# Assessment of 19 years of a prospective national survey on drug-facilitated crimes in France

Samira Djezzar, Jean-Michel Gaulier, Charlotte Gorgiard, Marjorie Chèze, Jean-Claude Alvarez, Claire Martin, Véronique Dumestre-Toulet, Michel Lavit, Olivier Mathieu, Hélène Eysseric, et al.

► To cite this version:

Samira Djezzar, Jean-Michel Gaulier, Charlotte Gorgiard, Marjorie Chèze, Jean-Claude Alvarez, et al. Assessment of 19 years of a prospective national survey on drug-facilitated crimes in France. Legal Medicine, 2023, 65, pp.102297. 10.1016/j.legalmed.2023.102297. hal-04585299

HAL Id: hal-04585299

https://hal.science/hal-04585299v1

Submitted on 24 Jul 2025

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished or not. The documents may come from
teaching and research institutions in France or
abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est
destinée au dépôt et à la diffusion de documents
scientifiques de niveau recherche, publiés ou non,
émanant des établissements d'enseignement et de
recherche français ou étrangers, des laboratoires
publics ou privés.

<figure><img src="image_1.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
Assessment of 19 years of a prospective national survey on drug-facilitated crimes in France

**Samira Djezzar**<sup>*a*</sup>, Jean-Michel Gaulier<sup>b</sup>, Charlotte Gorgiard<sup>c</sup>, Marjorie Chèse<sup>d</sup>, Jean-Claude Alvarez<sup>e</sup>, Claire Martin<sup>f</sup>, Véronique Dumestre-Toulet<sup>g</sup>, Michel Lavit<sup>h</sup>, Olivier Mathieu<sup>i</sup>, Hélène Eysseric<sup>j</sup>, Emilie Berland<sup>k</sup>, Carine Roussel<sup>l</sup>, Yvan Gaillard<sup>m</sup>, Anne-Sophie Hurtel-Lemaire<sup>n</sup>, Marc Deveaux<sup>d</sup>, Charlotte Pion<sup>o</sup>, French Addictovigilance Network.

<sup>a</sup> Addictovigilance center, hôpital Fernand Widal, AP-HP-Nord-Université de Paris,
200, rue du Fg Saint-Denis, 75010 Paris, France.

* Corresponding author. Tel (33) 1 40 05 49 62 ; E-mail address: samira.djezzar@aphp.fr

https://orcid.org/0000-0003-2413-230X

<sup>b</sup> Division of Toxicology, CHU Lille, France. https://orcid.org/0000-0003-1111-4671

<sup>c</sup> Forensic emergencies, hôpital Hôtel-Dieu, AP-HP. Centre - Université de Paris, France.

<sup>d</sup> ToxLab laboratory, Paris, France.

<sup>e</sup> Pharmacology-Toxicology Laboratory, hôpital Raymond Poincaré, AP-HP. Université Paris Saclay, France

<sup>f</sup> Toxicology Section, National Institute of Forensic Science, INPS-LPS75, Paris, France

<sup>g</sup> ToxGen laboratory, Bordeaux, France

<sup>h</sup> Pharmacokinetics and toxicology laboratory, CHU, Toulouse, France

<sup>i</sup> Medical Pharmacology and Toxicology Department, CHU Montpellier, France

<sup>j</sup> Pharmacology and Toxicology laboratory, CHU Grenoble, France

<sup>k</sup> Toxicology Section, National Institute of Forensic Science, INPS-LPS13, Marseille, France

<sup>l</sup> Toxicology Section, National Institute of Forensic Science, INPS-LPS31, Toulouse, France

<sup>m</sup> Lat Lumtox laboratory, La Voulte, France

<sup>n</sup> Pharmacoloy-Toxicolgy laboratory, CHU Amiens, France
° Addictovigilance department, Agence nationale de sécurité du médicament et des produits de santé (ANSM), Saint-Denis, France.

## Acknowledgments

### 1/ The French Addictovigilance Network members

Amélie Daveluy (Bordeaux), Reynald Le-Boisselier (Caen), Frédéric Libert (Clermont-Ferrand), Nathalie Fouilhé (Grenoble), Anne-Sylvie Caous (Lille), Alexandra Boucher (Lyon), Michel Spadari (Marseille), Céline Eiden (Montpellier), Juliana Tournebize (Nancy), Marie Gérardin (Nantes), Maude Marillier (Paris), Bernard Fauconnneau (Poitiers), Camille Ponte (Toulouse).

