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In the past year the media have given much attention to the issue of drug facilitated sexual assault (DFSA), more emotively referred to as ‘date-rape’1. In DFSA the victims are subjected to non-consensual sexual acts while they are incapacitated or unconscious through the effects of alcohol or drugs; they are therefore prevented from resisting or unable to consent2.
For a rapist, the ideal substance to facilitate a sexual assault is one that is readily available, is easy to administer, impairs consciousness and causes anterograde amnesia. Drugs that have been associated with sexual assaults include flunitrazepam, gamma hydroxybutyrate and ketamine2,3. To preserve any evidence of such drugs, practitioners involved in the forensic assessment of complainants of sexual assault are encouraged to request blood and urine samples at the earliest opportunity4,5. The perception that drugs are frequently being administered (to males as well as females) in order to facilitate a sexual assault has led to development of ‘prevention’ strategies—many of them originating from college and student campuses in the USA, where concerns first arose. The prevention strategies generally relate to ways of avoiding surreptitious addition of date-rape drugs to alcoholic drinks; so young people are advised ‘do not leave drinks unattended; don't take beverages, including alcohol, from someone you do not know well; at a bar, accept drinks only from the bartender or server; at parties, do not accept open-container drinks from anyone; be alert to the behaviour of friends—anyone appearing intoxicated may be in danger’ [www.gnesa.org/date_rape_drugs/drugs.html ]. The development of dipsticks that test drinks for drugs is being explored.
Important though these strategies are, few address or emphasize the evident fact that the most available and widely used date-rape drug is alcohol. Hindmarch and colleagues6 have reported the results of 3303 urine samples from individuals who claimed to have been sexually assaulted and believed that drugs were involved. 2026 samples were positive and in 44% of these the drug was alcohol alone. Alcohol, by itself or together with another agent, was by far the commonest substance detected, followed by cannabis (present in 30% of positives). Flunitrazepam was detected in 11 cases (0.54%) and gamma hydroxybutyrate in 100 (4.9%); ketamine was not tested. Hindmarch and colleagues conclude that no single drug other than alcohol can be particularly identified as a date-rape drug, and that alleged sexual assaults take place against a background of licit or recreational alcohol or drug use, where alcohol and drugs are taken concurrently. Despite these findings, media-led coverage and local initiatives7 still concentrate on the ‘drug’ aspect of DFSA.
In the past decade in the UK the ready availability of palatable high-alcohol-volume drinks, coupled with the so-called ‘ladette’ culture, seems to have generated greater public acceptance of heavy drinking in young people—a special cause for concern in young women8. There is reason to fear that alcohol manufacturers, by mixing alcohol with fruit juices, energy drinks and premixed alcopops and using advertising that focuses on youth, lifestyle, sex and fun, are trying to establish a habit of drinking alcohol at a very young age. The Chief Medical Officer has focused on the increasing incidence of cirrhosis, calling for a harm-reduction strategy in young people to prevent cumulative damage to the liver9. We suggest that an important part of any public awareness campaign on the hazards of heavy drinking is the increased likelihood of suffering a sexual assault.