim or because they wanted revenge (n=2), it
was a mistake (n=1), they had also used drug themselves (n=2), the victim knew they were being drugged (n=2), and
other (n=5). There were gender differences in reported motivations by perpetrators with women being more likely
to report a sexual motive and men more likely to mention fun. Although fun might seem innocuous, the authors
warn that some language (e.g., getting people to loosen up, thought they could have fun) could be interpreted as
indirect references to creating a coercive space for sexual activity to occur.

The review identified one more study where perpetrators reported on motivations. In McPherson’s (2007) thesis,
motivations for spiking (as reported by participants who reported at least one engagement in drink spiking
behaviour) were varied. Over 40% of motivations reported related to fun.

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A fifth (21%) focused on getting someone drunk (cause intoxication in others), perhaps to share a positive social
experience with them. Some were motivated by the potential for more sexual activity possibly to facilitate
consensual activity (not understanding the concept of consent fully perhaps).

Given the extent of detail provided in McPherson, data from the thesis has been reproduced into a table for ease of
viewing (see Table 4). Individual motives are grouped (loosely) based on what kind of motivation they might relate
to (e.g., fun, predatory, sexual). This has been done intuitively based on the individual variables, however, it is noted
no definitions of the individual motives could be found in the original source so some might be open to
interpretation.

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Table 2: Motivations for spiking (as reported by McPherson, 2007)

Motivation Buying/ Adding Adding

mixing alcoholic substances
cocktails or shots (%) (%)
adding alcohol
to punch (%)

Just for fun 21 43 43

To put people in a better mood 1 2 0
To get everyone drunk 1 1 0
Because the person was too straight 2 3 0
To show them a good time 2 7 7
Because I knew they didn't have the money to buy alcohol or drugs 7 8 14

Because the person needed to loosen up 6 7 0

I was doing the person a favour 1 3 0
I thought I was being a generous host 10 4 0
To liven up a party 1 2 7
Because I knew it would be funny 1 4 7
To share the buzz I was having 1 1 7
Appears to relate to boosting confidence of person drugging
To impress my friends 0 1 7
To make me cool within my group of friends 4 18 0
To make me more confident to approach others 1 3 7
To break the ice with someone 1 1 0
To get someone to like me 13 16 14
Appears predatory/aggressive
I thought it would make it easier to gain control over a person 1 3 0
Because the person asked for it 3 3 0
Because the person was rude to me 9 12 7
Because the person was dressed in a way that indicated that they 3 7 0
wouldn't have cared
To get someone drunk 4 7 21
Because the person looked like a drug user anyway 0 1 0
Because the person deserved it 2 6 7
Because the person had knocked me back earlier 3 6 7
Apparent sexual motive
I thought it would give me a better chance of having sex 15 10 14
To put people in the mood for sex 7 6 29
Because it's easier for me to approach people for sex if they're drunk 8 10 21
or drug-affected
Because I'm more successful at picking up when others are drunk or 0 1 0
drug-affected
Appears ambivalent
Because the person was drunk anyway 5 9 14
Because I knew the effects would only be temporary 0 2 0
I didn't think it would do any harm 1 3 7
Because I knew it wouldn't do any harm 4 8 7

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ADDITIONAL FINDINGS

Contexts in which spiking occurs

The review indicated that characteristics of spiking vary by context. For example, people presenting with
suspected spiking related to sexual assault are mostly female (e.g., McCormack et al., 2022; McGregor et al.,
2003; McGregor et al., 2004), timings often cluster late at night on weekend evenings (e.g., Tiemensma & Davies,
2018), and first suspicion of spiking/onset of symptoms often manifest in pubs/clubs (e.g., McPherson, 2007;
Quigley et al., 2009) but also house parties (e.g., McPherson, 2007; McPherson & Smith, 2006). However, it is
noted that Prego-Meleiro et al. (2022) looked at context and found that, although 30 out 53 cases were in the
nightlife context, only 2 were deemed to be involuntary consumption. Others were mixed (i.e., voluntary plus
covert administration) (40%), or involved voluntary use of substances by victim (opportunistic assault) (43%).
This highlights the importance of considering how voluntary consumption of substances might interact with
spiking and the vulnerabilities that might be associated with voluntary consumption (e.g., offender seeking to
assault someone who is intoxicated). It was also found some incidents occurred in domestic situations – for
example, as part of a pattern of domestic violence (see Prego-Meleiro et al., 2022, for examples).

There was also a series of papers on acute / deliberate poisoning of commuters on public transport. There were
papers from Bangladesh (Majumder et al., 2008, Basher et al., 2017), India (Kumaran et al., 2009), and Iran
(Gharedaghi et al., 2018). In these circumstances, it was often males who were targeted, and drugs were
administered covertly through food or drink, with the primary motivation appearing to be robbery/theft. There
was also a paper from Belgium (Ramadan et al., 2013) which outlined a series of cases where victim statements
indicated the ingestion could have taken place as they travelled on public transport. Police sent undercover
agents to the railway station on Friday afternoons and evenings and found a person who was offering welcome
cookies to Asian travellers. The offender was a Syrian national who arrived from Amsterdam and returned to the
Netherlands each day once his crime was committed. This was a case where a ‘date rape drug’ (Flunitrazepam –
otherwise known as Rohypnol) was used but this time for a series of robberies.

‘Date rape drugs’ are rarely found

Specific substances have been identified as ‘date rape drugs’ - these include gamma-hydroxybutyrate (GHB),
benzodiazepines (such as Flunitrazepam (Rohypnol)), and Ketamine. As far back as 2000, Slaughter was arguing
that focusing public attention almost exclusively on ‘date rape drugs’ is misleading and potentially dangerous.
Contrary to popular belief, so-called ‘date rape drugs’ are not commonly found by drug testing in suspected
spiking cases (e.g., Poulsen et al., 2021; Riedesser et al., 2011; Wille et al., 2021). For example, Caballero et al.
(2017) reported to have found so-called ‘date rape drugs’ in just 3 out of 152 cases. Paul and Mahesan (2019)
investigated the presence of date rape drugs (flunitrazepam, GHB, and Ketamine) in coroner reports and found
23 women tested positive for date rape drugs (at autopsy, 6 women were positive for Rohypnol, 15 for GHB, and
2 for Ketamine). However, this was over a 15-year time period (2000-2015) suggesting a low prevalence overall.

It is important to note here that a delay between ingestion and testing could explain negative test results in some
cases. For example, due to the short half-life of some ‘date rape drugs’ (e.g., GHB) (Fiorentin & Logan, 2019;
Jones et al., 2012; Juhascik et al., 2007), it is possible drugs were not found due to late screening (Du Mont et al.,
2010). This would be supported by Scott-Ham and Burton (2005) who warn that GHB is rapidly eliminated from
the body and so that it may not be detected in blood samples taken more than 6–8 hours after ingestion (12-18
hours for urine). However, at least one paper (Hughes et al. 2007) points out that many patients do attend
emergency departments early enough that, if GHB was in their system, it should be detected. In their study of
1,014 cases of alleged DFSA in the UK, Scott-Ham and Burton (2005) found no evidence Rohypnol (Flunitrazepam)
had been used covertly in their study but also that it can be detected in urine samples for at least 72 hours.

21
With this in mind, it is useful to note that the time between ingestion and sampling is reported in toxicology
papers and is often less than 72 hours (e.g., patients in Quigley et al. (2009) presented within 12 hours of drink
spiking) though Caballero et al. (2017) argue for even earlier collection of samples - within 6 hours – as this is a
key factor to obtain evidence in DFSA.

Aside from the potential issues with delayed testing (and the resulting false negatives), there was an overall
conclusion that more attention should be paid to risks from alcohol intoxication rather than drugs (e.g., Burgess
et al., 2009, Hurley et al., 2006, Scott-Ham & Burton, 2006, Taylor et al., 2004, Wille et al., 2021).

Framing of papers
The core topic(s) of each paper was identified for all papers. Relatively few (n=12, 14%) listed spiking as a primary
topic. Spiking was often explored within the context of something else, commonly other criminal offending. Often
papers were framed around an offence and then characteristics of these cases (which would include spiking)
were explored. Thus, many of the papers returned by the searches were on Drug-facilitated Sexual Assault
(DFSA), Drug-Facilitated Crime (DFC), Drug or Alcohol Facilitated Rape (DAFR), alcohol facilitated offences, date
rape, forced sex, incapacitated rape, rape, sexual violence (perpetration/victimisation) and/or sexual assault.
There were also a number of papers on criminal / acute poisoning, and one on synthetic cathinones as well as an
abstract for a conference paper about Methaemoglobinaemia (MetHb) (a condition associated with exposure to
drugs).

Spiking as an act in itself is neglected

As implied within the previous sections, spiking is rarely the focus of academic study itself. This means the
methods used to gather data (e.g., all incidents where someone reports a sexual assault and suspects
drug/alcohol facilitated, hospital records of people who have presented for testing post-offence) will likely miss
occasions of spiking unless the behaviour occurs in the context of a follow-on offence. This is because research
takes the offence as the starting point for data collection rather than the act of spiking itself. It is therefore
important to note that research studies with such data will only present a sub-sample of all potential incidents.

A considerable challenge in the identification of spiking is extracting data on cases where substances (alcohol,
illicit drugs, or medication) are administered covertly. Some papers were able to separate out deliberate spiking
(i.e., where a perpetrator adds a substance to a victim’s drink/food without their knowledge or consent) from
cases where the substances had been voluntarily ingested by the victim (and the offender might take the
opportunity to assault them whilst they are in a vulnerable state). However, other papers were unable to make
this distinction and only report on alcohol or drug facilitated crime overall (i.e., reporting on all methods of
administration together). These challenges are further compounded by issues of memory (i.e., a victim might not
remember what happened) (e.g., Hurley et al., 2006) for example, due to alcohol consumption (Quigley et al.,
2009), the frequent detection of multiple drugs (e.g., Majumder et al., 2008), and/or the use of self-report to
gather data from victims on what they have voluntarily consumed (which can be unreliable, especially if asking
about use of illicit substances to which victims might not want to admit).

There are also differences between papers in their definition of phenomena. For example, definitions of DFSA
vary. In some papers, DFSA is involuntary by definition (e.g., papers from France, for example, will only include
involuntary consumption as that is part of the definition of DFSA (and DFC) in that country). Others make the
distinction themselves using information about voluntary consumption as reported by victims (e.g., see Lawyer
et al., 2010).

22
However, other papers include both involuntary and voluntary ingestion in their definitions and/or could not (or
did not) distinguish between them (e.g., Bosman et al. 2011, Jones et al., 2008, Juhascik et al., 2007, Mognetti et
al., 2022). Some authors (e.g., Caballero et al., 2017, Cerdas et al., 2014, Negrusz et al., 2005, Prego-Meleiro et
al., 2022, Scott-Ham & Burton, 2005) use the terms proactive DFSA (to reflect involuntary / covert / unintentional
consumption) and opportunistic DFSA (where the victim is intoxicated due to self-administration) and report on
these separately. Even where distinctions are made, some authors (e.g., Scott-Ham & Burton, 2005) openly
acknowledge the potential of errors in classification into these types (e.g., in cases where it was not possible to
obtain sufficient information to decide whether or not the victim had taken the drug voluntarily).

Clearly allocating offences to involuntary/voluntary categories remains challenging for other researchers too. For
example, although Hagemann et al. (2013) found 57 out of 264 patients (22%) were identified as suspected
proactive DFSA, only 5 had tested positive for sedative drugs (clonazepam, diazepam, and/or oxazepam) that
were not accounted for by self-reported voluntary intake. They went onto say that these patients either gave a
history of alcohol/drug abuse or anxiety disorder, making recent voluntary intake of one or more of these drugs
likely and so the authors concluded that: “No cases could unequivocally be attributed to proactive DFSA” (p.777).

Hall et al. (2008) also discuss proactive versus opportunistic DFSA (in their introduction) but are unable to
distinguish between these in their data. Badour et al. (2020) separate out definitions for alcohol/drug-facilitated
(stated as involving perpetrator-administered drugs, alcohol, or other intoxicants that result in loss of
consciousness or impaired ability to control behaviour) and incapacitated (i.e., involving impairment that occurs
when the victim has voluntarily used alcohol or other drugs) offences but these are grouped together in the
results so in this study it was impossible to determine what proportion involved involuntary ingestion and thus
would be spiking. McCauley et al. (2009) are another example of research unable to distinguish between methods
of administration. For other papers, while toxicology results are available for some victims, it was stated they
can’t be used to reliably classify as voluntary versus involuntary either (as contextual information – such as
voluntary consumption information - is missing) (e.g., Dempsey et al., 2022, Juhascik et al., 2007).

LIMITATIONS

Many papers exclude participants based on age, just focusing on the age group where their chosen offence type
is most prevalent (e.g., McPherson, 2007 only includes people aged 18-35 years). Although understandable given
the scope of the various papers, this means there are gaps in our knowledge of other age groups’ experiences (if
any) of spiking. Often samples are predominantly young females, presumably as the starting point is sexual
violence and many victims of this are young women. More studies with male victims and a wider age range,
especially people over 35, would be beneficial as knowledge about these groups are minimal at present.

As outlined above, determining the method of administration (i.e., voluntary versus involuntary ingestion by the
victim) remains challenging to unpick, even with toxicology results and self-reported data on voluntary
consumption of substances.

Motivation is difficult to determine for certain as there have been few studies which ask perpetrators why they
commit spiking offences. The two that were found indicate that, contrary to what victim’s report / perceive which
is largely predatory motives (such as rape or assault), many perpetrators indicate they commit spiking behaviours
for less concerning reasons (such as to have fun or create a more enjoyable social space).

23
Having said this, some perpetrators do admit predatory or aggressive reasons for spiking and some behaviours,
although framed as harmless, could have concerning undertones (e.g., if you are giving someone alcohol with
the hope that this will mean they are more likely to have sex with you, this could indicate a lack of understanding
about consent). It may also be that perpetrators are engaging in impression management for their own benefit
(i.e., reframing it to protect their self-esteem and avoid cognitive dissonance) or for the benefit of the researcher
(as they don’t want to admit why they spike others). There was also no mention of monetary benefits indicating
that perpetrators who spike others to commit theft or robbery are not included in these samples.

24
 CONCLUSIONS
This review aimed to (1) identify what evidence there is for the occurrence of spiking (e.g., needle, drink)
using substances (e.g., drugs, alcohol) as an act in itself, or to facilitate the commission of another crime,
and (2) identify what the motivations are for spiking. The key findings of the review are summarised below.

A key driver for this review initially was a concern about needles/injections being used as a method of
administration. However, this review found no papers which reported on the prevalence of needle spiking.
This may be due to this being a new phenomenon and it is emphasised that robust empirical research is
needed to explore the prevalence and nature of this offence.

Although prevalence of needle spiking was not possible to determine, there was a wealth of relevant data
that provides some indication of prevalence for other kinds of spiking (e.g., drink, food). Using a definition
of spiking as the involuntary administration of a substance without the person’s knowledge or consent,
relevant information was identified in 47 out of 87 papers. These papers report varying rates of prevalence,
ranging from less than 1% to over two thirds depending on the type of sample being investigated. There
were substantial differences in samples making direct comparisons difficult. For example, sample size ranged
from under 100 to over 40,000, and some samples only included particular age groups (e.g., school-aged
only, over 18 only, 18-35 years only). Some samples were drawn from medical files/hospital data, others
were drawn from databases of various forensic institutes, and some were gathered via surveys or interviews.
It is positive to see that relevant information is available in the literature but additional focused work on
spiking prevalence would be useful to explore this in more detail and gain a better overall estimate of
prevalence.

The motivation of individuals to perpetrate spiking was rarely mentioned explicitly but could often be
inferred from the topic of the paper. Most often the topic under consideration was sex offending but
robbery/theft, kidnapping, and homicide were also mentioned. Swan et al. (2017) reported on motives of
perpetrators as inferred by others and listed motivations including having fun, and to get people to loosen
up, as well as more predatory motives such as to have sex with/sexual assault someone or to be mean/take
revenge. Two papers (McPherson, 2007; Swan et al., 2017) reported on motivations as identified by
perpetrators. Motivations included having fun, to calm someone down, to be mean, or to sexually assault
them (Swan et al., 2017);these authors also reported gender differences with women being more likely to
report a sexual motive and men more likely to mention fun. Participants (who had committed at least one
spiking perpetration) in McPherson’s (2007) work also commonly mentioned fun as a motivation. Other
motivations included getting someone drunk and facilitating sexual activity. Some of the narrative around
motivations (as described by perpetrators) is concerning as it indicates a lack of understanding around
consent. For example, although ‘to have fun’ might seem harmless, this language (e.g., getting people to
loosen up, thought they could have fun) could be interpreted as indirect references to creating a coercive
space for sexual activity to occur. This suggests that educational work might be needed to ensure people are
aware of the boundaries of consent in an environment where substances are being consumed (including
when these are consumed voluntarily).

25
The review identified a number of contexts in which spiking occurs and that the characteristics of spiking
and demographics of victims vary by context. Contexts include night-time economy / entertainment
environments (including house parties), where victims were often female, and timings clustered late at night
on weekend evenings. Some incidents occurred in domestic situations – for example, as part of a pattern of
domestic violence (Prego-Meleiro et al., 2022). There was also a series of papers on acute / deliberate
poisoning of commuters on public transport.

In these instances, victims tended to be male, substances were administered via food and drinks, with the
purpose of committing theft/robbery (see Basher et al., 2017; Gharedaghi et al., 2018; Kumaran et al., 2009;
Majumder et al., 2008; Ramadan et al., 2013).

‘Date rape drugs’ – such as GHB, Flunitrazepam (Rohypnol)), and Ketamine - have been commonly associated
with spiking incidents. However, the review indicated that these are not found as often as one might expect
in suspected spiking cases. In fact, in some studies they were found very rarely (e.g., no covert use Rohypnol
found by Scott-Ham and Burton (2005), and ‘date rape drugs’ found in just 3 out of 152 cases of DFSA by
Caballero et al., 2017). Although delays in testing could explain why some drugs are not found in some cases
(especially GHB which has a short detection window), many of the toxicology papers only include participants
who presented for testing quickly after suspected ingestion and so it might be expected these drugs, if
present, would be identified (though some authors do note false negatives are possible). An overarching
point made was that focusing on ‘date rape drugs’ is misleading and dangerous (Slaughter, 2000) and that
more attention should be paid to risks from alcohol rather than drugs (e.g., Burgess et al., 2009, Hurley et
al., 2006, Scott-Ham & Burton, 2006, Taylor et al., 2004, Wille et al., 2021). This is understandable as alcohol
(ethanol) was the most commonly found substance during testing and this can also be used to spike drinks
(e.g., putting an extra shot in someone’s drink or giving them an alcoholic drink instead of a non-alcoholic
one).