### 2/ Toxicological laboratories members

Delphine Allorge (CHU, Lille), Fabien Bevalot (LumTox laboratory, La Voulte), Luc Humbert (CHU Lille), Catherine Ganière-Monteil (CHU, Nantes), Aurélie Muckensturm (ToxLab laboratory, Paris), Damien Richard (CHU Clermont-Ferrand), Camille Richeval (CHU, Lille), Bénédicte Santin (INPS-LPS, Marseille), Thierry Soto (INPS-LPS, Ecully).

### 3/ Forensic emergencies / forensic medicine departments members

Elisabeth Alcaraz (CHU Hôtel-Dieu, Paris), Eric Baccino (CHU Montpellier), Catherine Dang (CHU Bondy), Céline Deguette (CHU Hôtel-Dieu, Paris), Isabelle Sec (CHU Hôtel-Dieu, Paris), Frank Questel (CHU Hôtel-Dieu, Paris).

Declaration of Interest: none
**Abstract**

Drug facilitated-crime or chemical submission (DFC/CS) is defined as the concealed or forced administration of psychoactive substances to a victim for criminal purposes. This is a national program set up in the early 2000s in the form of a prospective multicenter survey, the results of which this manuscript presents. Over this 19-year period, 5487 cases were collected, analyzed and classified into 54% of suspected cases, 29% of chemical vulnerability (CV) cases and 17% of proven DFC/CS cases. In the overall data, the most prevalent victims were female (81%), with an average age of 27 years. Sexual assault was the most frequent aggression (77%), followed by theft (14%).

Victims of proven DFC/CS cases were from of all ages including children and elderly. In 934 victims of DFC/CS, 100 various psychoactive substances were detected mostly represented by benzodiazepines and z-drugs (55%), various sedatives including antihistamines (16%) and non-therapeutic substances (16%). Gamma-hydroxybutyric acid (GHB) was found in 4% cases. In CV cases, alcohol (90%) and cannabis (32%) intake were mainly involved

In France, despite prevention messages, DFC/CS has been an epidemic for many years and has been proven by our national study. This national program has the aim to identifying the substances used but unfortunately not the goal to fight against this phenomenon. Since 2009, we observed a new *modus operandi* of the aggressors who pose as taxi drivers facilitating the reception of the victims leaving nightclubs. We can emphasize that GHB is not the "date rape drug" but rather the benzodiazepine class is.

**Key words:** Drug-facilitated crime; Date-rape drugs; chemical vulnerability; benzodiazepines; alcohol; GHB

**Abbreviations:**

ANSM: Agence nationale de sécurité du médicament et des produits de santé (National Agency for the Safety of Medicines and Health Products); BZD: benzodiazepines & z-drugs; CS: chemical submission; CV: chemical vulnerability; DFC: drug-facilitated crimes; GBL: γ-butyrolactone; GHB: Gamma-hydroxybutyric acid; MDMA: methylenedioxymethamphetamine; 4-MEC: 4-methylethcathinone, NTS: Non-therapeutic substances, PAS: psychoactive substances,
# 1. Introduction

Drug facilitated crimes (DFC) and chemical submission (CS) are terms for the same phenomenon in which the pharmacological effects of psychoactive substances (PAS) are used for non-therapeutic but rather criminal purposes. This phenomenon is spreading and becoming commonplace to the present day and has been documented elsewhere in numerous publications for several years [1-7]. If the crimes are focused on rape or sexual assault [8-12], various other criminal acts under the influence of PAS [13-18] are described among victims of all ages [14].

Because DFC/CS has become a major problem in France, professional health authorities set up a national survey and then defined it as the concealed or forced administration of PAS to a victim for criminal purposes<fnref n="1" />. A variant of DFC/CS called chemical vulnerability (CV) has also been defined as any form of aggression towards a victim while under the influence of intentionally ingested PAS [14, 19-20]. From a clinical point of view, sedation and disinhibition are the main effects sought in the context of DFC/CS leading the victim to perform acts incompatible with his or her conscious will, as well as anterograde amnesia preventing the victim from remembering details [14, 21]. The empathogenic effect with modification of emotions is also a factor facilitating the sexual act and can be sought by the use of substances such as methylenedioxymethamphetamine (MDMA).

We present an update of our previous reports [14, 22], which here bring together all data analyzed for 19 years (2001-2019). This is the first and longest specific multicenter investigation structured according to a well-established protocol.

# 2. Material and methods

The methodology remains the same as our previous publications [14, 22] and concerns a national multicenter and prospective study sponsored by the National Agency for the Safety of Medicines and Health Products (ANSM for "Agence nationale de sécurité du médicament et des produits de santé").

<footnote n="1">¹ Circular DHOS/O 2/DGS no. 2002-626 of December 24, 2002 relating to the care in health establishments authorized to carry out an activity of reception and treatment of emergencies, of people who are victims of the administration without their knowledge of psychoactive products. Available from: https://solidarites-sante.gouv.fr/fichiers/bo/2003/03-04/a0040202.htm. Accessed 25 April 2022</footnote>
The cases are collected by different services: forensic medicine, forensic emergencies, toxicological analysis laboratories and also the statements of the victims themselves in our center. These cases were documented by toxicological analysis of various biological samples from the victim (i.e., blood, urine, or hair) or the chemical weapon vector (e.g., the glass that contained the beverage). According to the consensus of the French Society of Analytical Toxicology (SFTA) [23] and subsequent international recommendations or guidelines [24-29], toxicological investigations were mainly performed using appropriate analytical methods using liquid chromatography with diode array (LC-DAD), mass spectrometry (LC-MS), tandem mass spectrometry (LC-MS/MS), or high resolution mass spectrometry (LC-HRMS), or gas chromatography with mass spectrometry (GC-MS) or tandem mass spectrometry detection (GC-MS/MS). The different laboratories that performed these analyses also participated annually in the external quality controls organized by the SFTA.

To examine the different characteristics between groups, the chi-square test was used.

## 3. Results

Between 2001 and 2019, 6497 cases of suspected DFC/CS were collected and analyzed. Were eliminated 1010 files (16%) because they had no criteria of our subject (no PAS detected despite toxicological analysis, or states of inebriation, duplicate files, etc.). This study was ultimately based on the evaluation of 5487 (84 %) files of potential victims of DFC/CS, which among them 2982 (54%) were classified as suspected DFC/CS (Fig. 1). These last files lacked clinical and/or toxicological data to establish an accurate diagnosis on the allegations of victims.

The 2505 (46%) remaining cases were divided into 2 groups: victims of CV with 1571 cases (29%) and that of victims of DFC/CS with 934 cases (17%). The distinction between the different groups is interesting because they have characteristics, although similar, were nuanced by some points, which will be discussed later (Table 1).

The study of aggregated data (n=2505) shows a female predominance at 81% of cases (n=2034) with an average age of 27 years. We have identified 440 underage children (18%). In all cases, the most affected victims belong to the 20-29 age group (Fig. 2).

Some victims reported having voluntarily used PAS, especially alcohol, which may have participated in the potentiation of the pharmacological effects (Table 1).
The most frequent attacks are rape/sexual assault (77%) and robbery (14%). Other, rarer but no less important offenses are listed in Table 1 with all characteristics of victims and contexts of the different groups and will be expanded below.

The main clinical features which lead victims to consult health professional were anterograde amnesia, vigilance or consciousness disorders related to the sedative effect of the molecules used and physical injuries indicative of the assault violence.

## 3.1. DFC/CS

This category of victims was distinguished by the consumption of at least one PAS without their knowledge or under threat. The 934 victims were mostly female (66%) including all ages (4 days - 97 years). Underage children victims represented 22% of the cases (n=205 of which 130 were under 15 years).

As the premeditation is the characteristic of this group, it is revealed by the choice of PAS masked in a vector, or ingested under the threat. In most informed cases, this chemical weapon vector was a beverage (70% of cases) which was alcoholic in 41% of cases and soft drink in 17% of cases. In a hospitalization context, the infusion of PAS in physiological saline by nurses (assailants) was noted in 5 cases (Table 2).

The forced taking PAS represented 13% of the cases, and more rarely the administration was carried out directly by the victim deceived by his attacker on the nature of the drug in 7% of the cases.