Two key findings from this review are around the framing of papers and how spiking as an individual act has
been neglected in the literature. Few papers listed spiking as their primary topic and spiking was often
explored within the context of something else, commonly other criminal offending. As such, papers often
started with the offence (e.g., rape, robbery) and worked backwards rather than looking at spiking and
working forwards to see what follow-on offences (if any) were committed. This is important as spiking is not
always followed by another offence. For example, Burgess et al. (2009) reported that, of 10 out of 236
participants in their UK study reported having a drink spiked, none had been subject to a sexual assault as a
result. It is possible the participants sought help before a follow-on offence could take place, but it does raise
the question of how many incidents of spiking might be missed if the starting point of the research is the
follow-on offence.

An additional challenge is presented in spiking (and associated) research as identifying cases where
substances (alcohol, illicit drugs, or medication) are administered covertly is frequently very difficult. For
some papers, although toxicology results are available, it is important to note that they cannot be used to
reliably classify method of administration unless additional information about the participant (i.e., their
voluntary consumption) is available. Even when information about voluntary ingestion by participants is
available, this can be incomplete and could contain errors (e.g., if the victim cannot remember or does not
want to disclose illicit drug use). Thus, even where distinctions were made between voluntary and
involuntary consumption, these were often caveated.

26
The overarching finding of this review is that more focused research is needed to accurately estimate the
prevalence of spiking. Attention needs to be paid to gathering data on voluntary consumption of substances
ensuring a safe space is provided for participants to feel comfortable revealed any illicit use. Allowances also
need to made for memory recall and so the timing of gathering this data might also be critical. To further
understand the scale of the problem, different methods of spiking – for example, injection/needle, drink,
food – should be considered. In addition, this review makes it clear that additional research on motivation
is needed. Only two papers reported on motivations from the perpetrator’s perspective (one from Australia
and one from the USA). Given differences in culture – e.g., fraternity party environments in USA – it may be
that these motivations do not translate into a UK context and so additional work is vital to explore this in
more detail.

27
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35
 APPENDIX A: LITERATURE REVIEW
TABLE
(n=87 sources)
Some findings are in bold – these have been highlighted as they might be of particular interest to the reader (i.e., relate directly to prevalence of, or
motivation for, spiking)

Type of
document Over-arching Findings
No. Reference Search Country Sample/data Findings (Prevalence) Notes
(no. of topic (Motivation)
pages)
1 Adamowicz Journal 2 Poland Date rape/ 33 victims/ Cases submitted to Institute of Forensic Research Sexual assault Drugs can be ingested
& Kala article (4) DFSA perpetrators of in Krakow (2000 = 0, 2001 = 2, 2002 = 0, 2003 = 11, (inferred from involuntarily.
(2005) sexual assault; 2004 = 20). topic)
biological Most common substances found amphetamine Reporting hard to unpick at times
fluids (blood / and 9THC. Alcohol, MDMA, benzodiazepines, (% and n used, some findings =
urine) propranolol, and lidocaine also found. whole sample, some = sub
25 victims, 8 56% of victims tested positive for a substance, 12% samples).
perpetrators alcohol and 24% of victims avowed to drinking
2000-2004 alcohol before the incident. MDMA in 8% victims,
benzodiazepines = 12%. Propranolol n = 1,
ibuprofen n = 1, lidocaine n = 1.
Perpetrators – amphetamines n = 5 (3 of which
also had 9THC), alcohol and nordazepam n = 1,
only one tested positive for alcohol though all
avowed to drinking.
2 Anderson Journal 1, 2 Australia DFSA Clinical files Complainants predominantly female (n = 190, Sexual assault Toxicological analysis conducted
et al. article (collected by 93%); Victim median age = 26 (range 18-54yrs). (inferred from in around 15% of sexual assault
(2019) (10) Victorian Institute All assailants were male (almost 60% known to topic) cases overall.
of Forensic victim, 24% strangers); Number of assailants = 1
Science) for all (n=131), 2 (n=20), 3+ (n = 1); 48% of assaults Paper separates out voluntary
cases of alleged occurred in private residences, 13% outdoors (car and involuntary ingestion.
DFSA between 1 park, park), 7% hotel/motel, 5% public venues
Jan 2011 and 31 (e.g., nightclubs); Occurred between 11pm and 6 Report that time delay between
Dec 2013. N = 204 am (n=160, 78%). 93.6% complainants reported assault and toxicological analysis
voluntary consumption of substances - mostly could explain some findings (e.g.,

36
 alcohol (n=164, 80%) but also prescription and 80% victims reported using
illicit drugs (24%) (stimulants (n=41, alcohol but only 24% tested
amphetamines, cocaine, MDMA), antidepressants positive for it).
(n = 33), and Marijuana (n=32)).
131 blood samples available for analysis – alcohol Limitation – only includes data
most commonly found (n=49); in all but one of for cases reported to the police
these cases there was self-reported alcohol (and referred for analysis) –
consumption; Benzodiazepine found in 36 cases paper argues there will have
but only 24 complainants self-reported use of been underreporting.
drug; 6 tested positive for GHB but only 4 self-
reported use; 11 reported no consumption of
substances but toxicological analysis detected
presence of something.
Overall, there were 14 cases with positive
toxicology results where complainant did not
report voluntary consumption of that substance
(paper states that this suggests drugs were used
covertly to facilitate sexual assault) (7%).
3 Badour et Journal 2 USA (based SVV / SVP 16,992 high Data from 16,992 out of 21,608 eligible students Sexual Alcohol/drug-facilitated was
al. (2020) article on author school students’ Demographics - 45% male, 82% White, 28% violence defined as involving perpetrator-
(14) location) self-reports SVP freshmen, 28% sophomore, 25% juniors, and 18% (inferred from administered drugs, alcohol, or
and SVV where seniors, 86% exclusively attracted to the opposite topic) other intoxicants that result in
SVV/ SVP was sex, 79% in a dating relationship, 50% sexually loss of consciousness or impaired
defined by three active. ability to control behaviour) or
tactics (sexual SVP rates = 10.8% of males, 5.3% of females. incapacitated (i.e., involving
coercion, SVV rates = 21.2% females, 13.3% males. impairment that occurs when the
drug/alcohol- For both sexes, the most common type of SVV victim has voluntarily used
facilitated or tactic coerced sex (males: 8.4%, females: 15.8%); alcohol or other drugs)
incapacitated sex, alcohol/drug facilitated or incapacitated sex Paper states “Separating
and physically (males: 8.2%, females: 9.3%), and physically forced predictors of intentional
forced sex), data sex (males: 4.7%, females: 5.5%). Both males and drug/alcohol facilitated SVP from
is from 2011, 26 females reported using alcohol/drug facilitated or incapacitated SVP are
high schools, 99 incapacitated sex at the highest rate (males: 8.5%, encouraged given the involuntary
item self- females: 4.1%), followed by sexual coercion nature of substance use in the
administered (males: 5.3%, females: 2.0%), and physically forced former” (p.642) – this indicates
questionnaire sex (males: 4.3%, females: 1.4%). they define drug/alcohol
facilitated as involuntary but
they have grouped it with
incapacitated so it is not possible
to determine what proportion of
this is involuntary ingestion
4 Bari et al. Journal R Bangladesh Acute Medical records 4,435 patients 59% were men, mean age 24.8, Reported to Does not report how motivation
(2014) article (5) poisoning of poisoned most common age group 21 to 30 years (42%). be homicide, is identified.
patients (aged Commuter poisoning (43%) was the most stupefying
over 10) treated frequently occurring type of poisoning in both men intent

37
 at department of and women in all 4 years followed by
medicine of organophosphate (OP) poisoning (26%).
Sylhet M.A.G. Intention of poisoning - suicide (2419, 55%),
Osmani Medical homicidal/stupefying intents (1919, 43%), other
College Hospital, poisoning by alcohol, rat killer, snake bites,
Sylhet, corrosives.
Bangladesh, 1 Jan Among the homicidal cases, men were significantly
2008 - 31 Dec more victimised (67% vs. 33%).
2011 “Homicidal poisonings occurred with stupefying
agents usually during work-related travels from
suburbs to cities or vice versa” (p.154)
5 Basher et Journal 2 Bangladesh DFC 38 patients with Most patients were male, average age 36 (range Robbery The sharing of food items during
al. (2017) article (5) acute poisoning 17-60). (inferred from travel is a widely adopted good
and suspected to 79% poisoned in or on transport, 21% were mostly topic) custom and facilitates their
be victims of travel related too (e.g., near car stand). exposure to this type of crime.
drug-facilitated Ingested method via food and drink, also
crimes admitted cigarettes. No females in the sample may be
to Dhaka Medical All victims lost valuables they had been carrying because female travellers are
College Hospital, Toxicological analysis revealed lorazepam and more cautious or because there
Oct 2008 - Dec other benzodiazepines, Midazolam was detected is a perception there is more
2008 in 12 cases, nordiazepam in 6 cases (metabolite of money and goods to gain from
diazepam) and diazepam in 3 cases. robbing men.
Conclusion: Offenders in Dhaka are using different
mixtures of benzodiazepines to incapacitate and Offenders might be linked to
then rob their victims. organised crime.
6 Basile et al. Journal 2 USA Alcohol or Survey of 41,174 41,174 respondents (22,590 women, 18,584 men) Rape and Large sample overall but don’t
(2021) article (7) drug involved people via the – number of people reporting forced rape or MTP made to know what the subsamples (of
sexual 2010–2012 (made to penetrate) was not reported. penetrate people who reported
violence National Intimate Among victims of physically forced rape, 26% of (inferred from experiencing forced sex or MTP)
Partner and female and 30% of male victims reported topic but also are
Sexual Violence substance use examples of
Survey (nationally 45% of male MTP victims reported substance use sex offences Study separates out voluntary
representative The majority of forced rape and MTP victims following and involuntary ingestion
random-digit-dial reported the perpetrator was using alcohol or proactive
telephone survey drugs. spiking are Perpetrators seek out people
of English- and Among victims of alcohol/drug-facilitated rape: provided) who are intoxicated voluntarily as
Spanish-speaking 30% of female and 32% of male victims reported they are vulnerable
adults in the involuntary use of substances, mostly drugs, and
United States) 84% of female and 83% of male victims reported Findings suggest involuntary use
voluntary use. of substances (30% of female
5% females reported involuntary use of alcohol victims and 32% male victims) is
only, 22% involuntary use of drugs, and 7% both. more common than previously
For males, 23% reported involuntary use of drugs documented.
only (other categories not reported).

38
 Among male victims of alcohol/drug-facilitated Limitations – excluded people
MTP, 15% reported involuntary use of substances without phones, victimisation
(9% drugs only, 4% both drugs and alcohol likely to be an underestimate,
(alcohol only not reported)) and 86% reported recall bias, perpetrator substance
voluntary use. use reported by victim.
Perpetrators often use alcohol and/or drugs during
offences, including cases where victim is under
influence of alcohol and/or drugs.
Overall, study reports “About 1 in 3 female and
male rape victims and about 1 in 7 male MTP
victims reported involuntary use of substances
during at least one first encounter, most commonly
drugs other than alcohol only” (p.6)
7 Bertol et al. Journal 2 Italy DFSA 256 female 73% (187) of women were from foreign countries, Sexual assault Ethanol induces amnesia and loss
(2018) article (9) patients 18 or suggesting either a poor confidence of Italian (inferred from of inhibitions and so in DFSA
over consulting women to report or it could be due to the high topic) includes where the victim is
the Sexual Assault number of tourists and young students in Florence encouraged to drink more than
Centre between Aged 7 – 54 median 22 (69% were aged 18-30) they planned to or drink
Jan 2010 – Jul 37% tested positive at least for a substance. beverages with alcohol added.
2018 Alcohol was the most detected substance (57
cases), followed by Cannabis (19 cases), cocaine It is difficult to distinguish what
(15 cases) and opiates/methadone (heroine: 5; quantity of alcohol has been
morphine:1; methadone: 6); benzodiazepines and covertly administered and what
amphetamine were found in 13 and in 2 cases, has been voluntarily consumed.
respectively.
Drug most likely to be connected to DFSA is GHB
but only one case of GHB consumption was
observed and no new psychoactive substances
were detected.
“Among the patients suspecting proactive DFSA,
sedative drug findings, not explained by voluntary
intake, were encountered”. (p.207)
8 Bidstrup et Journal 2 Denmark Sexual assault 130 case files 67 examinations in 2019 and 63 in 2020 Sexual assault Dark figure of crime means many
al. (2022) article (8) from clinical 125 females, 5 males, 70% aged 15-25 years. (inferred from sexual assaults do not result in an
forensic Voluntary intake of alcohol or drugs in 24hrs prior topic) examination.
examinations of to the assault reported as 46% (n=31) in 2019 and
individuals of 62% (n=39) in 2020. Data is from help-seeking
alleged sexual Voluntary intake not automatically classified as individuals (who might differ
assault, 1 April- DFSA. from people who don’t seek
30 June in both Identified as possible drug-facilitated sexual help).
2019 and 2020 assault (DFSA) = 32 (48%) in 2019 and 28 (44%) in
2020. Toxicological tests rarely
Suspicion of spiked drink 14 (21%) in 2019 and 8 performed due to delay between
(13%) in 2020. assault and reporting.

39
 Lockdown did not seem to change the overall Some DFSA might not be
number of examinations or the demographic and identified (e.g., if victim does not
criminological characteristics of the sexual assault want to be examined, stigma and
victims. victim blaming).
No decrease in cases of possible DFSA was found
despite the lockdown of nightlife venues.

9 Birkler et Journal 2 Denmark Sexual assault Biological 166 females, one male, 66% aged under 26, Sexual assault DFSA is defined as covert
al. (2012) article (8) specimens from average age 23.8. (inferred from administration in this study.
167 victims of 124 victims (74%) reported drinking alcohol prior topic)
sexual assault to the assault. It is likely some victims do not
examined at the 59 positive test results for alcohol (48%). report intake of medicinal drugs
Sexual Assault 35 were found positive for one or more drugs and drugs of abuse correctly.
Center (Aarhus, excluding alcohol (21%).
Denmark), Jun “DFSA is defined as covert or forced administration
2007 – Dec 2009 of sedative drugs or drugs of abuse and/ or alcohol
to the victim for the purpose of sexual assault”
(p.157)
20 of the victims reported they have been subject
to a drug-facilitated sexual assault (12%), average
age 23.7 (range 14-46).
DFSA – time to report median was 15hrs longer
17 out of 20 reported consuming alcohol prior to
the assault but only 4 of the 17 tested positive for
alcohol (note: none of the 3 who reported they
were not drinking tested positive for alcohol)
8 DFSA victims reported taking drugs (illicit or
otherwise) before the assault, all of whom tested
positive for drugs (not always what they had
admitted taking).
One of the victims who reported taking drugs was
forced to eat tablets – tested positive for
Alprazolam, diazepam and desmethyldiazepam.
One victim was offered a drink – tested positive
for Clonazepam, meprobamate and oxycodone.
9 reported they had taken no drugs, all were
negative except one who had oxazepram in their
system (and was reported to have been offered a
drink that tasted funny before she passed out).
Overall, 9 DFSA victims were positive for one or
more drugs, with 6 found positive for
benzodiazepines or other drugs with sedative
effects.

40
10 Bosman et Journal 2 Netherlands Sexual assault 135 cases of 94% female, mean age 25 years. Sexual assault In some cases, the absence of
al. (2011) article (7) alleged DFSA Blood and urine samples were tested for the (inferred from alcohol and drugs may represent
examined by presence of alcohol, drugs (drugs of abuse and topic) false negative results due to a
Netherlands prescription drugs), or both. In 27% of the cases, delay between the alleged
Forensic Institute, no alcohol and/or drugs were found. assault and sampling.
Jan 2004 - Dec With increasing time delay, more cases were found
2006 to be negative. Study could not discriminate
Alcohol is the most commonly found drug followed between proactive and
by non-opiate analgesics, illicit drugs, and opportunistic DFSA.
benzodiazepines.
11 Burgess et Journal 1, 2 UK Spiking; DFSA 200 10 out of 236 participants in the UK reported Implied DFSA Appears to conflate DFSA with
al. (2009) article (compared questionnaires, having a drink spiked and none had been subject (but report drink spiking at times (e.g.,
(15) to USA 20 interviews, 4 to a sexual assault as a result. and comment reports participant experiences
where focus groups with 17 out of 334 in the USA reported they had been on the fact of spiking then says but their
question- University victims of drugging though again no reports of that none of awareness of DFSA is…).
naire of 334 students (85% assaults. their
students female, mean age However, vast majority of participants knew about respondents Identifies a key problem in the
was carried 21), data DFSA. who had been introduction - “Drink-spiking
out) collection -2006- 110 (55%) UK participants claimed they personally spiked had cannot be clearly distinguished
2007 know someone who had had a drug slipped into also been from other potential causes of
their drink. sexually wooziness and dis-inhibition, no
112 (33.5%) of USA respondents had heard about assaulted) matter how certain one may feel
drugs being slipped into drinks at university and 57 that a loss of control was
(17.1%) said they personally knew of such an disproportionate to the quantity
incident. of alcohol consumed” (p.848)
There is fear of drink spiking and females saw
nights out as risky (UK). Framing of the paper is myth
Stated that: “Students in many cases judged busting with the overarching
certain bad-night-out episodes (loss of memory, message that alcohol is the
blackouts, ill feeling, dizziness) as likely to be biggest date rape drug.
related to tampering of drinks rather than the
quantity of drink itself” (p.859)
The voluntary nature of alcohol consumption is a
less desirable explanation of vulnerability (to DFSA)
12 Caballero Journal 2 Spain DFSA 152 alleged sexual 152 out of 445 cases of alleged DFSA received by Sexual assault Probable DFSA includes cases
et al. article (6) assault cases, Jan the National Institute of Toxicology and Forensic (inferred from where there is a convergence of
(2017) 2010 - Dec 2013 Sciences (Madrid, Spain) met the criteria of topic) at least one of the criteria
probable DFSA. reported by Du Mont et al. (2009)
Positive toxicological results in 86% of cases; for suspecting sexual assault and
substances identified were ethanol (77%), another for suspecting drug
pharmaceuticals (36%, mainly benzodiazepines) involvement.
and illicit drugs (29%, mainly cocaine), alone or in
combination. DFSA data not stored centrally
but authors argue this sample is
representative of Spain.