Although sexual assault was the majority of cases (54%), theft or burglary (adults) is in second position with 22% of cases. Deep sedation of the victims for abuse or criminal purposes was not negligible and represented 12% of cases, of which nearly 2/3 were children. In this category of DFC/CS were also found psychic manipulation, misappropriation of inheritance and kidnapping (Table 1).

The aggressor had operated in a private or intimate environment in 62% of cases and the assailant was rather known to the victim in 64% (Table 3).

Toxicological investigations were carried out in blood (69% of victims), urine (61%), hair (34%) but also in the chemical weapon vector and in products found during the judicial investigations. Biological samplings were performed within variable timeframes. This information is important to know in the assessment of causal imputability. Thus, we studied and matched the kinetic data of the PAS detected with the sampling time (Table 4).
## 3.2. Psychoactive substances (PAS)

PAS detected and taken into account were those used without the victim's knowledge or administered under threat. One hundred substances (Table 5) were detected in 934 victims accounting 1220 mentions because in some cases, assailants had used of more than one substance per victim. The detected substances were grouped into families of PAS and the pharmaceutic molecules were the most frequent substances used (81% of all mentions). Non-therapeutic substances (NTS) were found in 19% of mentions.

BZD represented more than 55% of mentions of all PAS, throughout these survey years, in victims including those the age under 15. The class of antihistamines and various sedatives were ranked in the second position (16%) ahead of NTS (16% of mentions) excluding GHB and its precursor γ-butyrolactone (GBL). Other PAS were opioids with 4% of mentions, antidepressants and various other substances were rarer with respectively 3% and 2% of mentions (Fig. 3).

In the BZD group, all the substances were represented in varying proportions but only three of them had detained more than half of the mentions. Clonazepam (20% of BZD mentions) ranked first until 2006 then after began to decrease. In second position, bromazepam and zolpidem were *ex aequo* at 17%. Zolpidem increased in particular from 2012 gradually replacing clonazepam. The Fig. 4 shows the first 5 PAS in the ranking and achieving 82% of the mentions of all BZD.

Concerning the antihistamines and other sedatives (neuroleptics, antipsychotics...), we note on their distribution of the Fig. 5, that doxylamine (27% of mentions of this group) and hydroxyzine (21%) were predominant and constantly detected since the beginning of the survey except during two years for each of them (respectively in 2005-2011 and 2006-2007). Other psychotropics were used less than 10% of mentions.

Among NTS, excluding GHB/GBL (see paragraph below), the high proportion of amphetamines dominated by MDMA (32%) was particularly outstanding (Fig. 6). Hedonic substances circulating essentially in the festive environment they were followed by ethanol (18%). It is important to specify here that alcohol was administered under threat.

## 3.4. Cases involving GHB/GBL, the so called “the drug of rape”

This group is characterized by only 4% of all victims of DFC/CS (n=36) who were scattered over time. The Fig. 6 shows the distribution of the number GHB/GBL cases between 2001 and 2019.
They were mainly located in Paris area (75%, n=27). The victims were female in 61% of cases (n=22) with an average of 27 years (10-46 years) and 4 minors were concerned.

Sexual assault was described in 67% of cases (n=24) including two children (10-year-old girl by use of GBL for incest and a case of prostitution of an 11-year-old girl using repeated administrations of GHB and other PAS).

Toxicological analysis was performed in blood (14 cases with GHB concentration ranging from 16 µg/ml to 338 µg/ml), urine (13 cases with GHB concentration ranging from 12 µg/ml to 2215 µg/m), hairs (17) and in the vectors/vials (5 cases of which 3 contained GBL).

## 3.5. Specific cases

### 3.5.1. Cases with PAS administered under threat

They were 90 victims (10% of the DFC/CS group) with an average age of 26 years, mostly female (78%). Sequestration was declared in 24% and sexual assault in 78%. In 41% of cases, victims were forced to drink alcohol or smoked cannabis (16%). The use of chloroform was described in 2 cases, one of which was complicated by death due to unintentional overdose.