41
 All victims were female, mean age 26.2 years
(range 13-55), physical or mental disability No men in the sample.
documented in 10% of cases (n=15).
Previous voluntary use of psychoactive substances Different specimens offer
was reported in 116 cases – of these, 111 admitted different detection windows.
consuming alcohol (73%), 12 (8%) illicit drugs and 9
(6%) pharmaceuticals. Early collection of samples
Offences committed in entertainment venues (within 6 hours) is a key factor to
(n=47), homes/hotels (n=38), and streets/public obtain evidence in DFSA.
places (n=26).
13% of cases could be classified as proactive DFSA
“Date rape drugs” such as GHB and Ketamine,
highlighted by the media, were only found in 3
cases in this sample (all Ketamine).
Scopolamine not detected in any cases in this
sample.
13 Cabarcos- Journal 2 Spain Sexual 69 cases of sexual 69 cases received between 2009-2021 (low Sexual assault Small sample (given the timescale
Fernandez article (5) assault/ DFSA assault referred number corresponds to a small area of Spain) (inferred from covered).
et al. to the Forensic 67 females, 2 males. topic)
(2022) Toxicology Service Aged between 14 and 65 (55% between 18-30) Proportion of positive results
in Santiago, 12- All registered as possible victims of sexual assaults recorded for victims who stated
year period Blood, urine, and/or hair samples. voluntary ingestion not reported
Positive result in 88% of cases (n=61). (though this data was missing in
Of these 77% positive for alcohol, 34% drugs most cases).
(mainly benzodiazepines), 26% for illicit drugs
(mainly cocaine followed by cannabis) alone or in
combination (though 53% positive cases were only
for alcohol).
Voluntary ingestion of alcohol reported in 13% (9
cases), information not available for 60 cases.
Voluntary cannabis use reported in 7% of cases.
14 Cerdas et Journal 2 Costa Rica Rape 272 reports of 38 rapes per 100,000 people, 96% victims female, Rape (inferred Study was able to extract cases
al. (2014) article (6) rape received by 50% aged 10-19 years, 99.5% perpetrators were from topic but which were drug/alcohol
Judicial male. also examples facilitated and method of
Investigation 259 out of 272 reports contained information and of rape administration (opportunistic vs.
Agency between drugs/alcohol. following covert).
Jul 2012 - Jun 14% of rapes could be classified as proactive drug proactive
2013, cases facilitated (defined as rapes in which the spiking are
reported within perpetrator administered the victim an provided)
30 days of the incapacitating or disinhibiting substance (e.g.,
rape drugs or alcohol) in order to commit the rape).
25% of rapes could be classified as opportunistic
drug facilitated (defined as rapes where the
victims were intoxicated by their own actions to
the point of being unable to defend themselves).

42
15 Cunningha Conferenc 2 UK (inferred Sexual assault All clients 40 out of 46 (87%) female, median age of 27 years Sexual assault Only abstract was available.
m et al. e abstract based on reporting sexual 14 (30%) Black. (inferred from
(2010) (for location of assault seen by 24 (60%) females reported vaginal rape (6 of these topic)
poster) authors and GUM between reported vaginal and anal), all males reported anal
reference to August 2008 and rape.
BASHH March 2009 (46 Perpetrator known in 27 (63%) of cases.
standards) people) 6 out of 46 cases (13%) were suspected DFSA.
16 Dalaker et Conferenc 1 Norway Spiking 101 patients (101 101 patients (2.7 per week) presented at the clinic Not stated Only abstract was available.
al. (2020) e abstract blood samples with suspected poisoning inflicted by others
and 71 urine 64 females, 37 males, median age = 24.
samples), aged Blood samples = ethanol (n=65; 64%),
16 or over who tetrahydrocannabinol (THC) in 4 (4%),
presented at Oslo benzodiazepines in 4 (4%), lamotrigine in 2 (2%),
Accident and cocaine in 2 (2%), amphetamine in 4 (4%),
Emergency methylenedioxymethamphetamine (MDMA) in 3
Outpatient Clinic (3%), and tramadol in 1 case (1%). In the urine
within 48 hours of samples we found ethanol in 52 (73%), cocaine in 5
suspected (7%), opiates in 2 (3%), cannabis in 5 (7%),
poisoning, Sep benzodiazepines in 1 (1%), MDMA in 3 (4%),
2018 to May 2019 amphetamine in 5 cases (7%).
In one third of the cases, no drugs were detected.
17 Dempsey Journal 2 USA DFSA Blood and/or 1,230 cases – samples – 53 (blood only), 132 (urine Sexual assault Time delay between alleged
et al. paper (7) urine specimens only), 1,045 (blood and urine) but total number (inferred from event and sample collection is
(2022) from 1230 sexual screened for this study was 1,240 specimens topic) not included in the study (and
assault related relating to the 1,230 cases. could impact findings).
cases submitted 67% alleged victims were female, 5% male, 28%
to Houston unknown. Low number of submissions
Forensic Science 21% White, 13% Black, 5% Hispanic, less than 1% could reflect low reporting of
Center from 1 Jan Asian, 13% Other, 48% unknown. sexual assault.
2014 – 31 Dec Average age was 26, range 3-78 years (age
2020 unknown in 3% of cases). Only 22% of cases that screened
Ethanol detected in 212 (17%) of samples (it was positive at presumptive stage
the only substance in 185 samples). were confirmed by further
62% of samples (n=786) were presumptive positive analysis.
for at least one drug mostly cannabis (74%),
benzodiazepines (29%), cocaine/benzoylecgonine Lab does not test urine for
(28%), amphetamines (29%), and ethanol so in urine only cases this
methamphetamine (19%). data was missing. Thus, the study
149 samples were confirmed positive for drugs under-estimates ethanol in DFSA.
other than ethanol and 27 confirmed positive for
drugs and ethanol together, 259 cases had Testing does not cover all
multiple drugs. possible substances that could be
45 different substances detected. used in DFSA.

43
 From 2014 to 2020 the number of DFSA cases
submitted to the forensic service doubled but still
only account for around 17% of the labs work.
18 Djezzar et Book 2 France DFC / DFSA Reports on study Data available 890 out of 2144 cases of victims
al. (2014) chapter with 890 victims under influence of psychoactive substance in the
(36) of assault under time period.
the influence of a Prevalence of DFC generally increased over time
psychoactive (less than 1% of cases in 2001/2002, increasing to
substance, 2003 - 6% 2003, and was 18% by 2011).
2011 Identification of the substances used in this study
was based on the result of toxicological analysis
(and sometimes on the offenders’ confessions
(n=24)).
473 cases met the criteria of probable chemical
submission or DFC (i.e., a premeditated choice of
substance by the offender, cases of forced
ingestion also included).
Victims submitted to forced ingestion
represented 8% of cases in this series (29 women
and 11 men).
Over half of victims were female (n=295, 62%)
Age range 2 months – 90 years (mean 29.8yrs for
individuals over age 1) (two victims babies –
2months and 8months).
Voluntary ingestion of substances reported by
victims as well.
Often met in party context (n=101) or home
/equivalent setting (e.g., hotel, prison) (n=222)
DFCs – sexual assault or rape (51%), 219 cases
(46%) sexual assault, 104 cases theft (22%), 21
cases rape and theft together (4%), sedation for
purposes of homicide (37, 8%), other (physical
assault, kidnapping, mental manipulation in a
context of inheritance theft) 2% (n=9).
DFC was identified in 83 cases (18%) based on
either severe amnesia (where sexual assault
could not be confirmed or excluded by an adult
Storage conditions and time
between screening and
confirmation testing could lead to
loss of drug.
It is unknown if the drugs
detected were taken voluntarily
or not. Toxicology results cannot
differentiate between voluntary
and covert administration.
Rape, theft, Introduction states “Drug-
homicide, facilitated crime (DFC) is a
kidnapping, general term that includes
physical robbery, money extortion,
assault deliberate maltreatment of
vulnerable people (children,
including Munchausen by proxy
syndrome; the elderly; the
disabled; and/or mentally ill
people), rape and sexual assault:
drug-facilitated sexual assault
(DFSA) is a subset of DFC” (p.11)
DFC defined as perpetrator giving
substance to victim.
Chapter provides table including
drugs used in DFC (grouped by
type of drug).
Voluntary substance use can
create vulnerability.
Summarises literature for DFC in
USA, Canada, Australia, UK,
Ireland, Netherlands, Germany,
Denmark, Norway, Sweden,
Poland, Belgium, Italy, and Spain.
44
 victim) or due to abnormal symptoms /behaviour
reported by persons caring for the victim (where
the assailant did not complete the crime).
Range of drugs found mostly benzodiazepines (or
derivatives) Flunitrazepam found in 14 cases
GHB (or GBL which is precursor to GHB) found in
15 cases.
19 Du Mont et Journal 2 Ontario DFSA 882 sexual assault 977 consecutive sexual assault victims in original Sexual assault DFSA is a common problem
al. (2009) article (7) (infer victims presenting sample – 882 eligible for inclusion. (inferred from
Canada) at one of 7 Defined victims of drug-facilitated sexual assault as topic) “It is possible that not all victims
hospital based those who presented to a centre within 72 hours of suspected drug-facilitated
sexual assault of being assaulted and who provided at least 1 sexual assault in our study
centres in valid reason for suspecting that they had been experienced surreptitious
Ontario, Jun 2005 drugged and sexually assaulted. drugging. The voluntary use of
– Mar 2007 855 out of 882 (96.2%) were women, mean age alcohol, over-the-counter
27.2 (range 16-91 years) (note under 16 excluded medications and street drugs,
from the sample). alone or in combination, could
184 (21%) met the criteria for suspected DFSA. have resulted in incapacitation”
Victims of DFSA more likely to present at large (p.158)
urban centre for care, be employed, to have
consumed over the counter medications (47 out of Limitations: sample only
179 compared to 54 out of 640 for non-DFSA represents people who present
cases) and street drugs (47/179 compared to to sexual assault service, data
127/640) and to have consumed alcohol (158 out could be missing where victims
of 178 compared to 390 out of 666 non-DFSA). suffer amnesia.
20 Du Mont et Journal 2 Canada DFSA 882 sexual assault 977 persons who reported a suspicion of sexual Sexual assault Looks like the same sample as Du
al. (2010) article (6) victims presenting assault were screened - 882 were included in the (inferred from Mont et al. (2009) though
at one of 7 study. topic) reported average age is slightly
hospital based 184 of 882 eligible participants met suspected different.
sexual assault DFSA criteria.
centres in Mean age was 25.8 years, 96.2% were female and Findings may under- or over-
Ontario, 65% White. estimate the true rate of
Information was Urine samples were positive for drugs in 45% of intentional drugging.
collected over a cases, alcohol in 13%, and both drugs and alcohol
22- month period in 18%. Given the delayed presentation
beginning in June The drugs found on toxicological screening were of many who suspected DFSA and
2005 unexpected in 87 of the 135 (64.4%) cases with a the short half-life of some ‘date
positive drug finding and included cannabinoids rape drugs’, it is possible drugs
(40%), cocaine (32%), amphetamines (14%), were not found due to late
MDMA (9%), Ketamine (2%), and GHB (1%). screening.
Male DNA was unexpected in 30 (47%) of 64 cases
where it was found (i.e., the client denied having
had consensual sexual intercourse in the week
prior to being examined).

45
 In 74.2% of suspected DFSA cases with a
toxicological finding, at least one CNS active drug
and/or alcohol was found.
The presence of unexpected drugs was common –
49% of all suspected DFSA victims (64% of cases
with a positive toxicological finding), a drug was
found that had not been reported as voluntarily
consumed.
“Even accounting for substances reported to
having been voluntarily consumed and focusing on
only unexpected toxicological results, ‘date rape
drugs’ were found in very few cases” (p.336)
21 Du Mont et Journal 2 Canada DFSA 184 sexual assault 184 cases of suspected intentional drugging – of Sexual assault Analysis of sub sample of dataset
al. (2016) article (8) victims presenting these 178 had urine samples that could be (inferred from from Du Mont et al. (2009) and
one of 7 hospital analysed. topic) Du Mont et al. (2010) – “This
based sexual 87 cases classified as predatory DFSA (47%). study is part of a larger DFSA
assault centres in 91 DFSA cases in which voluntarily reported Project for which the methods
Ontario, Jun 2005 drug(s), or no drug(s) at all were identified in have been described elsewhere
– Mar 2007 toxicological screening (non-predatory DFSA cases) (Du Mont et al., 2009; Du Mont et
Compared the two and found predatory DFSA al., 2010).” (p.394)
were more likely to present later, more likely to
report mental health issues in last 6 months, less Limitations: sample only
likely to be students, more likely to report represents people who present
voluntarily consuming street drugs in the 72hrs to sexual assault service
before the assault, less likely to have consumed
alcohol, more likely to have been assaulted by Victims may have been given
multiple assailants. Also, more likely to report incapacitating drugs that the
that the mode by which they suspected having laboratory was unable to detect
been drugged was a recreational drug/non- (e.g., because some drugs, such
alcoholic drink (28% vs. 10%), whereas they were as Flunitrazepam, do not remain
less likely to have suspected that an alcoholic stable over time)
drink was the vehicle (47% vs. 63%).
Factors not associated - age, sex, ethnicity, living
situation, and living with a disability, prescription
medication and over-the-counter medication use
72 hours before examination, last known location
before assault, and last known action before
assault, day of assault, types of sex acts
(cunnilingus/fellatio, oral/anal/vaginal
penetration), weapons present/used, and physical
injuries present.
“Odds of experiencing a predatory DFSA were
more than 3.5 times greater in cases in which the
mode of suspected drugging was a recreational
drug or non-alcoholic drink” (p.398)

46
22 Eagling et Confer- 1 UK Methaemoglo 205 enquiries Most calls related to the recreational use of Not stated Only abstract available.
al. (2020) ence binaemia (involving 187 poppers.
abstract (MetHb) individuals) to the In 4 cases the cause was listed as “spiked Did not separate out spiked and
(condition National Poisons drink/unknown”. unknown.
associated Information
with exposure Service about
to drugs) MetHb over the
5-year study
period
23 Elliott & Journal 1 UK Spiking 180 requests for From 180 total requests (2002-2004), based on Not stated Most referrals were for
Burgess article (6) toxicological the limited clinical details stated; 89% involved suspected spiking. However, not
(2005) analysis for suspected spiked drink, 6% involved a all cases referred specifically
individuals drugging/doping incident, 4% involved alleged mention sedation or
presenting to sexual assault, and 1% involved other factors (e.g. incapacitation and few mention
their GP or physical assault). date rape or sexual assault.
hospital following Referrals peaked in Dec/Jan possibly associated
self-reported or with Christmas/New Year. Some peaks in Apr/May
surreptitious drug as well though this is unexplained.
administration Requests related to 66% female v 34% male,
(e.g., spiked average age = 25yrs.
drink); Jul 2002 to Toxicology in 169 cases (blood, urine) – most
Jun 2004 commonly detected compound = ethanol (n=41,
24%), amphetamines (n=19, 11%), cannabinoids
(n=16, 9%), benzodiazepine (n=9, 5%), and cocaine
(4%). Other substances in 2% or less. No GHB or
Flunitrazepam detected in any cases.
50-60% of cases = no substances found – reasons
for this could include there was no drug, time
delay between administration and sample
collection, or levels too low to be detected.
Total cases analysed 2002-2003 = 59, 2003-2004 =
110.
Many of the substances found could be
administered by the victim (as opposed to
covertly), cannabis would be difficult to administer
covertly, some drugs could be therapeutic and
used by the patient themselves (e.g.,
benzodiazepines for anxiety, opiates for pain
relief).

24 Fiorentin & Journal 2 USA DFSA 1,000 consecutive Gender and age were available for 613 cases (and Sexual assault Unclear how cases were selected
Logan article cases submitted 92% of these were female), mean age 26.8 (range (inferred from (other than to cover large
(2019) (11) to NMS Labs for a 1-64 years). topic) number of states)
DFSA toxicology
panel from Mar

47
 2015 - Jun 2016, 784 cases (78%) were positive for one or more
cases from 37 US intoxicating substances (216 cases (22%) were
states and 1 negative for any substance).
territory Found most often were ethanol (31%, 309) and
cannabinoids (29%, 288), amphetamine/
methamphetamine (17%, 165),
cocaine/metabolites (10 %, 104) and clonazepam
(8%, 76).
Positive for 1 substance (276 cases), 2 substances
(220 cases), 3 substances (109 cases), 4 substances
(63 cases), 5 substances (37 cases) and 6 or more
substances (79 cases).
Benzodiazepines and GHB are frequently cited as
“date rape” or incapacitating drugs -
Benzodiazepines were found in 21% (n = 210) and
GHB was detected (above the reporting limit of 2
mg/L in blood or urine) in 6% (n = 59) of the cases
Where age range known – positive results for GHB
were 3 (out of 28) 1-15year olds, 14 out of 203 16-
29 year olds, and 6 out of 108 30-64 year olds.
The benzodiazepine scope in this is very
comprehensive (including 24 compounds) and
sensitive when compared to other studies which
analyse fewer substances (which could explain why
they found higher instances of this drug than other
published studies).
Concludes “Intoxication by ethanol alone or in
combination with other substances may contribute
to some forms of DFSA” (p.58)
Benzodiazepines and GHB act synergistically with
alcohol.
25 Gee et al. Report R UK DFSA 120 police- Aimed to assess the nature of DFSA in England
(2006) (34) referred victims (though notes that the findings do not characterise
who reported to the prevalence of DFSA in the participating police
the police that force areas or the country as a whole).
they had 120 cases were submitted for examination
experienced or 119 of the 120 victims had reportedly been
suspected a DFSA drinking alcohol though alcohol was only detected
within the in 62 (52%) cases (in 22 out of the 62 (35%) of
previous 72 these cases blood alcohol levels at the time of the
hours, cases came incident were estimated to be greater than 200 mg
from 6 police (i.e., more than 2-3 times the driving limit of 80
forces mg)).
Controlled or prescribed drugs were detected 57
cases (48%).
GHB has a short half life and
detecting presence dependent on
time of sampling
“The interpretation of GHB is
complicated by virtue of it being
an endogenous compound from
diet and metabolism in humans”
(p.58) – go on to say “GHB is also
present is wine and beer, and is
an endogenous compound in
humans being formed from the
metabolism of succinate
semialdehyde” (p.61) and so care
must be taken in interpretation.
Toxicological results alone do not
distinguish between voluntary
self-administration versus
surreptitious administration.
Sexual assault Report on Operation Matisse (for
(inferred from ACPO).
topic)
The inference drawn is that some
offenders facilitate sexual assault
by administering drugs, including
alcohol to victims.
Some offenders may prefer to
commit opportunistic assaults
after the victim has become
intoxicated following their own
use of drugs and/or alcohol.
48
 Cannabis and cocaine were the most commonly Authors argue the potential for
detected drugs (in 20% and 17% of cases the victim to deny voluntary
respectively). taking of drugs cannot be
The combination of drugs and alcohol would dismissed.
exacerbate intoxication.
Rohypnol (Flunitrazepam) was not detected in any
of the submitted cases.
GHB was detected in two cases.
10 cases (8%) were suspected DFSA assaults in
which a sedative or disinhibiting drug was
detected which either had been given to the
victim by an alleged assailant or where the victim
denied its legitimate use (5 were cocaine, 2 cases
involved the sedative drugs diazepam and
temazepam 1 case involved MDMA (ecstasy) and
the other two cases involved GHB).
In 11 other cases DFSA could not be discounted
due to a lack of clarity surrounding the
circumstances of the case (cocaine featured,
three involved administering alcohol (2 covertly,
one more openly)).
Some of the cases could be opportunistic DFSA
assaults (i.e., where an assailant assaults a victim
who is profoundly intoxicated by her/his own
actions) – therefore high alcohol levels (especially
if combined with sedating or disinhibiting drugs)
can play a major part in these types of cases
When looking at whole sample, strangers and
assailants who met on the day of the assault
account for most cases.
The most common place at which first contact was
made was pubs and clubs (prior to the assault),
accounting for half of cases (when the location was
known).
26 Gharedaghi Journal 2 Iran DFC Urine / blood 53 patients – 8 (15%) female, 45 (85%) male, mean Robbery Authors emphasise that negative
et al. article (7) samples from all age was 31.6, range 7-65 years. (77%) and results in DFC victims does not
(2018) patients referred Drugs were commonly given in drinks (45%) and Rape (4%) mean that no drug has been
to two university during transportations (45%). administered it could be due to a
hospitals of Method of administration – patient offered delay in reporting or drug
Tehran with the something to eat (71%), gave away free food on metabolism from the body.
complaint of religious ceremonies (13%), offered medication for
being poisoned by treatment (e.g., of a headache) or as a part of
another person to employment process (in 15% of the cases)
facilitate a crime, 55% said there was no change in the taste of their
food/drink.

49
 Feb 2009 - Mar Patients had usually been referred with mild loss
2010 of consciousness (57%).
Most common drugs given were metoclopramide
and dextromethorphan (19%).
Opioids are the most commonly involved drugs in
DFCs (23, 43%) but Metoclopramide (10, 19%),
benzodiazepines (7, 13%), Theobromine (5, 9%),
and antihistamines (3, 6%) are also commonly used
for this purpose (5 other drug were found in 1 case
each).
Type of the drug was not related to motive of
administration.
In 49 cases (93%), no history of recent
drug/medication use was reported. Of the 4 who
reported use, 1 claimed to be on addiction
withdrawal using codeine and ibuprofen (no
positive test result), 1 used tramadol, 1 was on
diabetic and cardiovascular medications, and 1
admitted infrequent use of amphetamine.
Motive – robbery (41, 77%), rape (2, 4%), not
defined (10, 19%).
“About 43% of our victims were intoxicated by
poisonous drinks unwillingly” (p.5)
Almost 38% of offenders pretended to eat from
the same drink or food to gain the victims’ trust.
27 Greene et Journal 1 UK Spiking 78 participants 82% (n=64) female, mean age 24yrs (range 19- MDMA in 3 All participants approached to
al. (2007) article (5) provided 67 blood 52yrs), mean time of exposure 5.9hrs (range 1- people who take part consented to join the
samples and 75 12hrs) denied taking study; unknown if there are any
urine samples, Peak time of presentation = between 2-3am. Peak in could biases in clinical staff who
aged 18 or over time of the week was Friday and Saturday evenings indicate approached them (e.g., didn’t
who had (67% presented between 6pm on Friday and motive to due to time pressure)
presented at midday on Sunday). commit
emergency Half of exposures were reported to have occurred sexual assault Inaccurate or untruthful patient
department in a club, bar (32%), private residence (8%), and (due to its history about drug exposure; a
alleging they had unknown (10%). disinhibition potential source of reporting bias
consumed a Ethanol was detected in 89.7% of participants. qualities)
spiked drink in (60% of participants had a serum ethanol Not all people who think they
the last 12 hrs, concentration associated with significant Detection of have been spiked attend
recruited intoxication). sedative emergency departments so there
between Dec Illicit drugs (n=12, 15%) participants; 7 denied drugs (where might be missing data
2004 and Oct intentional exposure (3 cannabis, 3 people denied
2005 (captured methylenedioxymethamphetamine, 1 c- taking them
pharmaceuticals hydroxybutyrate). Medicinal drugs (n=13); only 1 voluntarily)
used in last 24hrs) exposure was unexplained (benzodiazepine). could indicate
Overall illicit or medicinal drugs of unexplained motive to

50
 origin were detected in 8 (10%) participants. commit
Unexplained sedative drug exposure was only sexual assault
detected in 2 participants (3%).
Exposure to cannabis might be intentional or
unintentional.
Conclusion – “The use of sedative drugs to spike
drinks may not be as common as portrayed in the
mainstream media. Sedative drugs commonly
associated with drink spiking were detected in only
a small minority of study participants.” (p.757)
28 Hagan & Journal 2 USA DFSA Toxicology Of the 45 sexual assault samples submitted, 6 Sexual assault Focus on cathinones so only
Reidy article (5) samples from 45 (13%) were positive for synthetic cathinones / rape reported on these cases.
(2015) victims presenting (methylone) without any toxicological finding of
to the Rape ethanol, GHB or Ketamine. The number of victims,
Treatment Center Victim 1: Female unknown age reporting that her voluntarily or involuntarily using
in Miami-Dade ex-boyfriend had raped her. No other drugs found. synthetic cathinones potentially
and reported a Victim 2: Kidnaped and placed in a car with three higher than the 13% found in this
rape unknown males. She was then forced to take a pill study.
and then subsequently forced to have oral sex with
all three males. Ethanol and D9-carboxy-THC also Time delay between report of
found. rape and taking samples could
Victim 3: Attacked and raped by multiple present a problem.
assailants. D9-carboxy-THC COC,
Methamphetamine, amphetamine, and
Methylenedioxymethamphetamine also found.
Victim 4: Sexually assaulted by several subjects and
held against her will for six days. During this time,
she was constantly abused. D9-carboxy-THC and
Naproxen Dextromethorphan (can cause sedation,
confusion and blurred vision) also found.
Victim 5: Disclosed that she had been drinking and
then was forced to ingest a ‘‘molly.’’ Upon
awakening, she discovered she had been raped. No
other drugs found.
Victim 6: One attacker raped victim. No other
information provided. D9-carboxy-THC, cocaine
and metabolites, alprazolam and metabolites (this
is a benzodiazepine that is known to cause
sedation and mental confusion) found.
Drugs commonly thought to be utilized in DFSA
cases (e.g., Flunitrazepam, GHB, and Ketamine)
were not reported in this study.
29 Hagemann Journal 2 Norway DFSA Urine and/or 264 out of 730 people (aged 12 or over) who Sexual assault Sexual assault is underreported –
et al. article (8) blood samples for attended the centre during the timeframe were (inferred from this sample only includes people
(2013) 264 female included in the sample (reasons to exclude topic) who attended the centre.

51
 patients aged 12 included male patients, cases with no toxicology,
or over sexual assault not suspected, not medically Data on voluntary intake may be
presenting to the examined, declined to participate) incomplete – people might fear
Sexual Assault Patients mostly 18-24yrs (n=137), followed by 25 revealing they take illicit drugs
Center at St. or over (70), then 12-17yrs (57) or worry about being blamed for
Olavs University Data available for 257 about alcohol intake – 35 their assault.
Hospital, had none, 50 had intake of less than 5 units, and
Trondheim, 172 had intake of more than 5 units; 76 self- Conclude opportunistic DFSA
Norway, 1 Jul reported ingestion of one or more drugs (medical (rather than proactive DFSA) is
2003 – 31 Dec and/or illicit) more common in patients
2010 Ethanol and/or drugs were detected in 155 out of attending the centre.
264 cases (59%).
50 patients (19%) tested positive for drugs other
than ethanol – of these, benzodiazepines/
benzodiazepine-like drugs were found in 31,
central stimulants in 14, cannabinoids in 13 and
opioids in 9.
Tested positive for ethanol only (n=105), drugs
only (n=36), or both (n=14).
No patients tested positive for GHB.
57 patients (22%) suspected proactive DFSA, but
only 5 had tested positive for sedative drugs
(clonazepam, diazepam and/or oxazepam) that
were not accounted for by self-reported
voluntary intake (2%). These patients either gave
a history of alcohol/drug abuse or anxiety
disorder, making recent voluntary intake of one
or more of these drugs likely and so the authors
concluded that: “No cases could unequivocally be
attributed to proactive DFSA.” (p.777)
30 Hall et al. Journal 1, 2 Northern Alleged DFSA 107 cases of Identified from Forensic Science Northern Ireland Sexual assault Introduction distinguishes
(2008) article (8) Ireland sexual assaults (FSNI) database – 30 requests made in 1999, 2000 (inferred from between proactive DFSA (covert
submitted for = 36, 2001 = 21, 2002 = 61, 2003 = 47, 2004 = 48, topic) or forcible administration of a
forensic analysis 2005 = 51) – increase in requests could be substance to facilitate an
(toxicology) reflection of guidance to test where drugs are offence) and opportunistic DFSA
1999 - 2005 suspected. (assault on victim profoundly
Percentage of cases containing alcohol, drugs or intoxicated by their own actions)
both was 66% in 1999, 42% in 2000, 71% in 2001, though this study was not able to
75% in 2002, 64% in 2003, 71% in 2004 and 78% in distinguish between
2005. administration methods.
Presence of drugs (alone or in combination)
doubled between 1999 and 2005. Resource limitations placed
Drugs detected include paracetamol, venlafaxine, restrictions on data available
toluene, codeine, morphine, cannabis, diazepam (only cases with toxicology
and metabolites, dihydrocodeine, diamorphine, included in the study, reasons not

52
 MDMA, MDA, cocaine metabolite, temazepam and to request toxicology include very
cannabinoids. young or very old victim, historic
9-21% of cases per year = no substances found cases, >24 hrs passed,
3-12% of cases per year have a time delay of >12 murder/unexplained death with
hours – some of these cases might, therefore, be suspected sexual motive).
false negatives.
Difficult to distinguish between voluntary and
involuntary use – e.g., positive results for
benzodiazepines could reflect prescribing practice,
some drugs are used recreationally.
No “date rape” drugs (GHB, Rohypnol) identified
(could be due to delayed reporting) and other
drugs might have been taken voluntarily.

31 Hindmarch Journal R USA Sexual assault 3303 urine 2026 (61%) proved positive for one or more Sexual assault Warns these results do not imply
et al. article (9) samples, substances. (inferred from a causal relationship between
(2001) collected in an Alcohol (either alone or in combination with other topic though substances and sexual assault
independent drugs) was the most common substance found see notes)
testing (1358, 67% of positives). Could be some false negatives for
programme from Cannabis was the second most prevalent drug alcohol and GHB due to delay in
individuals who (613, 30% of positives). collecting samples.
claimed to have GHB found in 3% of samples.
been sexually Flunitrazepam found in <1% of samples (n=11) Opposite issue with other drugs –
assaulted and Benzodiazepines, cocaine, amphetamines, opiates, e.g., cannabis (depending on the
believed that and barbiturates also found. frequency and pattern of use)
drugs were “Detailed examination of the testing results does can be detected for up to 2
involved, Jun not support the contention that any single drug, weeks, so can many barbiturates
1996 – Feb 2000 apart from alcohol, can be particularly identified as and benzodiazepines. Also noted
a ‘date rape’ drug. Rather, the alleged sexual that “prescription medicines
assaults may often take place against a taken licitly during the period of
background of licit or recreational alcohol or drug sensitivity of the assay will show
use, where alcohol and other drugs are frequently in the analysis, even though there
taken together. The extensive forensic database may be no causal relationship
examined here does not support the concept of a whatsoever with the alleged
commonly occurring ‘date rape’ scenario, in which assault.” (p.200)
the victim’s drink is covertly ‘spiked’ with a tablet,
capsule or powder containing a sedative-hypnotic.”
(p.197)
Review of urine samples volunteered by persons
alleging a drug mediated – however “It does not
imply that there is a causal relationship between
particular substances and sexual assault. No claims
are being made that any of the drugs featured here
had actually been used in a drug-assisted assault”
(p.200)

53
32 Horvath & Journal 2 UK Drug assisted 93 rape cases The majority of rapes where alcohol or drugs are Rape (inferred Can distinguish between
Brown article rape where the victim implicated are circumstances where the victim has from topic) voluntary and involuntary
(2007) (14) was under the self-intoxicated through alcohol consumption - ingestion.
influence of voluntary intake of alcohol in 86% of cases,
drugs/alcohol, voluntary intake of drugs in 22.6% of cases. Sample only includes rapes which
reported to the There were relatively few cases in which drugs were reported to the police.
police, Nov 1999 had been administered surreptitiously – no cases
– Nov 2004 where victim consumed alcohol involuntarily and The term ‘‘drug-assisted rape’’
5.4% of cases victim consumed drugs may be a misleading, mainly
involuntarily. because when people think
In the few cases where victims consumed drugs about drugs in the context of
involuntarily some did not know what they were rape they immediately think of
and samples were not collected in time to identify Rohypnol or GHB – authors
the drugs. However, 2 victims reported being suggest DDAR (Drug and/or Drink
forced to take cocaine and 1 was given an Assisted Rape) might be better.
unidentified white powder.
No clear clusters of victim characteristics around
the drugs involuntarily variable.
Compared offence behaviours (e.g., weapon use,
sex acts) for three groups – alcohol voluntarily,
drugs voluntarily, drugs involuntarily – no
significant differences found.
Cases reclassified – scale 1 what was consumed to
incapacitate the victim (drugs, alcohol, both),
scale 2 how they became incapacitated (victim
induced, offender induced, both)- report for
victim induced 4 drugs, 55 drink, and 7 both, for
offender induced 2 drugs, 3 drink, and 5 both,
report for both. victim/offender induced 2 drugs,
11 drink, and 3 both.
33 Hughes et Journal 1 Wales Spiking Patients 75 patients presented with allegation of drink Not stated
al. (2007) article (3) presenting to an spiking. Entry into study based on patient
emergency Aged 16 or over included in study. believing they were spiked.
department with Blood or urine taken and tested and follow up
alleged drink phone call. Paper concludes that most
spiking in 12 68% (51 out of 75) patients were female. patients alleging drink spiking
months from Most patients (82%) attended over a weekend test negative for drugs of misuse
October 2004, 42 with 50 (66%) attending between 10pm and 3am and propose symptoms are more
urine samples and 42 urine samples obtained (56% of study group) – likely to be the result of excessive
34 blood samples 8 (19%) tested positive. alcohol consumption. A number
No one testing positive for Rohypnol, Ketamine, or of these patients probably had
GHB indicating these are not being used for spiking their drink spiked with alcohol,
in the area. but this is difficult to determine.

54
 34 blood samples obtained – 32 (94%) tested Possible that claiming a drink has
positive for alcohol (many to a high level). been spiked is an excuse of
All except one patient admitted drinking alcohol becoming incapacitated via
before attending (individual toxicology results for voluntary consumption.
that person not reported).
None of the patients who tested positive for
drugs of abuse reported voluntary ingestion
before presentation or being on regular
medication.
49 took part in the telephone interview (42 had
provided samples, 7 had not) – alleged spiking took
place in 23 different places, 4 places mentioned
more than twice (though one nightclub was
mentioned 7 times and another mentioned 8
times), the 8 patients with positive results all gave
different locations, 5 patients reported others had
been spiked at the same time as them (but not
attended hospital).
7 patients had informed the police.
Most patients presented on the night of the
alleged incident so even drugs with a short
detection window (e.g., GHB) should have been
detected. If patients presented after this, it is
possible they tested negative despite their drink
being spiked.

34 Hurley et Journal 1, 2 Australia DFSA Files (collected by 17% (76 out of 434) cases of adult sexual assault Sexual assault Covert administration was
al. (2006) article (5) Victorian Institute was identified as DFSA. (inferred from considered when (1) complainant
of Forensic 95% female, average age = 25.6yrs. topic) reported a drug may have been
Science) for all Median delay from time of incident to examination used, (2) preliminary police
cases of sexual was 20hrs (range 2 -106hrs). investigation raised the
assault for the 12- Most cases between Thursday and Monday. possibility, or (3) clinical evidence
month period Clarity of victim recall of events was ‘‘unclear (or of effects of drugs by examining
concluding April patchy)’’ in 59% of cases, ‘‘no recollection’’ (24%), practitioner.
2003, N = 434, ‘‘clear and concise’’ (15%), and not recorded (4%).
penetrative and Relationship between the alleged assailant and the Papers states able to distinguish
non-penetrative victim (self-reported by victim) was recorded in between administration
acts included, for 80% of cases. recorded, 62% = ‘recent methods.
sub sample of acquaintance’, 15% = ‘unknown assailant’, 3% = a
DFSA – blood and partner, and 1% = a ‘client’. More attention should be paid to
urine collected if 86% = a single assailant. All alleged assailants were role of alcohol rather than “date
<24hrs passed male. rape” drugs like GHB or

55
 and urine only if 77% had consumed alcohol prior to the assault and Flunitrazepam which were not
>24hrs alcohol was still present in 37% of cases when found in this study.
examined (7% stated they had not been drinking
and data was missing for 16%). Many victims had poor recall of
49% reported using prescription medications (5% the event.
said they hadn’t, data missing for 46%) and 26%
reported the use of recreational drugs (denied by Many victims had consumed
11%, missing for 63%). large amounts of alcohol and/or
In the 22 cases where covert drug administration taken drugs prior to the assault
was suspected by the victim (5%), the method of (could affect recall).
administration was suspected to be ‘drink spiking’
in 82% (18/22). In the remaining 4 cases more
specific suspicions were recorded: ‘tablet injected’
(n=1), cannabis (n=2, no method of
administration), and amphetamine (n=1, no
method of administration).
Drugs not reportedly consumed by the victim
were detected in 15 cases (20% of the study
group or 3% of all adult sexual assault cases). No
single drug identified in these cases - the drugs
detected included cannabis (n=4), antidepressants
(n=4), amphetamines (n=3), benzodiazepines (n=4)
and opiates (n=3).
Study concludes that covert administration of
drugs in adult sexual assault is uncommon though
the true incidence may be higher (due to non or
delayed reporting) or lower (due to inaccurate
self-reporting of drug consumption).
35 Jones et al. Journal R Sweden Sexual assault Blood and urine All female, over 60% aged 15-25, mean age 23.9yrs Sexual assault Unable to distinguish between
(2008) article (7) specimens from In 772 cases (43% of total) ethanol was the only (inferred from methods of administration
1806 female drug identified. topic)
victims of alleged In 215 cases (12%) ethanol occurred together with State in the introduction
non-consensual at least one other drug. “Compelling evidence that a
sexual activity, Licit or illicit drugs were identified in 262 cases person was indeed incapacitated
includes all cases (15%). by intake of drugs, whether
on forensic Amphetamine and tetrahydrocannabinol were the voluntary or involuntary is not
database most common illicit drugs. easy to obtain from results of
(TOXBASE) Among prescription drugs, sedative-hypnotics toxicological analysis of blood
registered (such as diazepam and zopiclone) were common and urine alone” (p.41)
between 2003- findings along with SSRI antidepressants and
2007 various opiate analgesics.
Need to consider voluntary intake of alcohol and
prescription drugs.
High blood alcohol levels could be related to
voluntary intake.