### 3.5.2. Minor victims aged under 15

Minors under 15 represent a noteworthy rate of 14% (n=130) of DFC/CS cases. These victims were particularly subject of sedation (55%, n=71 cases). Beside pedophilia (35%), 36% of children (n=47) were victim of repeated sedation for child abuse which is defined as « chemically beaten children ». However, even if this sedation was not intended to cause harm, consciousness disorders was serious (42% of cases). More macabre, in 18% of cases (n=24), the induced sedation was for the purposes of subsequent homicide by other means (drowning, carbon monoxide intoxication).

### 3.5.3. Victims aged 70 and over

They were only 3% of DFC/CS victims (n=32) and differ from the others on various points including sex, type of offence, perpetrators and symptomatology. This group accounted for 53% men (n=17). The home is the location of more than 59% of the cases and 38% in health and retirement facilities. In this last situation, a case-series of 7 victims, residents of a retirement home, were subjected to cocktails of neuroleptics and antipsychotics to ensure sedation during the same period. This population of elderly was exposed to more serious complications than young adults since it can be seen that consciousness disorders concerned a high prevalence as 76% (n=22)
of the informed cases (n=29), the need to use flumazenil (BZD antidote) was reported in 2 cases and respiratory
disorders in two other cases.

**3.5.4. Chemical submission for the purpose of repeated theft by a serial thief**

We describe a case-series of five men which were victim of theft after they ingested an alcoholic beverage spicked by a mixture of association of BZD and antihistamines<fnref n="2" />. The judicial investigation requisitioned a bottle containing numerous drugs from the assailant (Fig. 7).

**3.6. Chemical vulnerability (CV) due to voluntary consumption of psychoactive substances**

In this category of 1571 victims, the offender had taken advantage of a clinical situation that he has not
premeditated beforehand. We had separated victims into two subgroups according to their consumption.

The first, subgroup A (72%, n=1131), collected the cases of victims who have voluntarily consumed of non-therapeutic substances (NTS).

The subgroup B (28%, n= 440) using usual or occasional psychotropic treatment and who have consumed before
the assault NTS. Although the profiles of the victims are similar in various aspects of the phenomenon but some
points distinguish the two subgroups:

- the average age was significantly different (Fig. 2) with a younger average age evaluated at 24 years for the
victims of the sub-group A (vs 32 years) with a higher proportion of minors (16% vs 11%).

- the context of the aggression was of a festive one in the sub-group A (52%) whereas in the sub-group B, the
intimate or private environment was predominated (50%).

- among the perpetrators, taxi drivers or fake taxi drivers showed a greater proportion in the subgroup A. (Table
3).

- victims of the sub-group A consulted earlier after the attack were those (62% vs 47% in less than 16 hours after
the aggression).

For the two subgroups, ethanol was mostly declared/detected (90%), followed by cannabis (32%), cocaine (9%) and MDMA/amphetamines (3%). The other substances are less frequent (Table 1). No PAS other than those consumed by the victims was detected by toxicological analysis.

**4. Discussion**

<footnote n="2">² Chèze M, Lenoan A, Deveaux M, Pepin G. Soumission chimique en série. XVth Congress of SFTA meeting, Paris, 6-8 June 2007.</footnote>
This national multicenter prospective survey of DFC/CS and CV over a 19-year period is unique in this forensic expertise area. This study targeted cases specifically concerned with offenses and all kinds of crimes perpetrated under the influence of PAS, while the scientific literature studied PAS detected in the bodily fluids of victims of sexual assault [1-4, 6-10, 30].

It is important to distinguish between the two categories DFC/CS and CV for several reasons. On a psychological level, the victims feel less guilty when they discover that their aggression is not related to a risk-taken by their own will but due to the administration of PAS without their knowledge. In addition, the possibility of overdose or potentiating interaction is possible or even dangerous. On the other hand, and in the case of a CV, they become aware of the danger of consuming substances, especially alcohol, while being isolated from their relationships. They subsequently adopt a more cautious behavior by limiting and controlling their consumptions or by designating an “evening captain” (person who stays sober and watches over their friend to drive them at the end of the party). On a forensic/criminal level, the premeditation represents an aggravating circumstance for the assailant when identified and apprehended.

From year to year, the victim's profile remains unchanged and the PAS used were mainly the same.