56
 Cannabis could be related to voluntary intake
“Interpreting the analytical results in terms of
voluntary vs. surreptitious administration of drugs
and the degree of incapacitation in the victim as
well as ability to give informed consent for sexual
activity is fraught with difficulties” (p.40)
Conclusion includes statement “High therapeutic
concentrations of sedative-hypnotic drug with
short elimination half-lives, such as zolpidem and
zopiclone, tends to implicate their use in chemical
submission” (p.45)
36 Jones et al. Journal R Sweden Sexual assault Data from the All female, average age 24, 72% were between 15 Sexual assault Limitation: amount of time that
(2012) article (8) national forensic and 29 years. (inferred from passes after the offence before
toxicology Ethanol and other drugs were not detected in 31% topic) biological specimens are
database of cases (459). obtained for toxicological
(TOXBASE) for Blood-ethanol was positive in 658 cases. Ethanol analysis.
cases registered plus drugs were present in 188 cases (13%) and
as sexual assault one or more other drugs alone in 210 cases (14%). Drugs, such as z-hypnotics and
and rape, 2008 - 2 Cannabis (marijuana) and amphetamines were the GHB, have short elimination half-
010, n=1,460 major illicit drugs. lives and so a negative toxicology
cases Main prescription drugs identified were diazepam, report does not rule out that they
alprazolam, zopiclone as well as newer had been administered to, or
antidepressants. used by, a victim.
Predominance of alcohol in cases
Antidepressants (citalopram, venlafaxine and
fluoxetine) are common prescription drugs.
Cannabis and amphetamine are popular
recreational drugs in Sweden and so “It is difficult
to envisage surreptitious administration of these
drugs” (560)
Zopiclone (a hypnotic drug) was identified in 13
blood samples and this substance might make
people drowsy (thus more susceptible to a sexual
crime). “A likely scenario is that zopiclone was
taken as a sleeping aid whereafter victims became
vulnerable to sexual advances from an
acquaintance or perpetrator” (p.560)
“Because ethanol is a legal drug, many victims
probably met their assailant at a bar, a pub or a
party where alcohol was served” (p.560)
37 Juhascik et Journal 2 USA DFSA People attending 859 patients reported sexual assault – of who 144 Sexual assault Voluntary intake of drugs was
al. (2007) article (5) one of 4 clinics had urine and hair specimens tested. (inferred from underreported.
with complaint of Most of the 144 were White aged 18-25, men not topic)
sexual assault, 1 excluded from study, but the sample was all DFSA definition includes taking
female in this instance. advantage of someone who is

57
 Jan 2002 – 31 Mar 43% of 144 subjects (and 7% of all 859 impaired due to voluntarily
2004 complainants) were characterised as DFSA (based consumption (also limited sample
on blood testing, no change in classification when to DFSA to be presenting within
hair samples were then considered). 72hrs of consumption).
Difficult to ascertain if DFSA was involuntary as
estimates would depend on accurate self-reporting Distinction between involuntary
of substance consumption (which is considered and voluntary consumption
unreliable). cannot be made on the basis of
toxicology results.

GHB has short half-life and can be

missed if specimens not collected
within a few hours of ingestion.
38 Kapitány- Journal 2 Hungary GHB involved Review of medical Relates to 352 patients - 54% males / 46% females, DFSA and Aimed to distinguish between
Fövény et article (7) crimes reports for 408 mean age was 26.9 (range 14 – 75). acquisitive intentional and unintentional
al. (2017) GHB-intoxication Police brought patient to hospital in 30 cases (8%) crimes GHB consumption.
cases (352 182 out of 408 samples (45%) a psychoactive
patients) from substance was detected (where no substance
Péterfy Sándor found this was either because no sample was
Street Hospital tested or drug already metabolised at time of
Clinic and testing).
Casualty Centre GHB detected in 131 cases (34%).
GHB was solely consumed in 113 cases (29%).
Ethanol detected in 56 cases (14%).
Both ethanol and GHB detected in 15 cases (11%).
Other substances found Benzodiazepine,
Amphetamine, Opioid, THC, and Cocaine.
GHB use intentional in 79 out of 114 cases where
GHB solely consumed and 7 out of 17 cases where
GHB and other psychoactive substances found.
Rate of voluntary GHB use was 62 out of 332 cases
where the patient presented once, and 49 out of
76 cases where there has been multiple registered
intoxications.
Out of 352, identified 111 intentional cases (32%)
and 46 unintentional (13%) consumption of GHB –
sexual offences and acquisitive offences were
only found where there was unintentional
consumption.
More unintentional consumption for female
patients.
Identified 11 DFSA (9 females) and 38 acquisitive
crimes (all related to different patients, 26 male)
– no cross over, patients were either a victim of
one or the other offence.

58
39 Kilpatrick Report 2 USA Drug Interviews with Defines drug-facilitated rape as “drugs, alcohol, or Rape (inferred DF rape is defined as intentional
et al. (72) facilitated, 5,000 women other intoxicants deliberately given to the victim by from topic) administration (incapacitated is
(2007) Incapacitated aged 18-86 (3001 the perpetrator” (p.2) the term used for self-
and national sample Findings indicate nearly 3 million women have administration of substances).
Forcible and 2000 from experienced drug-facilitated rape during their
Rape universities) lifetime and nearly 200,000 in the past year. Self-report data.
Victims of DF rape less likely to report to police
30% of DF rape cases result in injury and 21% seek
medical attention.
Most perpetrators are known to victims (in all
types of rape).
For college women - estimate nearly 160,000
have experienced drug-facilitated rape in lifetime
and 100,000 in past year.
40 Kouta et al. Journal 2 Cyprus Date rape 476 female 84% aged 18-24. Some Female only sample.
(2013) article (9) college students, 1.3% (n=5) reported an attempted date rape. participants
survey, focus 1.9 % (n=7) reported being forced to give someone reported they
groups x2 (n=8), oral sex and 1.9% (n=7) reported being raped on a had been
interviews x5, date. forced to
Nov 2006 – Apr Participants were asked “reasons of giving in to have sex by
2007 unwanted sexual intercourse with a date since someone
finishing high school” – 6 (3.6%) reported being giving them
forced by being given alcohol or drugs on a date, alcohol or
8 (5.4%) reported sometimes / always they are drugs
forced by being given alcohol or drugs.
41 Krebs et al. Journal 2 USA Sexual assault Self-report data Female sample, 67% White, 16% Black, 14% other, Sexual assault “Most sexual assaults occurred
(2009) article from a random 63% were aged 18-20 (inferred from after women voluntarily
(12) sample of Almost 20% experienced some type of completed topic) consumed alcohol, whereas few
undergraduate sexual assault since entering college. occurred after women had been
women from 2 AOD-enabled SA (n = 466, 7.8%) (women who had given a drug without their
universities been voluntarily consuming alcohol and/or drugs knowledge or consent.” (p.639)
(N=5,446) prior to being assaulted).
Certain drug facilitated SA (n = 31, 0.6%) (women Female only sample from two
who indicated they had been given a drug other universities.
than alcohol without their consent prior to being
assaulted).
Suspected drug-facilitated SA (n = 103, 1.7%)
(women who were not certain whether or not
they had been given a drug without their consent
prior to the assault).
Other incapacitated SA (n = 48, 1.0%) (women who
indicated they were victims of a sexual assault
while incapacitated but unable to determine how
they became incapacitated).

59
42 Kumaran et Journal 1, 2 India Spiking Biological samples 49 males and 7 females, mean age 36, median age Robbery Timeframe of dataset not stated.
al. (2009) article (4) (gastric lavage, 29, age range 19 -52, train travellers. (inferred from
blood, urine) from Peak hour of presentation between 2-3am topic)
56 train travellers Administered via drinks (e.g., tea, fruit juice, soft
who were spiked drinks, alcohol) (n=47) and eatables (e.g., biscuits)
in their food or (n=13).
drink; excludes Ethanol detected in 26 males (22 of which
cases of alleged reported they had consumed alcohol).
DFSA Ketamine detected in 8 blood samples, all denied
self-ingestion.
Drugs detected in 44 individuals (barbiturates,
benzodiazepine, opiates, promethazine, tricyclic
antidepressants).
11 samples were positive for multiple drugs
Samples were negative for amphetamines,
cannabinoids, cocaine, gamma hydroxy butyric,
and Flunitrazepam.
Patients reported they were not misusing drugs
or using them as regular medication – authors
infer from this that drugs were used to facilitate
robbery.
12 did not test positive for anything – authors
suggest this could be due to time delay between
ingestion and testing.
43 Larsen & Journal 2 Denmark Sexual assault All 55 male Male victims accounted for less than 2% of the Sexual assault Male victims only.
Hilden article (4) victims attending total number of visits to the centre in the time (inferred from
(2016) the Centre for period (55 out of 2,912). topic)
Victims of Sexual 53% were aged15 and 24 years.
Assault in In all cases the perpetrator was male.
Copenhagen, Victims alcohol intake – 18 none, 11 drank 1-5
Denmark, Mar units, 25 more than 5 units.
2001 - Dec 2010 8 men (15%) had amnesia for some or all the
details of the assault due to a high intake of
alcohol.
In 16 out of 55 (29%) cases, the victim suspected
drug rape.
In twelve cases (21%) this information about the
perpetrator was not present, most often because
the victim had no specific memory or knowledge of
the perpetrator due to suspected drug rape.
Male victims more likely being victim of drug rape
than female victims attending the centre.
44 Lawyer et Journal 2 USA Forcible, drug 314 college 314 female undergraduates, mean age 20.1 yrs, Rape (inferred Distinguished between methods
al. (2010) article (9) facilitated and students, spring 87% White, 97% unmarried. from topic) of administration (voluntary
semester 2004 versus involuntary).

60
 incapacitated “Assaults were coded as drug-facilitated when the
rape alcohol/drug was reportedly taken “involuntarily”
or “a little bit of both.” Assaults were coded as
incapacitated if the alcohol/drug was taken
“voluntarily.”” (p.455)
30% (n = 93) reported 168 total incidents of some
sort of assault experience since the age of 14.
5% (n = 17) reported a total of 28 forcible assault
experiences (22 total sexual assaults and 6 total
rapes.
30% (n = 93) reported a total of 140 incidents of
drug-related assault experiences (99 total sexual
assaults and 41 total rapes). Within the sexually
assaulted sample, all reported experiencing a drug-
related sexual assault or rape.
77 out of 93 victims of drug-related assault
provided information on consumption – 65 were
classified as incapacitated (84%) and 12 (15%) as
drug-facilitated – thus involuntary incapacitation
preceded 15% of drug-related assaults.
Of the 12 drug-facilitated assaults – 4 committed
by a friend. 5 by a stranger, 2 by an acquaintance
known for less than 24hrs, and 1 by an other
adult. Assaults took place in the perpetrators
home (n=1), house party (5), bar or restaurant (5),
and no response (1).
The majority of drug-related assaults (96%)
involved alcohol consumption prior to assault.
Concludes: Drug-related sexual assaults on college
campuses are more frequent than forcible assaults
and are most frequently preceded by voluntary
alcohol consumption.
45 Majumder Journal 2 Bangladesh Criminal All admissions Travel-related poisoning increased from 6 to 10%
et al. article (7) poisoning (N=10,549), all of all admissions per year (210 out of 3266 in 2004
(2008) poisoning cases, to 309 out of 3842 in 2006).
also sub sample Travel-related poisoning is 47–56% of all admitted
of hospital poisoning cases.
records for 130 Sample of 145 cases – 98% male, mean age 28.8
consecutive years (range 16–80, n=130) in the 2004 series and
patients aged 16– 37 years (range 25–60) in the smaller 2006 sample
80 years who (n=14 reported here so one age must be missing
were admitted data).
with central Incidents were associated with bus (76%), taxi,
nervous system train, and air travel, or local markets.
depression after
“Although the current findings
suggest that the most frequent
drug-related rape scenario
involves voluntary alcohol/drug
consumption, this is not to say
that perpetrators do not in some
cases induce incapacitation by
adding a “date rape” drug to the
victim’s drink without her
knowledge” (p.459)
Limitations: relatively small
convenience sample, follow up
questions only about most
intrusive assault (rather than all
assaults experienced), only
looked at male perpetrator/
female victim context.
Theft Identifying drug-facilitated
crimes is complicated by the
frequent detection of multiple
drugs and the difficulty of
distinguishing between
voluntary and involuntary
ingestion (which largely depends
on the accuracy patients’ self-
reporting drug consumption).
The use of benzodiazepine drugs
in Bangladesh – either as a
prescribed medicine or drug of
61
 travelling on 98% of patients remembered buying or accepting abuse - is uncommon (no history
public transport food or drinks before losing consciousness. of medically prescribed or
(teaching hospital Direct financial damage (missing property) ranged voluntary ingestion of these
in Dhaka, from no property loss (52% of all 145 patients) to found in this study).
Bangladesh), Jan - all goods carried, with the highest values equalling
Jun 2004; and a US-$ 500 in cash or a taxicab.
convenience Mobile phones, wallets, credit cards, watches,
sample of 15 such wedding rings and valuable official documents
patients admitted were frequently missing.
during 3 days in 94 urine samples analysed - 74% tested positive for
May 2006 benzodiazepines.
15 urine samples analysed - lorazepam was
detected in all, 5 also contained diazepam or
metabolites, nitrazepam was found in 3.
“The massive medicosocial emergency of travel-
related poisoning in Bangladesh is the result of
drug-facilitated organized crime, and theft of the
incapacitated persons’ property is not
opportunistic but the goal for which they are
poisoned. Benzodiazepine drugs have been the
drugs of choice of the perpetrators at least in the
Dhaka Metropolitan area and during the periods
sampled” (p.14)
46 Marinetti & Journal 2 Miami (infer Synthetic 43 cases where 42 white males and females aged 19 to 53 years Not stated Synthetic Cathinones found in
Antonides article USA) Cathinones synthetic and one 34-year-old Hispanic male. bath salts.
(2013) (12) cathinones found, 17 driving under the influence, 1 domestic
the Toxicology violence, 4 suicides, 12 overdoses, 6 accidents, 1 The desired effects of synthetic
Section of the homicide and 1 drug-facilitated assault. cathinones are euphoria, rush,
Montgomery alertness, talkativeness, sexual
County Coroner’s arousal, focused mind and an
Office/Miami overall positive feeling.
Valley Regional
Crime Laboratory Unknown if drug-facilitated
assault was voluntary ingestion
(paper indicates some people do
take synthetic cathinones
voluntarily).
47 McCauley Journal 2 USA Drug/ alcohol Nationally 12% of girls experienced at least one form of Sexual assault Not able to distinguish between
et al. article (7) facilitated and representative sexual assault. (inferred from methods of administration – IS
(2009) incapacitated sample of 1,763 2% experienced IS/DAFS. topic) and DAFS reported on together.
sexual assault adolescent girls IS/DAFS accounted for 18% of all reported sexual
assaults, with a prevalence of 4% among girls 15 - Hard to generalise because (1)
17 years of age and 0.7% among girls 12 - 14 years Girls might be reluctant to reveal
of age. experiences of IS/DAFS especially
if they had consumed substances

62
 “Participants were classified as having experienced voluntarily, (2) 46% of
an incident of IS/DAFS if they reported an incident households approached did not
of sexual assault as part of the sexual assault take part, and (3) small sample
screen or the IS/DAFS module that included either (n=37) of girls had reported
voluntary use or administration of drugs or alcohol experiencing IS/DAFS.
that led to the respondent being passed out,
unaware of what was happening, or unable to
control the situation.” (p.296)
Analysis of case characteristics of the ‘‘most
recent-only’’ incident conducted on a sample of 37
who had least one IS/DAFS experience - 68% of the
cases involved endorsements of being ‘‘too drunk
to know what was happening’’ during the assault,
48% stated that they were actually ‘‘passed out’’
because of alcohol or other drugs during the sexual
assault.
48 McCauley Journal 2 USA Incapacitated Data from Part of larger survey (3,001 women) but only Rape (inferred Defines 3 types of rape as
et al. article (9) drug structured selected those aged 18-34 (n=1,998) to analyse, from topic) “Women qualified for history of
(2010) facilitated and telephone average age 26.9yrs forcible rape if they reported an
forcible rape interviews with Questions included “Has anyone ever had sex with experience of perpetrator use of
women aged 18– you when you didn’t want to after you drank so force or threat of force. A woman
34 (n = 1,998) much alcohol that you were very high, drunk, or qualified for history of
passed out?” and “Has anyone ever had sex with incapacitated rape if she
you when you didn’t want to after they gave you, perceived that the perpetrator
or you had taken enough drugs to make you very had raped her when she was
high, intoxicated, or passed out?” (p.134) intoxicated and/or impaired via
Asked additional questions to try to distinguish voluntary intake of drugs or
between drug-facilitated rape and incapacitated alcohol. Women reporting a
rape. history of drug/alcohol facilitated
23% (n = 464) reported a lifetime experience of at rape reported that the
least one type of rape. perpetrator deliberately
Lifetime prevalence of forcible rape was 18.6%. attempted to produce
Prevalence of incapacitated rape was 5.3%. incapacitation by administering
Prevalence for drug/alcohol-facilitated rape was drugs or alcohol to the victim”
3.5%. (p.135)
Approximately 60% of women meeting
classification for incapacitated rape or
drug/alcohol-facilitated rape also met classification
for a forcible rape experience.
Victims of incapacitated rape and drug/alcohol-
facilitated rape were more likely than women
without such histories to report past-year
marijuana and illicit drug use (victims of IR also
more likely to report binge drinking).

63
49 McCormac Journal 2 USA (based Injury in 157 patients from 157 patients, mean age was 27.9 years (range 13- Sexual assault Data from inner city community
k et al. paper (6) on location sexual emergency 79 years), 76% aged over 18, 92% female. (inferred from so might not be generalisable to
(2022) of authors assaults department 22 (14%) reported drug-facilitated assault where topic) other communities.
and how trauma centre an unknown substance was given to them.
start of and community 39 cases were alcohol related (25%) (victim Sample could miss cases where
introduction hospital, 1 Jul described as intoxicated) and 4% included use of sexual assault was secondary to
is framed) 2019 – 31 Jul an illicit drug (n=6). Definition of these variables other trauma or not disclosed.
2020 aged 13 or appears to indicate these are voluntary ingestions,
over with a chief and reporting indicates this does not overlap with
complaint of the DFSA variable (“We found alcohol to be the
sexual assault most common substance associated with SA,
whereas DFSA and illicit drug use were relatively
low” (p.676)
50 McGregor Journal 2 British DFSA All sexual assault “A suspected DFSA case was defined as a sexual Sexual assault DFSA defined as deliberate and
et al. article Columbia victims who assault victim who presented to the SAS with a self- (inferred from where victim unaware they were
(2003) (11) (infer presented to reported suspicion of having been drugged, topic) being drugged (does not include
Canada) British Columbia unexplained anterograde amnesia, and/or other deliberate drugging where
Women’s Sexual evidence that suggested to the attending examiner victim was aware of this).
Assault Service that deliberate drugging may have been involved”
(SAS) between (p.73) Authors note developing a
1993 – 1999 “Excluded in this definition were those victims definition of DFSA was
(N=1,421) reporting alcohol overuse and memory loss challenging.
consistent with volume of alcohol consumed. We
also excluded individuals who were aware that Reference made to forcible
they were being deliberately drugged (e.g., those injection.
who described an assailant forcibly injecting them
with a drug).” (p.73) Increasing rate of DFSA could be
Cases presenting 7 or more days post-assault influenced by media
excluded. attention/public awareness –
1,421 individual met inclusion criteria, mean age encouraging people to come
25.8 years (range 12 – 85), 97% (1372) were forward.
female.
172 (12%) cases identified as suspected DFSAs Delayed presentation can cause
(note defined as covert deliberate problems for gathering evidence
administration). including toxicology samples.
Toxicology results only available for 20 out of 172 E.g., to detect many
cases – 4 tested positive for alcohol, 4 for benzodiazepines urine samples
benzodiazepines, 3 for cannabinoids, 1 are needed within 12-72 hours.
amphetamine, and 1 cocaine. 3 screens tested
positive for multiple substances.
General trend – increasing proportion of cases of
DFSA (of all sexual assaults) per year, rate was
double in 1999 compared to previous years
DFSA and non-DFSA cases compared – similar
proportion of female victims, same mean age,

64
 similar proportion involved a known assailant.
DFSA cases tended to present later (median 18
hrs compared to 10hrs for non-DFSA) and were
less likely to have police involvement (49%
compared to 66%), lower occurrence of genital
and extra genital injuries in DFSA (possibly due to
victim being less able to physically resist due to
the effects of the drugs).
51 McGregor Journal 2 Canada DFSA Individuals DFSA defined as “when an individual has been Sexual assault DFSA defined as surreptitious
et al. article (5) referred to sexual sexually assaulted due to the surreptitious (inferred from administration of drugs.
(2004) assault care administration of drug(s) thereby rendering topic)
referral service in her/him unable to give consent” (p.441) Increased incidence could be
hospital, 1 Jan Presentation more than 30 days after the assault linked to media attention and/or
1993 – 31 May (n=12) excluded. better public awareness or could
2002 Sample for analysis n=1,594, DFSA n=246 (15%), reflect real rise, also raise
235 out of 246 were females, 9 out of 11 cases question of whether drugs are
with male victims presented after 1998. easier to access due to the
Mean annual incidence of female DFSA increased internet.
from 3.4 per 100,000 (years 1993-1998) to 10.7
per 100,000 (years 1999-2002). Amnesia and/or delay in
Highest DFSA incidence was for females 15-19 presenting for examination could
years. lead to some drugs not being
detected.
52 McPherson Thesis R Australia Spiking 805 participants 235 men (30%), 557 women (69%) and 3 (0.4%) Motivations – Advert for study stated aim to
(2007) (416) surveyed about who did not specify gender (data for 8 appears to as reported look at spiking so might be more
experiences of be missing), participants reported residence in 370 by victims appealing to victims of spiking
spiking (included different geographic areas of Australia, age 18-35 include sexual (which could influence estimates
victimisation and (participants outside this age range excluded), assault, of prevalence).
perpetration) mean age 23.7yrs. robbery, and
Prevalence of drink spiking – 207 participants kidnapping. Sample limited by area and age
reported they believed they had experienced a group.
spiking incident (166 once, 6 twice, 2 four times, Motivations –
and 2 on 5 occasions). as reported
Reasons they felt they had been spiked (they can by
select more than one) – unexplained drunkenness perpetrators –
(70%), physical symptoms (69%), someone told often centre
them (13%). on making the
Locations – bars (25%), nightclubs (46%), house social
party (15%), hotel (8%). environment
Often perpetrators unknown (52%) but can be easier for the
stranger (22%), acquaintance (15%) or friend person, to get
(11%). people to like
136 out of 207 described how they were victims them, or
of a crime as a result of the spiking incident – because they
sexual assault (9% of 207), robbery (1%), thought it

65
kidnapping (1%), drink spiking (3%), non- would be
consensual substance use (5%), violation of rights funny, there
(2%), could have been raped (6%), and could have are more
been killed (2%). sinister
Participants reported 96 men and 431 women they predatory
knew had experienced a spiking incident. motivations
In most spiking cases victims are cared for by reported by
friends, thus avoiding further victimisation some (see
Drink spiking victimisation was predicted by use of findings
tobacco, marijuana, ecstasy, amphetamine, and column)
cocaine. Previous victimisation of oral sexual
assault was also a predictor. Victims had stronger
expectations that alcohol increases their
confidence and ability to initiate sexual
interactions.
Factor analysis – items relating to perpetration of
drink spiking – “first factor included behaviours
relating to adding substances to both alcoholic
and non-alcoholic beverages and adding alcoholic
shots to non-alcoholic beverages. The second
factor incorporated behaviours relating to mixing
or purchasing cocktails, adding alcohol or
substances to punch, and adding alcoholic shots
to alcoholic beverages” (p.128)
Some participants exhibited a willingness to
perpetrate spiking – 29-30% reporting a
willingness to buy, or mix, cocktails for others
without detailing the contents of the cocktail to
the intended consumer.
19% reported a willingness to add alcohol to
punch. 7% reported their willingness to add
alcoholic shots to alcoholic drinks.
3% reported their willingness to add alcoholic
shots to non-alcoholic beverages.
1% were willing to add a substance to any type of
drink.
Some participants had engaged in drink spiking –
buy/mixing cocktails (45%- 49%), and adding to
punch (26%).
6-16% reported at least one occurrence of adding
alcoholic shots to another person’s drink without
their knowledge or consent and 1% of
participants had added a substance to a beverage
under these circumstances.

66
Men more likely to report drink spiking
perpetration.
Motivations for spiking (as reported by
participants who reported at least one
engagement in drink spiking behaviour) – just for
fun, I thought it would be make it easier to gain
control over a person, I didn’t think it would do
any harm, I thought it would give me a better
chance of having sex, to get someone to like me,
to make me cool with my group of friends, to put
people in a better mood, to get everyone drunk,
because I knew the effects would only be
temporary, because the person asked for it,
because the person was too straight, to show
them a good time, because I knew they didn’t
have the money to buy alcohol or drugs, because
the person was rude to me, because the person
needed to loosen up, I was doing the person a
favour, because the person was dressed in a way
that indicated they wouldn’t have cared, to
impress my friends, I thought I was being a
generous host, to get someone drunk, to make
me more confident to approach others, to break
the ice with someone, because the person was
drunk anyway, to liven up the party, to put
people in the mood for sex, because the person
looked like a drug user anyway, to share the buzz
I was having, because I’m more successful at
picking up when others are drunk or drug
affected, because the person deserved it, because
it’s easier for me to approach people for sex if
they are drunk or drug affected, because the
person had knocked me back earlier, because I
knew it would not do any harm, because I knew it
would be funny.
Spiking perpetration predicted by the expectation
that consumption (or acceptance) of alcohol by
other people demonstrates their sexual attraction
to others, and (less often) expectations that
alcohol results in others being interested in
engaging in casual sexual activity. Expectation
that alcohol increases one’s own confidence was
also a predictor.
Prevalence of using alcohol to spike might be
explained by motivations that appear to centre

67
 on socialising and fun. Feasible that perpetrator
thinks they are doing a good thing for friends in
some instances.
Over 40% of motivations reported related to fun.
21% focused on getting someone drunk (cause
intoxication in others), perhaps to share a
positive social experience with them. Some
motivated by potential for more sexual activity
possibly to facilitate consensual activity (not
understanding the concept of consent fully
perhaps).
53 McPherson Confer- 1 Australia Spiking Over 400 people 25% report an experience of spiking. States Only abstract was available.
& Smith ence aged 18-35 35% report a friend has experienced spiking. motivation for
(2006) abstract Predominantly committed by strangers. perpetration
Prevalence of spiking at nightclubs and house were
parties. investigated
Low reporting of spiking incidents. but did not
provide
details in the
abstract
54 Moghadda Journal 2 Iran Criminal Biological samples 70% male, 30% female. Robbery
m & Rahimi paper (7) poisoning (blood, urine) 38% aged 31-43, 35% 18-30, 15% 44-56, 13% 57- (80%), rape
(2021) from 40 patients 70. (12.5%)
of suspected 75% sedentary level of consciousness, 18%
drug-facilitated orientated, 8% ‘mild com’ (p.3).
crime (DFC), Place of poisoning – workplace (30%), park
survey data (17.5%), vehicle (17.5%), home (15%), dormitory
collected as well, (10%), garden (7.5%), unspecified (2.5%).
outpatient 90% was via food, 7.5% drinking, 2.5% uncertain
emergency room, 92.% had one positive substance test, 7.5%
Nov 2018 to Jun negative test.
2019 Most used drug was diazepam (70%), clonazepam
(35%), oxazepam (24%), morphine (19%),
amphetamine/methamphetamine (11%),
alprazolam/ methadone (5%), tramadol (3%).
Motivation for poisoning was robbery (80%), rape
(12.5%) and unknown (7.5%).
55 Mognetti Journal 2 Italy Alcohol / drug 222 sexually 1,204 patients examined over the time period, of Sexual assault Sample mainly Italian adult
et al. article related sexual abused women which 222 met the inclusion criteria. (inferred from females (ethnic minorities not
(2022) (16) harassment reporting to Sant’ 65 (29%) were taking prescription medication on a topic) represented).
Anna Hospital regular basis.
Turin between 1 155 (70%) patients declared they had taken Most results reported for whole
Jan 2008 – 31 Dec alcoholic substances and/or drugs in conjunction sample rather than comparing
2017, aged 14 or with the event - 86 (56%) reported having drunk findings for voluntary versus
over who involuntary ingestion.

68
 declared alcohol alcohol, 36 (23%) had taken drugs and 33 (21%)
and/or drug had taken both.
intake or had Voluntary intake – 87% for alcohol and 44% for
physical and/or drugs.
psychological Intake of alcohol and/or drugs was described as
signs and/or forced (12%) or supposed to be unconscious
symptoms that (55%) in other cases.
led healthcare (Four women declared no intake, and data was
professionals to missing in 63 cases).
suspect Specimens were tested in all cases – 141 (63%)
alcohol/drug use, tested positive for drugs and/or alcohol (21 only
and where a alcohol, 48 only one drug, 25 multiple drugs, 18
complete medical alcohol and drugs, 28 substance that does not
record and affect nervous system).
toxicology test 48 positive test results for sedatives, 40 for alcohol
results were No correlation between having declared to have
available taken drugs (with or without alcohol) and a
positive toxicological result for drugs.
56 Monk & Journal 2 UK Sexual assault 286 young people 286 aged 12 – 25, 19 males 267 female. Sexual assault “It was not uncommon for
Jones article (7) aged 12 – 25, 71% had consumed alcohol before being assaulted (inferred from complainants to allege that their
(2014) alleged sexual (differences by age with percentage who had topic) drink had been spiked and
assault, attended consumed alcohol generally increasing with age – attribute their intoxication to this,
Lancashire SAFE e.g., none of the 12-year-olds but all of the 24- rather than the excessive amount
centre between 1 year-olds had consumed alcohol). of alcohol they had consumed in
May 2011 – 30 Of those who had consumed alcohol, 76% had a short space of time” (p.59)
Apr 2012 drunk more than the recommended daily alcohol
intake, and almost a third had also taken drugs Limitation: few males in the
91 victims (32%) self-reported use of drugs (illicit sample, under or late reporting
or otherwise), 16 of these had taken more than of DFSA especially by younger
one drug in the preceding 24 h and 71% had people – this could explain why
combined drugs with alcohol. Mostly prescribed GHB (which metabolises quickly)
medication. was not found.
No cases involving GHB but 7 where victim took an
unknown drug.
There was only one case of suspected covert drug
administration, and one forcible drug usage (2 0ut
od 286, 0.7%); in all other cases alcohol or drugs
were taken voluntarily.
57 Mortesen Confer- 1 Denmark Spiking Medical records 23 out of 571 referrals with suspected intoxicants Not stated Only abstract was available.
et al. ence from people or drug intoxication over the study period were
(2016) abstract presenting to the suspected victims of drink spiking.
emergency Represents 0.27 out of 1000 presentations to the
department of emergency ward.
Bispebjerg Mean age = 22 (range 15 – 35 yrs), 19 female, 4
Hospital male

69
 (Copenhagan) 4 patients suspected MDMA and 1 suspected GHB
between 10 Jan Staff suspected ethanol to be the only exposure in
2013 and 20 Sep 7 cases, but this was only measured in 6 (mean =
2014, 571 1.4, range 0.9-2.0).
referrals 5 patients screened for paracetamol and
acetylsalicylate poisoning (all negative).
No other toxicological screening completed.
58 Negrusz et Report R USA DFSA 144 sexual assault State “drug-facilitated sexual assault (DFSA) has Sexual assault Aimed to distinguish between
al. (2005) (208) complainants been recently coined to describe victims who were (inferred from methods of administration.
recruited via 4 given a drug by an assailant and subsequently topic)
clinics (each in a sexually assaulted” (p.2) but note that other Quantity of substance in urine
different state), definitions of DFSA are wider so they distinguish does not allow for determination
urine and hair between DFSA1 (surreptitious administration) and of dose or identify method of
samples (tested DFSA2 (voluntary e.g., recreational use by victim) – administration (hence asking
for presence of 45 cannot always be certain if people fall into DFSA1 questions as well).
drugs), survey or DFSA2, some cases classified as unknown.
about assault and All participants were female over age of consent, Points out the literature defines
voluntary intake average age 26.6yrs (range 18-56), 71% White/ DFSA differently – some only
13% Latino / 8% Black / 8% unknown. include cases where drugging is
119 out of 144 returned the survey – when asked covert, others include all drug-
if they believed that they were given a drug facilitated regardless of whether
surreptitiously, 28 (24%) answered yes, 14 (12%) ingestion was voluntary or
answered maybe or could not remember, and 77 involuntary.
(65%) said no.
Note: no Latino women thought they had been Highlights time of presentation is
given the drug surreptitiously (and only 2 important – e.g., if victim
suspected it). presents within 6 hrs, substances
73 women admitted to using at least one of the found were likely in their system
compounds being analysed (66 of these were for at the time of the assault.
ethanol, either alone or in combination with
something else, recreational use of drugs of abuse Limitations: low recruitment of
(cocaine, amphetamines, or marijuana) was participants at some sites.
reported by 22, none admitted using barbiturates,
benzodiazepines, PCP, methadone, or opiates).
Drugs found where women did not admit to use –
cocaine 18 cases, THC (26), opiates (10),
benzodiazepines (5), amphetamines (6).
3 women had a prescription for clonazepam and
this was only found in these three cases; No one
admitted using Ketamine and Scopolamine and
none was found; No one admitted GHB and it was
only found at levels considered endogenous (i.e.,
originating from within the person); No one
admitted using Flunitrazepam but was found in 4
cases.

70
 59 women returned for a second visit – 29 tested
positive for at least one drug of abuse.
Washington clinic – 15 cases, 2 DFSA1, 9 DFSA2.
Texas clinic – 31 cases, 2 DFSA1, 9 DFSA2.
Minnesota clinic – 42 cases, 1 DFSA1, 18 DFSA2.
California clinic – 56 cases, 1 DFSA1, 15 DFSA2.
Overall 6 DFSA1 and 51 DFSA2 (DFSA unknown in 9
cases overall, 8 of which victim did not complete
questionnaire).
DFSA1 aged 22-42, 5 White, 1 Black.
DFSA2 aged 18-54, 37 White, 3 Black, 5 Latino.
4% were evaluated as to have been victims of
DFSA through surreptitious drugging.
DFSA rises to 35% when voluntary drug use by the
victim is included.
Authors suggest the true value of DFSA for their
sample is likely somewhere between the two
figures.
5% of participants were positive “date-rape” drugs
(Flunitrazepam, clonazepam, GHB, Ketamine,
Scopolamine) – however, clonazepam was only
found in subject’s who admitted to having a
prescription for it. Flunitrazepam was found in
several cases, some of whom were positive on
both visits. “Therefore, most of the subject’s
positive for these drugs had taken them by their
own accord and not received them surreptitiously.”
(p.189)
GHB, Ketamine, and Scopolamine were not found.
However, as GHB having endogenous levels in the
body, it was difficult to determine if GHB was given
to victims who presented more than 12 hours after
the alleged assault. It is possible that, in some
cases where the victim believed they were given a
drug, they were given GHB but did not report to
the clinic quickly enough for the analysis to detect
quantities above endogenous levels.
59 Paul & Confer- 2 Las Vegas Date rape Medical records, Standard toxicology screening from whole blood Not stated Only abstract available.
Mahesan ence (infer USA) drugs police report, and toxicology analysis for all cases.
(2019) abstract autopsy findings 23 women tested positive for date rape drugs. Some results difficult to
for all female At autopsy 6 women were positive for Rohypnol, understand based on the minimal
decedents aged 15 for GHB, and 2 for Ketamine. information in an abstract.
20-55 who tested “After clinical, autopsy and police report review,
positive for 74% of 17/23 women had no clinical suspicion of Decedent is a deceased person.
Flunitrazepam, DRD involvement at the time of death. Specifically,

71
 GHB and 83% (n55) women had no suspicion of
Ketamine flunitrazepam use prior to toxicology results.”
referred to the (p.98S)
Clark County
medical
examiner, 2000-
2015
60 Pelletti et Journal 2 Italy Drug Circumstantial, Focus on victims of drug-facilitated crimes (DFC) Homicides (6) Size of database not reported.
al. (2018) article (8) facilitated autopsy, and other than DFSA and victims of acute intoxications and robberies
crimes and toxicological data Searched database for cases of “DFC other than (3)
acute for cases of DFC DFSA” and “Acute Intoxication” in which categorised as
intoxication (not DFSA) and “psychoactive drugs” or “prescription drugs” or DFC
acute intoxication “licit drugs” were found in the blood samples of
from database at victims.
the Forensic 11 cases of acute intoxication – 2 accidental, 9
Toxicology Unit, suicides or suicide attempts.
University of 9 cases of DFC other than DFSA – 6 homicides (2 of
Bologna, 2013 - which cause of death was poisoning) and 3
2017 robberies.
DFC cases - 89% (8/9) of victims were women, 33%
(3/9) were over 75, 89% (8/9) of the perpetrators
were men, ten pharmaceuticals were found in the
blood, and benzodiazepines were found in all
cases; – the pharmaceuticals found in blood were
(a) obtained illegally by the perpetrator only in one
case (11%); (b) prescribed to the victim in 33.3% of
cases (3/9; in all crimes against elderly); (c)
prescribed to the perpetrator and administered to
the victim in 33% of cases (3/9); (d) both (b) and (c)
in 2 cases (18.2%).
61 Poulsen et Journal 2 New Drug and All of toxicology 162 cases, 159 female and 3 male, average age 25 Sexual assault Introduction states finding date
al. (2021) article (9) Zealand alcohol results for DFSA (range 12–55). (inferred from rape drugs is rare in toxicology
facilitated cases in New Of the 162 cases submitted for alcohol analysis, 76 topic) research, more common is
sexual assault Zealand Dec 2015 were positive for alcohol in blood and/or urine assaults via impaired consent as a
– 2018 (N=161), Cannabis is the most frequently detected illicit result of excessive alcohol
blood / urine drug - detected in 31 blood samples and 15 urine consumption or illicit drug use.
samples samples. 42 suspected victims admitted cannabis
use (including 3 cases of synthetic cannabinoids).
No positive results for cocaine - 2 victims admitted Substances are found in samples
cocaine use, but the sampling time in both cases where victim has not declared
was >20 hours. voluntary use – e.g., 10
Methamphetamine was detected in 12 blood and methamphetamine was found
18 urine samples - 9 cases of admitted use and where victim not declared use.
there were 10 cases where methamphetamine was
detected but not declared.