In the DFC/CS category, the BZD remains always predominant [1, 8, 30] that the different molecules of which vary in proportion from one year to another due to the impact of ANSM regulatory measures on these drugs. Thus, after a peak in 2006, clonazepam-related case rates began to decrease due to numerous French reglementary measures [31]: restriction of the prescription and modification of the coloring of the oral solution (blue to alert the victim) [14]. Zolpidem has also experienced the same fate [32] leading to a change in the choice for other BZD. The H1 Antihistamines drugs and sedatives [15-16] were the followed group of PAS and the use of doxylamine and hydroxyzine is almost constant in time.

Moreover, we emphasize the use of opiate substitution drugs but also ketamine that are dangerous to handle.

More rarely, recent (quetiapine) [33] or older (scopolamine) [34-35] molecules were also reported.

Regarding NTS, the hedonic PAS as phenethylamines including MDMA and cathinones (33% of all NTS mentions) trend to be used frequently since 2011. The cathinones in our study could be considered as drug-facilitated sexual assault in the chemsex context [36].

The specific use of GHB/GBL is rare (4%) in our study while it was found in varying proportions in other studies approaching 5.9% [21, 30] with serious complications in some cases [37]. This low percentage could be explained by the rather strict control (narcotic) in France and its handling is too dangerous.

However, this survey highlighted a number of important points:
- Despite preventive measures with information messages, the phenomenon remains current and strengthens over time with the same characteristics as those described in our previous publications [14, 22]. This reality, found beyond our borders, is attested by the international publications that accumulate to date [1-7].

Unfortunately, the results of this survey are not exhaustive and only reflect the emerging part of the problem, since many victims did not dare to complain for many personal reasons often influenced by the close entourage [38]. The high proportion of incomplete cases (54%) in our study testifies the possible inadequacy of the care of these victims for various reasons (the high cost of toxicological analysis, the long sampling time, lack of analysis or the context...).

The category of CV cases reminds us the risk of voluntary consumption of NTS [39] in a festive setting (especially for alcohol in 90% of cases) and must allow to become aware of the seriousness of such exposure if one does not surround oneself with preventive measures. The victims of sub-group A were younger than the victims of the subgroup B and DFC/CS. Unfortunately, a focus on students [20, 40-42] miss in our study. The socio-economic data was not the goal in this study. However, we can postulate that the group of the youngest victims could involve the students. This group represented the most important population of victims (79% of sub-group A, 48% of sub-group B and 47% of DFC/CS group).

In basis of the clinical and pharmacological data observed in the three groups, some differences can be made between them. Alcohol has a short half-life and its effects fade more quickly than the other PAS, administered alone or in combination with alcohol in the other two groups. Therefore, subgroup A victims had significantly the highest rates of samples taken within 16 hours (Fig. 8) and of the amnesia that disappears faster than that induced by BZD for example. In the same line of reasoning, the observed physical injuries had resulted from alcohol-induced aggressive behavior in victims who attempted to defend themselves during the assault (Fig. 9).

The different kinds of attacks varied in the two groups (DFC/SC and CV): while they were diverse in the DFC/SC group, the aggressions reported in the CV group are only of three orders: sexual aggression including rape, more rarely physical violence and theft. These unpremeditated attacks were aroused by the state of the victims who seem vulnerable by their abnormal behavior (inebriated state) whereas in the DFC/CS the assault is premeditated in advance. In our study, we have clearly observed that the sexual assault of the sub-group A (NTS) had taken place rather in a festive context and by attacker's unknown to the victim, unlike the victims of DFC/CS who are in confidence with their relatives planning a criminal act. This aspect is not always described elsewhere and when it happened, the opposite situation was reported [39].

There are two *modi operandi* in particular:
1) In the specific cases of CV where alcohol consumption is highly predominant, some of perpetrators were taxi drivers since 2009. They were requested for the return home or it's false taxi drivers who expect, near the releases of clubs, for the young drunk women in the early morning (Table 4).

2) A more painful observation concerns the young victims and especially the children. The induction of sedation has two purposes. The first one concerns qualified as "chemically beaten children", is sought by the parents or the nanny to ensure peace of mind. The use of PAS is considered trivial until the occurrence of serious medical complications. The toxicological analysis of the hair in this situation, as well as the elderly victims is a fundamental step and highlight a repeated intake of these PAS [15-18]. The second purpose for sedation is that carried out for infanticide (by means other than poisoning in this study).