72
 Small number of cases of MDMA (n=3) and two “One of the major challenges of
cases of other illicit drugs both related to glue assessing the role of drugs in
sniffing. DFSA is placing the presence of
Medicinal drugs often found were antidepressants, the drugs in a sexual assault
anticonvulsants and antipsychotics (detected in 28 victim’s sample into context.
blood and 41 urine samples). Drugs that are found in DFSA
Citalopram - detected in 8 blood and 10 urine samples may not be “specific” to
samples, all but one case declared their use. this offence but rather a
Fluoxetine found in 6 blood and 8 urine samples, reflection of the general
all but two cases declared their usage of this drug. availability and drug use in that
Quetiapine was present in 4 blood and 5 urine geographical location at the time.
samples, all but one case declared their usage. The other major factor is
Other detected drugs in this category included identifying covert drug
venlafaxine and risperidone. Opiates and administration versus voluntary
analgesics also found. recreational drug consumption.”
Benzodiazepines detected in 14 blood and 21 urine (p.50)
samples. The most frequently detected
benzodiazepine was diazepam, which was found in
six blood and nine urine samples. For 2 blood
samples and 4 urine samples, usages were not
declared by the complaint.
Clonazepam was detected in 3 blood and urine
samples and not declared in only one case.
Most of the drugs detected are commonly used
rather than “date rape drugs.” This study indicates
alcohol and increased blood alcohol concentration
positively correlates with DFSA.
62 Pragst et Journal 2 Germany Poisoning 68 non-fatal and Mostly suicides, 1 case of child maltreatment and 1 1 case victim Only looks at DPH.
al. (2006) article (9) with 55 fatal case where the drug was forcibly administrated in was murdered
diphenhydra poisonings with a drug facilitated crime. and items
mine (DPH) DPH alone or in Drug facilitated offence against 90-year-old stolen,
combination with female, made to drink a suspension of tablets, perpetrator
other drugs, strangled, and property stolen. had used DPH
investigated in in another
the Institute of case of
Legal Medicine of robbery,
the University injury and
Hospital Charite´, assault
1992 - 2004
63 Prego- Journal 2 Spain DFSA DFSA cases Focus on assaults on young women in leisure Sexual assault Distinguished between voluntary
Meleiro et article received by the contexts related to night-time, party culture, and (inferred from ingestion, covert administration,
al. (2022) (10) National Institute dating. topic but also forced administration (where this
of Toxicology and Study of assault contexts, assault experiences, and examples of occurs) and cases where
Forensic Sciences profiles of victims. Phase 1 of the study DFSA voluntary and covert both
(Madrid) between (descriptive analysis) included 53 cases, phase 2 following occurred.

73
1 Jan 2012 and 31 (identifying new contexts and victim information) proactive
Dec 2017; included 22 (from a total of 85 referred cases). spiking are
forensic, health, 30 out of 53 (56%) occurred in nightlife context. provided) Context can influence
and police reports Typically involved drinking alcohol, pubs/clubs, administration method used. In
and victim occurring during night or early morning at night-time space, there are more
statements, 85 weekends. opportunities due to voluntary
cases referred, 53 Second context where assaults occurred in home consumption of alcohol.
included in phase context (n=16) – three situations (cohabitation Proactive (either covertly or
1 and 22 in phase between underage people and caregiver adults, forced) is needed in other
2 of the study cohabiting couples, and minors kidnapping. No contexts.
clear temporal trend in these cases.
Other contexts (n=7): 2 labour, 2 education, 1 Analysis limited to reported cases
healthcare, 1 women trafficked for forced and there might be differences in
prostitution, and 1 daily life of people with reporting depending on context.
intellectual difficulties (ID).
Night-time context: 13 cases involved voluntary
use of substances by victim (opportunistic
assault) (43%), 2 cases involuntary (proactive)
(7%), 12 voluntary plus covert administration
(mixed) (40%), 3 unknown (10%).
Domestic context: 12 proactive (75%) (covert in 5
cases of cohabiting couples, and 2 where there is
child and caregiver, but forced in 4 cases where
child lives with caregiver and the 1 kidnapping), 4
unknown (25%).
Other contexts: n=8, 1 mixed (14%) labour
context, 7 proactive (86%) and identified covert
for 1 healthcare and 1 daily life of person with ID
within this.
21 out of 53 proactive in total (40%)
Repeat DFSA in some cases (including labour and
forced prostitution).
Multiple assailants occurred in all contexts but
most DFSA was single offender (14 in night-time,
15 in domestic, and 3 in other contexts) (note
there was missing data here so number of
assailants are unknown in some cases).
Assailants tend to be known in domestic context,
less so in other contexts.
Most victims were female.
Wide range of drugs used in DFSA assaults.
Examples of proactive drugging:
One man assaulted in night-time context –
proactive-covert tactic used.

74
 Domestic context: female and male children and
teenage girls experience repeated attacks from
one male using proactive-forced strategy.
Proactive-covert used against male teenager in
isolated assault by one male. Couples context
female partner experiencing repeated assaults
from one male using proactive-covert strategy.
Kidnapper used proactive-forced strategy.
Other contexts: education teenage girls (aged 13-
15) assaulted by one male were proactive
assaults, domestic service example where female
aged 40-45 suffered repeated assaults from
proactive-covert strategy; women 40-45 age
range in healthcare, forced prostitution, and ID
cases as well, again proactive strategies were
used, repeated assaults in first two cases, isolated
assault for person with ID.
64 Quigley et Journal 1 Australia Spiking 101 patients Of the 97 cases included in the analysis, only 9 One patient
al. (2009) article (7) presenting at were deemed to be plausible cases of spiking. reported they The frequency of illicit drug use
hospital with Of the 9, 4 were cases where patient denied thought it was and excessive alcohol
suspected drink taking the drug that was detected in their urine. a prank. consumption makes it difficult to
spiking within last Of the four - 1 was a 20 year old male who determine if a person has had
12hrs thought his friends had spiked him as a prank. Sex worker their drink spiked.
Aged 16 or over One was a 19 year old female who developed had been
Presented symptoms after leaving a nightclub. One was a 23 drugged by a Limitation - reliant on patients
themselves to year old sex worked who had voluntarily ingested client and giving an accurate drug/alcohol
hospital or were ecstasy but had GHB in her system. The fourth taken to a history.
brought by police was a 30 year old woman who developed room where
or friends symptoms 30mins after drinking something that there were Limitation – there was a local
Clinical staff also had been left unattended in shopping centre. The two other awareness campaign (by police
entered cases remaining 5 cases were where the alcohol history men, but she and universities) about spiking
where there was was inconsistent with the levels of ethanol has no which could have prompted visits
reasonable detected. memory of to hospital.
suspicion of drink 88% (of 97) were female, mean age 23, range 19- what
spiking 28, 59% aged under 25. happened Limitation – no records of
Blood and urine Only 25% presented between Monday-Thursday. until she information for people who
samples 72% reported onset of symptoms of drink spiking woke up in declined to take part.
in pubs or nightclubs. hospital. She
No cases where a sedative drug was likely to have reported to Even when the case involving
been used illegally. police that drugs was identified as plausible,
Illicit drugs identified in 28% (27 out of 97) cases money and a the authors expressed
often (85% of these) with 2 or more substances mobile phone uncertainty as to whether these
(including ethanol). was stolen. were spiking incidents (e.g.,
Ethanol was the most commonly detected female in shopping centre had
substance. access to the drugs, and/or

75
 No cases of Ketamine or Flunitrazepam ingestion Authors state symptoms could reflect migraines
were detected. the low she is known to experience).
With the exception of the plausible drink spiking prevalence of
cases all opiates and benzodiazepines detected in sexual assault Five cases were high ethanol
urine had been prescribed to the patient. means this levels and authors argue this is
35% of patients still believed they had been a study is too evidence that alcohol is being
victim of spiking irrespective of the results. small to used for spiking. But, relying on
Unlike other studies, this study considers clinical, comment on patient recall of alcohol
historical (including drug and alcohol ingestion) this. consumption when they have
and laboratory data on patients who believe that high ethanol levels makes it
they have had their drinks spiked which helps difficult to determine if their
unpick this more. drink was spiked.
Findings do not support public perception that
sedatives are being used to spike drinks – no
evidence of sedative being used in club/nightclub
setting.
65 Quintana Journal 2 Spain DFSA 240 incidents with Increasing incidence of DFSA – could be real rise or Sexual assault Method of administration not
et al. article (9) 326 criminal acts increase in reporting. (inferred from reported (voluntary versus
(2020) (e.g., there can be 53% assaults occurred in a residence (victim, topic) involuntary) though this was
multiple victims perpetrator or third party). framed as an intentional act by
or perpetrators), Most common scenario was to administer the perpetrator at times.
sexual crimes substance elsewhere (e.g., night life) and then take
committed the victim to a residence to commit the offence Under-reporting of rape could
through chemical 71% of the crimes take place at night (10pm – influence representativeness of
submission, 1 Jan 6am), and on weekends (41% occurred on a the sample.
2008 – 31 Dec Saturday or a Sunday).
2017 32% of cases occurred during the weekend nights,
though this increases to 45% if Friday is considered
as the beginning of the weekend.
246 victims – 90% female, 10% male; mean age
24.2, 68% aged over 18 and 32% minors overall
though 58% of males were minors.
233 aggressors – 98% male, 2% female (n=4 female
perpetrators), mean age 33.1.
66 Ramadan Journal 2 Belgium Involuntary 16 male Asian Toxicology screening obtained in 12 patients Robbery Flunitrazepam is also known as
et al. article (4) intoxications patients, aged 28- revealed the presence of Flunitrazepam Rohypnol.
(2013) with 50, presenting to Victim statements indicated the ingestion could
Flunitrazepam emergency have taken place as they travelled on public
department after transport.
travelling through Police sent undercover agents to the railway
a main rail station on Friday afternoons and evenings and
station, 17 Jan found a person who was offering welcome cookies
2003 – 29 Aug to Asian travellers. The offender was a Syrian
2003 national who arrived from Amsterdam and

76
 returned to the Netherlands once his crime was
committed.
Flunitrazepam is well known as a rape drug but in
this case was used in a series of robberies.
67 Razzaq et Journal 2 Pakistan Drug assisted Urine, stomach, Set age limit of 15 – 65 years – sample included 84 Robbery Males more frequently targeted
al. (2018) article (6) robbery and blood males and 16 females. for robbery as they travel more
samples, 100 Among the used drugs 50% were benzodiazepines, and carry more goods.
cases, Services 32% opium derivatives, and 4% phenobarbitone.
Hospital, Lahore, Rat poison also found in 2 cases.
Jul 2016 - Jun Delivery mode in the poison intake was through
2017 soft drinks (54%), food (8%) and fruits (38%).
The victimized persons included 60% passengers,
20% pedestrians, 8% Taxi drivers, and 6% females
attending marriages.
68 Richer et Journal 2 USA (based DFSA 390 patients who 414 presented during the time but 24 excluded Sexual assault Separated out types of DFSA –
al. (2017) article on author presented acutely (e.g., data missing/there was a reason to think DFSAI (knew substance given
(19) location) to an urban rape sexual assault did not occur) so 390 included in against their will, they learned
treatment center, final sample for analysis. substance was given without
Jan 2007 – Dec 331 women (88%) and 46 men (12%) with a mean their knowledge, or suspected
2008 age of 30. one of the above plus a
DFSA accounted for over half of the total sexual symptom of incapacitation) and
assault (SA) cases - 29% classified as DFSA-I DFSAVI (voluntary intake and no
(n=114) and 23% as DFSA-VI (n=90) (46% not DFSA, reason to suspect substance
n=186). given against their will or
46% of males (21 out of 46) were victims of DFSA- without their knowledge).
I compared with 28% (93 out of 331) for females
Involuntary DFSA (DFSAI) (in which an
incapacitating substance was administered to
victims without their knowledge or against their
will) increased from 25% (47 out of 186) to 33%
(67 out of 202) cases over the 2-year period.
Similar average time to emergency room (27 hrs
for DFSAI and DFSAVI) (50 hrs on average for non-
DFSA).
Reporting to police – 73% non-DFSA, 70% DFSAI,
and 63% DFSAVI.
69 Riedesser Confer- 2 Hamburg Alcohol 48 cases from Unlike media portrayals, date rape drugs like GHB Sexual assault Only abstract was available.
et al. ence (infer facilitated sex Department of or benzodiazepines were rarely found in actual (inferred from
(2011) abstract Germany) offences Sexual Offences cases. topic)
of the State Office Forced consumption of alcohol corresponded with
of Criminal increased drunkenness of victim and occurred in a
Investigation place that the perpetrator had control (like his
Hamburg, home).
interviews with
first aiders in

77
 police and non-
government
organisation,
focus on victims
14-18 years old
but included 12-
21 years
70 Saint- Journal 2 France Sexual assault 756 victims of 756 cases some removed leaving 496 of which 68% Sexual assault Able to distinguish between
Martin et article sexual assaulted under 15 and 32% 15 or over and the mean age (inferred from voluntary and involuntary
al. (2007) (10) examined at the was 16.5 years. topic) ingestion.
Centre for Victims 7% of all the victims studied reported they had
of Sexual assault some diminution in consciousness following the Note that “’drug facilitated
(CVSA) of the alleged events. Among them, 22 women (2.9% of sexual assault’ (DFSA)
Tours University all the victims studied) presented clinical signs corresponds in France to the
Hospital, 1 Jan suggestive of drug-related submission. The following definition: the
1996 - 31 Dec remainder stated that they had voluntarily taken administration for criminal
2002 alcohol or drugs. purpose of a psychoactive
product without the victim’s
knowledge” (pp.320-321)
71 Scott-Ham Journal 2 UK DFSA 1,014 cases of Alcohol (either alone or with an illicit and/or Sexual assault Concerted effort made to
& Burton article alleged DFSA medicinal drug) was detected in 470 of all cases (inferred from distinguish between voluntary
(2005) (12) analysed at the (46%). topic) and involuntary ingestion in
Forensic Science Illicit drugs were detected in 344 cases (34%), DFSA cases.
Service (London cannabis was the most commonly detected (26%
Laboratory), Jan of cases), followed by cocaine (11%). Sedative drug There remains the possibility that
2000 – Dec 2002 found in 179 cases, of which 158 were voluntary a few of the cases (either those
ingestion. discounted or those believed to
21 cases (approximately 2% of the total number be deliberate spiking cases) have
of cases) were attributed to involuntary ingestion been wrongly classified because,
(i.e., considered to be a deliberate spiking DFSA in a minority of the cases only, it
case). This included 3 cases where victims were was not possible to obtain
allegedly given Ecstasy (MDMA) without their sufficient information to decide
knowledge. Other drugs detected included GHB whether or not the complainant
and the benzodiazepine drugs diazepam and had taken the drug voluntarily.
temazepam.
Another nine cases (1%) involved the complainant Just because cases are not spiking
being either given or forced to ingest does not mean people consent to
pharmaceutical tablets or an illicit drug – alleged sex in DFSA cases.
method of ingestion were to be given ‘wrong’
tablets (1), forced to swallow (3), poured into
mouth (1), given for ‘medical condition’ (1), given
to ‘cheer her up’ (1), or fingers rubbed in cocaine
and rubbed onto gums (2).
No evidence Rohypnol (Flunitrazepam) had been
used covertly in this study – it can be detected in

78
 urine samples for at least 72 hours so if it was
there, it would have been found.
Overall, there were only a few cases where a
sedative drug was detected and its presence
could not be attributed to voluntary use.
72 Scott-Ham Journal 2 UK DFSA 1,014 cases of Samples taken from 391 out of 1014 victims within Sexual assault Looks like sub-sample of dataset
& Burton article (5) alleged DFSA 12hrs of the alleged incident. (inferred from used by Scott-Ham & Burton
(2006) analysed at The Of these, the majority (81%) contained alcohol topic) (2005)
Forensic Science though this was not surprising as most of the
Service (London alleged incidents were associated with social Attention has been on drug
Laboratory), Jan situations (pub, bar, night-club or party), where it spiking but advice/warnings
2000 - Dec 2002 is expected that alcohol would have been should be given about risks of
consumed. alcohol consumption.
It was not possible to determine if all of the
alcohol detected was consumed voluntarily but it Not possible to determine
is suggested that there is a limit to the amount of method of administration.
alcohol that could be added to a drink without a
person’s knowledge.
73 Slaughter Journal R USA Drugs in New test made Nearly two thirds of samples contained alcohol or Sexual assault Study did not provide
(2000) article (6) (inferred sexual assault available in May drugs – found alcohol in 63%, marijuana in 30%, (inferred from information concerning
based on 1996, as of 2 Mar other substances found (often in combination). topic) circumstances surrounding the
location of 1999, 2003 GHB and flunitrazepam found in less than 3% of victims.
author and specimens had positive samples – also their use appeared to be
reference to been analysed declining over the two-year study. Heavy use of drugs like alcohol
47 states from 47 states, Not surprised to find benzodiazepines as these are can have similar effects to drugs
including urine legally available. like GHB (intoxication,
California) Discusses how voluntary intake of illicit drugs or disinhibition, amnesia).
use of more than one drug can create risk of
potent central nervous system effects. Public attention focused almost
exclusively on date rape drugs is
misleading and potentially
dangerous.
74 Swan et al. Journal 1 USA Spiking 6064 students 6064 students – 3755 (62%) female, 2229 (37%) Sexual Response rate 39%.
(2017) article from 3 male, 80 (1%) no gender recorded. assault, fun,
(12) universities White 80%, Black 7%, other (includes Asian, to get Don’t know if victims were
Survey data Hispanic, Mixed, American Indian or Alaska Native, someone to actually drugged or not (many
collected March- Native Hawaiian or Other Pacific Islander). relax, by victims not certain either).
April 2010-2013 58% first year students, 23% sophomores, 10% mistake (e.g.,
Aged 18-24 (other juniors, 8% senior, 1% not reported. the drugger Possible some victims drank too
age groups Aged 18-24 (68% 18-19). was trying to much or drank more potent
excluded) 462 students (7.8%) reported 539 incidents of drug someone alcohol than they were used to.
spiking. else)
83 students (1.4%) reported 172 incidents of Some drugs (including over the
drugging someone or knowing someone who has Some counter drugs) can interact with
drugged someone. gendered alcohol increasing its effects.