**5. Conclusion**

This national multicenter prospective survey of DFC/CS and CV over a 19-year period is unique in this forensic expertise area.

If the young woman represented the frequent and classic model of the victim, men and extreme ages are not spared. The name "date-rape drug" is wrongly attributed to GHB, at least in France because its use did not reach 4% of our cohort. It's rather BZD which deserve this naming due to their highest prevalence each year.

However, no preventive measure has, to date, shown significant effectiveness. Neither changing the color of the solution of clonazepam nor its classification as narcotic solved the problem of DFC/CS. Implementing drug regulatory changes only shifts the choice from one molecule to another. This means that the premeditated intentions of criminals cannot be countered within this phenomenon. Crime has not regressed but has fully blossomed in a time when the availability of products has become child's play with the internet market, the black market and the sometimes convenience prescription of drugs. DFC/CS is also trivialized by the movies where the phenomenon is openly described without filter.

**Funding:** This Study was supported by the health authority: the National Agency for the Safety of Medicines and Health Products (ANSM), investigator of this survey.

**Compliance with Ethical Standards:** Not applicable

**References**
[1] C.T. Hagemann, A. Helland, O. Spigset, K.A. Espnes, K. Ormstad, B. Schei, Ethanol and drug findings in women consulting a Sexual Assault Center--associations with clinical characteristics and suspicions of drug-facilitated sexual assault, J Forensic Leg Med. 20(6) (2013) 777-784. https://doi.org/10.1016/j.jflm.2013.05.005.

[2] A. Xifro'-Collsamata, A. Pujol-Robinat, E. Barbería-Marcalain, A. Arroyo-Fernández, A. Bertomeu-Ruiz, A. Bertomeu-Ruiz, F. Montero-Núñez, J. Medallo-Muñiz, A prospective study of drug-facilitated sexual assault in Barcelona, Med Clin (Barc). 144(9) (2015) 403-409. https://doi.org/10.1016/j.medcli.2014.11.026.

[3] C.G. Caballero, Ó.Q. Jorge, A.C. Landeira, Alleged drug-facilitated sexual assault in a Spanish population sample, Forensic Chemistry. 4 pp (2017) 61-66. http://dx.doi.org/10.1016/j.forc.2017.02.009.

[4] M. Kapitány-Fövény, G. Zacher, J. Posta, Z. Demetrovics, GHB-involved crimes among intoxicated patients, Forensic Sci Int. 275 (2017) 23-29. https://doi.org/10.1016/j.forsciint.2017.02.028.

[5] X. Wang, S.S. Johansen, M.K.K. Nielsen, K. Linnet, 2018. Hair analysis in toxicological investigation of drug-facilitated crimes in Denmark over a 8-year period. Forensic Sci Int. 285, e1-e12. https://doi.org/10.1016/j.forsciint.2018.01.021.

[6] H. Poulsen, M.J. McCarthy, J. Baker, A. Verma, H.J. Moir, T. Brodie, B. Thatti, G. Trotter, B. Rooney, Toxicological assessment of the role of alcohol and drugs in drug-facilitated sexual assault cases in New Zealand, J Anal Toxicol. 45(1) (2021) 44-52. https://doi.org/10.1093/jat/bkz110.

[7] E. Bertol, M.G. Di Milia, A. Fioravanti, F. Mari, D. Palumbo, J.P. Pascali, F. Vaiano, Proactive drugs in DFSA cases: Toxicological findings in an eight-years study, Forensic Sci Int. 291 (2018) 207-215. https://doi.org/10.1016/j.forsciint.2018.08.032.

[8] M.A. ElSohly, S.J. Salamone, Prevalence of drugs used in cases of alleged sexual assault, J Anal Toxicol. 23 (1999) 141-146. https://doi.org/10.1093/jat/23.3.141.

[9] M.P. Juhascik, A. Negrusz, D. Faugno, L. Ledray, P. Greene, A. Lindner, B. Haner, R.E. Gaensslen, An estimate of the proportion of drug-facilitation of sexual assault in four U.S. localities, J Forensic Sci. 52(6) (2007) 1396-1400. https://doi.org/10.1111/j.1556-4029.2007.00583.x.