79
Of 83 who had drugged/knew someone who had perspectives
drugged – 45 stated once, 11 twice, 9 3-5 times, 3 on motive Victims often do not remember
6-9 times, 6 10 or more times (all relate to this what happened when they were
term). Further 9 said yes but not this school term. drugged
51 (of the 83) provided information on motive.
Motives were fun (14), to have sex with/sexually Anecdotally “getting roofied” is a
assault someone (12), unknown (6), calm catch all term for being drugged
someone down/make them sleep (5), to observe and can be used for any drug put
effects of drugs (3), drugger was mean or wanted into a drink
revenge (2), by mistake (1), drugger had also used
drug themselves (2), person knew they were
being drugged (2), other (5).
Females reported sexual motivation most often (9
out of 12), males reported fun motivation most
often (8 out of 14).
People who reported being drugged/knowing
someone who had been drugged reported the
following motives – to have fun (30), get people
to loosen up (18), sex/sexual assault (57),
unknown (47), mistake (9), mean/revenge (6),
other (33) (again females more likely to report
sexual motive (50 out of 57) and males more
likely to report fun (19 out of 30).
Some language (e.g., getting people to loosen up,
thought they could have fun) could be interpreted
as indirect references to creating a coercive space
for sexual activity to occur.
Participants who had drugged someone/knew
someone who had drugged someone reported
38% druggings occurred in a house/apartment,
24% fraternity, 15% bar, 13% dorm, 10% sorority.
Results from drugging victims were similar (e.g.,
38% in houses/apartments) though more in
fraternity (30%) and bars (26%) and less in dorm
(5%) and sorority (1%). Other locations included
party, concert/public event, hotel/vacation, high
school, and club.
Over half of participants who had stated what drug
was used (28 out of 88) reported it was rohypnol.
Other drugs mentioned were Xanax (10), ecstasy
(8), cocaine (6), GHB or methamphetamine (3),
Ketamine (2), Benadryl (1). Other drugs listed
included Advil, alcohol, Adderall, benzo
(presumably benzodiazepine), laxatives, LSD, rum,
Valium.

80
75 Tanoli et al. Journal 2 Pakistan DFSA / date Hospital records “Date rape is defined as sexual assault where the Sexual assault Defines date rape as a form of
(2022) article (6) rape for all sexual victim and the offender are or were in a personal (inferred from acquaintance rape
assault allegation relationship, such as a first date or an ongoing topic)
from 2016 - 2022 relationship, and if drugs, alcohol, or any agent 15 cases identified as date rape in
were used to incapacitate and enable the assault” table 1 but subsequent
(p.4339) descriptives on date rape include
187 claims of sexual assault reported, 15 (7%) of 18 cases.
which were date rapes.
No date rapes recorded before 2019 (1 in 2019, 2 Method of administration
in 2020, 5 in 2021, and 7 in 2022). (voluntary versus covert) not
Alcohol and drugs were used in 61% of all incidents reported.
In 24% of all cases it was suspected an inhalation
anesthetic agent used.
In date rape cases (n=18) in tables presented the
type of substance used was reported as a drug in 6
cases (33%), suspected inhalant anesthetic in 7
(39%) cases, and alcohol in 5 cases (28%).

76 Taylor et al. Report 1 Australia Spiking Between 1 Jul 2002 and 30 Jun 2003 it is Sexual assault Forensic evidence does not
(2004) (183) estimated there were 3,000-4,000 suspected and robbery support the idea that
incidents of drink spiking occurred in Australia. but no follow- Flunitrazepam, GHB, and
20-30% spiking incidents reported to the police on Ketamine are commonly used in
involve sexual assault, and it is estimated victimisation spiking.
approximately 1 in 3 of all spiking involved a sexual in most cases
assault. Alcohol found most often. This
60-70% involved no additional victimisation. could be because it is commonly
15-19 spiking incidents per 100,000 people in used to spike drinks, other drugs
Australia in 2002/03. have left the body at the time of
4 in 5 spiking victims are female. testing, or people are unaware of
Half of spiking victims are under 24, 1/3 aged 25- how much they are actually
34. drinking.
Majority of drink spiking incidents have no
associated criminal victimisation indicating that
“prank spiking” may be a common motivation
5% of spiking involve robbery.
2 in 3 spiking incidents occur in licenced premises
(although for sexual assault victims incidents are
equally likely to occur at home).
Many victims don’t know the offender.
Where perpetrator was identified spiking can be
perpetrated by strangers or known acquaintances
Incidents involving sexual assault are more likely
to occur with a known offender.
Memory loss common symptom reported by
victims.

81
 Most spiking offences not reported to the police
and few offenders apprehended.
Forensic testing rare and often inconclusive.
77 Thompson Journal 2 Scotland Sexual assault 113 people who 101 women, 12 men. Sexual assault Paper does not include details
(2005) article (3) (based on experienced 19 out of 103 cases (18%) reported as (inferred from about how spiking incidents are
reference to sexual assault involvement of drugs (‘spiked drink’). topic) identified.
Lothian attended the 9 out of 103 cases reported as involvement of
University GUM at Lothian alcohol.
Hospital) University
Hospital
78 Thompson Journal 1, 2 Scotland Sexual assault 212 individuals 212 individuals – 190 females (median age 21), 22 Sexual assault Caveat their findings about
(2006) article (3) attending a city males (median age 20). (inferred from suspected drink spiking.
centre GUM clinic 113 attended a sexual assault clinic (5 males, 108 topic)
between 1 Apr females), 99 used walk-in services (17 males, 82
2002 and 31 Mar females), median age for sexual assault clinic lower
2004 following an than for walk in clinic (31% of sexual assault clinic
acute sexual patients were under 16, could reflect referral
assault pathway).
Suspicion of drug facilitated (‘spiked drink’)
assault (where documented) = 24% of cases (19
out of 94 females and 20 out of 71 males).
Involvement of alcohol (where documented) = 10
out of 94 females, 9 out of 71 males.
But, paper states “Toxicology results are not
routinely available, and it is possible that the
relatively high proportion of individuals suggesting
a spiked drink do so in order to avoid
acknowledging (both to themselves and others)
that they had simply had too much to drink”
(p.188)
79 Tiemensma Journal 2 South Africa DFSA 107 adult 908 adult patients of alleged sexual assault Sexual assault Study concluded DFSA is mostly
& Davies article (8) survivors of attended over the study period with DFSA (inferred from opportunistic, with ethanol
(2018) suspected DFSA suspected by the patient and/or the examining topic) suggested to be the most
who reported to medical practitioner in 107 cases. commonly involved drug (despite
Victoria Hospital 97% (n=104 out of 107) of DFSA survivors were limitations in detection due to
Clinical Forensic female, 48% (n=51) aged 18-24years, 73% (n=78) delays in reporting).
Unit in Cape presented within 24hr of alleged DFSA.
Town, between 1 30 patients (28%) reported a history of mental Method of administration not
Oct 2013 - 30 Jun health issues, drugs and/or alcohol use, or prior reported though they did
2016, Blood, sexual abuse. identify at least 34 cases where
urine, and/or hair Most incidents took place in the late evening/early the detection of drugs did not
specimens were morning (45%, n=48 12am-6am and 6 (6%) 10pm correlate with reported use.
screened for to midnight).
drugs of abuse Over half of incidents were at the home of the
and breath assailant(s), a friend or the patient (n = 62, 58%)

82
 alcohol Specimens were positive for drugs and/or ethanol
measurements in 72 patients (67%), with other drugs being
taken (after July detected in 60 patients (56%).
2015). Patient, Signs of intoxication were observed by the
incident and attending practitioner in 51 cases (48%).
examination Common symptoms in DFSA cases included partial
history or total amnesia, sedation, drowsiness, confusion,
dissociation, nausea, impaired judgement,
blackouts and pass outs.
69 patients (64%) reported consuming alcohol, 67
of which were prior to/around the time of the
incident.
26 patients reported prescription drug use and 22
patients (21%) reported recreational drug use
Overall, 90 patients (79%) reported voluntary use
of alcohol and/or recreational/medicinal drug use
around the time of the assault.
The study indicated at least 34 cases (32%) where
detection of drugs did not correlate with their
reporting of voluntary use.
80 Vecchio et Confer- 2 Italy DFSA Patients seeking “The inclusion criteria were partial/ complete Sexual Authors state the absence of
al. (2014) ence health care after amnesia for the alleged assault and/or (i) suspicion assaults injury or signs/symptoms of
abstract sexual assault and of covert drug administration and/or (ii) voluntary (inferred from intoxication at the time of
no 185 for which the intake of substances and/or (iii) signs/symptoms of topic) medical examination do not
Pavia Poison intoxication” exclude a DFSA.
Control Centre 51 patients mean age 26, 99% female.
(PPC) was 34 patients (66%) reported suspicion of covert Only the abstract was available.
contacted (from drug administration and 24 (47%) admitted
emergency voluntary consumption of drugs of abuse. This looks like preliminary
departments and Samples collected between 3 and 72 hours after findings for the study reported in
sexual assault violence. Vecchio et al. (2015a). Note that
referral centres Ethanol found in blood in 17 cases (33%) and urine 24 (47%) of patients reported
from across Italy), in 28 cases (55%). voluntary consumption of drugs
Nov 2011-Sep Other detected substances were benzodiazepines of abuse in this abstract but only
2013 (11), cocaine/benzoylecgonine (5), 11 (12%) admitted this in the
tetrahydrocannabinol (3), morphine (1), larger study. It is presumed the
methadone (1) and venlafaxine (1). difference may be that this
sample includes all voluntary
consumption whereas Vecchio et
al. (2015a) specifically stated as
reporting on all drugs except
alcohol.
81 Vecchio et Confer- 2 Italy DFSA 90 patients “The inclusion criteria were partial/ complete Sexual Only the abstract was available.
al. (2015a) ence seeking health amnesia for the alleged assault and/or (i) suspicion assaults
care after sexual of covert drug administration and/or (ii) voluntary

83
 abstract assault and for intake of substances and/or (iii) signs/symptoms of (inferred from Study did separate out voluntary
no 72 which the Pavia intoxication” (p.267) topic) and covert administration
Poison Control 90 patients, 98% female, mean age 26 years methods but specific findings for
Centre (PPC) was 60 patients (66%) reports suspicion of covert drug test results (positive or negative)
contacted (from administration and 11 (12%) admitted voluntary and substances found not
emergency consumption of drugs of abuse (excluding alcohol) reported for covert in the
departments and Samples collected between 3 and 72 hours after abstract (only overall).
sexual assault violence
referral centres Negative test results in 27 cases (30%), ethanol Authors state the absence of
from across Italy), found in blood in 33 cases (37%) and in urine in 54 injury or signs/symptoms of
Nov 2011-Sep cases (60%), other substances detected were intoxication at the time of
2014 benzodiazepines (n=16), cocaine and metabolites medical examination do not
(n=16), other drug of abuse (n=14), and drugs exclude a DFSA.
(n=10).
82 Vecchio et Confer- 2 Italy Incapacitating 45 patients “The inclusion criteria were partial/complete Robbery Only the abstract was available.
al. (2015b) ence substances seeking health amnesia for the robbery and/or (i) physical (inferred from
abstract and robbery care after robbery incapacity during the crime and/or (ii) suspicion of topic)
no 73 and for which the covert drug administration and/or (iii)
Pavia Poison signs/symptoms of intoxication” (p.267)
Control Centre 45 patients, mean age 47 years, 44% female.
(PPC) was 14 (31%) reported physical incapacity during the
contacted, Nov crime.
2011 – Sep 2014 Hypothesised method of administration was
ingestion in 10 cases and forced inhalation in 8
cases.
Robberies were committed in the home of the
victim in 22 cases (49%).
Samples were collected between 1-96 hours after
the robbery.
Most frequently detected substances were
Benzodiazepines (clonazepam, alprazolam,
lorazepam, bromazepam) and zolpidem (n =18,
40%). Negative for all substances investigated in 20
cases (44%).
83 Watt et al. Journal 1 South Africa Forced sex 785 females Demographics – all female aged 18-90 years (mean Sexual Limitation – survey items might
(2015) article recruited from 12 32.2, SD 11.4) predominantly Black (42%) or violence be misinterpreted by
(20) alcohol serving Coloured (56%) mostly unmarried (75%), 68% met (inferred from participants.
venues, self- criteria for hazardous drinking, 78% lived within topic but also
administered walking distance of the venue and 47% attended examples of Single question on forced sex had
surveys on the venue at least weekly. 18% reported. forced sex low sensitivity (missed 51 cases
experiences of experiencing IPV in the last 4 months and 10% had following of forced sex that were identified
forced sex a history of childhood sexual abuse. proactive when more specific questions
(data is part of a Forced sex defined as any occasion of forced sex spiking are were used).
community based by physical force, threats, or spiked drinks) provided)
longitudinal study

84
 on HIV risk in the 18.6% reported lifetime experience of forced sex Women who drank at hazardous
context of alcohol (n=146). levels reported higher levels of
serving 10.8% reported recent experiences of forced sex forced sex.
establishments in (n=85).
Cape Town) (12 Sex was forced by spiked drinks 44 out of 785
venues selected (5.6%) in past 4 months, and in 57 out of 785
from a list of 124) (7.3%) in lifetime.
Spiking was correlated (p<.001) with other
methods of force/coercion including physical
force (0.558), threat (0.574), talked into it (0.378),
and trickery (0.378).
51 women reported they had recently been forced
to have sex (via physical force, spiked drink etc.)
but when asked the single question of whether
there had been any forced-sex experience they
reported “no” (indicates victims don’t always
interpret actions as force). (also note 39 women
who reported forced sex did not report any of the
forced sex criteria this study uses (force, threat,
spiking)).

84 Wille et al. Journal 2 Belgium DFSA 79 victims of 92% female, 5% male, 2.5% gender neutral, 70% Sexual assault Detection of drugs can be
(2021) article DFSA, 2017-2018 aged 18 and over, 19% between 16-18, 10% (inferred from difficult if there is a time delay.
(20) between 14-16, and 1.3% between 10-14. topic)
In 18% of cases, the victim believed to have been Urine is the most useful specimen
administered a drug by the perpetrator (unclear if in DFSA as drugs and their
the victim believes this or the authors due to metabolites become more
phrasing) n=14 cases. concentrated in urine samples
4% of victims admitted voluntarily using drugs and have a longer detection
around the time of the assault. window.
46% of victim admitted voluntarily consuming
alcohol. State it is important to gather
1 victim said they took drugs and drank alcohol information on voluntary
34% took medication in the week before the consumption of substances by
assault. victims.
Blood and urine collected in 73 out of 79 cases
29 blood samples and 23 urine samples tested Victims do not always disclose
negative. that they have consumed drugs
14 blood samples (19%) and 21 (27%) of urine or alcohol.
samples tested positive for ethanol.
One or more illegal drugs were detected in 14 Increased risks are associated
blood samples and 19 urine samples. with voluntary alcohol
Of the 14 cases where the victim was believed to consumption.
have been drugged – using table 1 (which outlines
all results for all participants), identified all were

85
 female, 11 out of 14 were over 18 and 3 were 16-
18 years, 11 had drunk alcohol voluntarily (of
these 7 tested positive for drugs other than
ethanol and/or aspirin, 1 tested positive for
aspirin and metipranol, and 3 were negative for
all substances). One who had drunk alcohol and
taken medication in the last week had a range of
drugs in their system. 3 had not voluntarily taken
anyway – two tested negative, one tested
positive for Trazodone, Aripiprazol, and OH-
risperidone.
Study concludes ‘commonly-used’ illicit drugs,
psychoactive medicines, and ethanol are more
prevalent in DFSA cases than the date rape drugs
that are prominent in the media.
85 Williams et Confer- 2 UK (based Sexual assault 21 males who Age: under 13 (n=3), 18- 97 years (n=18), 50% Sexual assault Only abstract was available.
al. (2012) ence on author attended a sexual White/28% Black/2% Asian, 56% homosexual and (inferred from
abstract location) assault referral 44% heterosexual, 78% referred within 72hrs of topic) Small sample.
(for centre for a assault.
poster) forensic medical A third reported suspected drug facilitated sexual No information about method of
examination assault. administration (e.g., involuntary
between 1 Jan versus voluntary).
2011 – 31 Dec
2011
86 Wolitzky- Journal 2 USA Dating 3,614 young Dating violence was defined as sexual assault, Rape (inferred Unable to separate out method
Taylor et al. paper (8) violence / people aged 12- physical assault, and/or drug/alcohol-facilitated from topic) of administration for DAFR.
(2008) DAFR 17 completed a rape (DAFR) perpetrated by a girlfriend, boyfriend,
telephone or other dating partner.
interview on DAFR was defined as being the victim of unwanted
dating violence sex (i.e., vaginal, anal, and/or oral penetration)
(nationally while high, drunk, or passed out from drinking or
representative taking drugs. DAFR was coded ‘‘yes’’ if participants
sample) took the drugs or alcohol on their own accord or if
they were given the drug by the perpetrator or
someone else – only administered to girls.
Prevalence of dating violence was 1.6% (2.7% of
girls, 0.6% of boys) - equating to U.S. population
estimates of about 335,000 girls and 78,000 boys
Sexual assault prevalence 0.9% of sample, girls
1.5%, boys 0.3%.
Physical assault prevalence 0.8%, girls 1.2%, boys
0.4%.
DAFR prevalence 0.1% of whole sample, 0.2% of
girls, data wasn’t collected for boys.

86
87 Xifro- Journal R Spain DFSA Every adult “Drug-facilitated crime is the surreptitious Sexual assault Part of DFC definition is
Collsamata article (7) consulting an administration of psychoactive substances for (inferred from surreptitious administration.
et al. emergency criminal purposes” - specifically “Suspected DFSA topic)
(2014) service because of was defined according to the criteria by Du Mont et In relation to not finding “date
alleged sexual al. (2009): suspicion by the victim of having been rape drugs”, the authors note
assault and “drugged,” presence of at least one of the 16 “these substances are not
receiving forensic symptoms associated with DFSA and a valid reason predominant in the French
assessment in the for suspecting sexual crime” (p.404) national registry of proven DFSA
city of Barcelona, Under 18s and absence of valid reason to suspect cases, whereas benzodiazepines
1 Jan – 31 Dec sexual assault were reasons for exclusion or analogues are” (p.408)
2011 124 cases, 10 under 18, none excluded due to lack
of valid reason to suspect assault, sample Sample only includes people who
therefore 114. report sexual assault to the
35 out of 114 cases (31%) met suspected DFSA emergency service, study limited
criteria. to data from one city in one year,
32 out of 35 female, mean age 27.4, all had relatively small sample size.
consumed alcohol prior to the assault, 7 admitted
drug abuse, 6 took psychoactive medications
Compared with the other victims, suspected DFSA
cases were more likely to experience amnesia, to
have been assaulted by night, after a social
situation and by a recently acquainted man, to
have used alcohol before the assault and to be
foreigners.
Suspected DFSA group - ethanol was detected in
blood or urine in 48% of analysed cases. At least
one central nervous system drug other than
ethanol was detected in 61% of these cases
(mainly stimulant drugs of abuse).
“The main result of our study is that almost one in
every three individuals treated for sexual assault
in Barcelona (31%) presented DFSA” (p.407)
Did not detect the presence of substances known
as “rape drugs” or “date-rape drugs” (such as
Flunitrazepam, GHB, Ketamine or Scopolamine).

87

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