[10] M. Scott-Ham, F.C. Burton, A study of blood and urine alcohol concentrations in cases of alleged drug-facilitated sexual assault in the United Kingdom over a 3-year period, J Clin Forensic Med. 13 (2006) 107-111. https://doi.org/10.1016/j.jcfm.2005.10.006.
[11] B. Marc, F. Baudry, P. Vaquero, L. Zerrouki, S. Hassnaoui, H. Douceron, Sexual assault under benzodiazepine submission in a Paris suburb, Arch Gynecol Obstet. 263 (2000) 193-197.
https://doi.org/10.1007/s004040050282

[12] J. Du Mont, S. Macdonald, D. Kosa, An Examination of Victim, Assailant, and Assault Characteristics among Cases Classified as Predatory Drug-Facilitated Sexual Assault, Women's Health Issues. 26(4) (2016) 393-400. https://doi.org/10.1016/j.whi.2016.05.010

[13] C. Bismuth, S. Dally, S.W. Borron, Chemical submission: GHB, benzodiazepines and other knock out drops, J Toxicol Clin Tox. 35 (1997) 595-598. https://doi.org/10.3109/15563659709001238

[14] S. Djezzar, N. Richard, M. Deveaux, Epidemiology of drug-facilitated crimes and drug-facilitated sexual assaults, in: Toxicological aspects of drug facilitated crimes, P. Kintz Ed, Elsevier, 2014. pp 11-46.
https://doi.org/10.1016/B978-0-12-416748-3.00002-5

[15] P. Kintz, M. Villain, V. Cirimele, Determination of trimeprazine-facilitated sedation in children by hair analysis, J Anal Toxicol. 30 (2006) 400-402. https://doi.org/10.1093/jat/30.6.400

[16] P. Kintz, J. Evans, M. Villain, G. Salquebre, V. Cirimele, Hair analysis for diphenhydramine after surreptitious administration to a child, Forensic Sci Int. 173 (2007) 171-174.
https://doi.org/10.1016/j.forsciint.2006.12.006

[17] P. Kintz, M. Villain, V. Dumestre-Toulet, B. Capolaghi, V. Cirimele, Methadone as a chemical weapon: two fatal cases involving babies, Ther Drug Monit. 27 (2005) 741-743.
https://doi.org/10.1097/01.ftd.0000179850.50019.7d

[18] P. Kintz, M. Villain, V. Cirimele, Chemical abuse in the elderly: evidence from hair analysis, Ther Drug Monit. 30 (2008) 207-211. https://doi.org/10.1097/FTD.0b013e31816bac44

[19] A. Abbey, T. Zawacki, P.O. Buck, M. Testa, K. Parks, J. Norris, S.E. Martin, J.A. Livingston, P. McAuslan, A.M. Clinton, C.L. Kennedy, W.H. George, K.C. Davis, J. Martell, How does alcohol contribute to sexual assault? Explanations from laboratory and survey data, Alcohol Clin Exp Res. 26 (4) (2002) 575-581. PMID: 11981135; PMCID: PMC4484266.
[20] D.E Howard, M.A. Griffin, B.O. Boekeloo, Prevalence and psychosocial correlates of alcohol-related sexual assault among university students, Adolescence. 43 (172) (2008) 733-750. PMID: 19149143; PMCID: PMC2679161.

[21] A. Grela, L. Gautam, M.D. Cole, A multifactorial critical appraisal of substances found in drug facilitated sexual assault cases, Forensic Sci Int. 292 (2018) 50-60. https://doi.org/10.1016/j.forsciint.2018.08.034.

[22] S. Djezzar, F. Questel, E. Burin, S. Dally, French Network of Centers for Evaluation and Information on Pharmacodependence, Chemical submission: results of 4-year French inquiry, Int J Legal Med. 123 (3) (2009) 213-219. https://doi.org/10.1007/s00414-008-0291-x.

[23] Chemical submission: analytical aspects, consensus of the French Society of Analytical Toxicology (SFTA), Ann Toxicol Anal. 15 (2003) 239-242.

[24] Society of Forensic Toxicologists (SOFT) Drug-Facilitated Sexual Assault Committee. Recommended Maximum Detection Limits for Common DFSA Drugs and Metabolites in Urine Samples Rev-10/2005. Available at: https://www.safvic.org/wp-content/uploads/2017/05/Detection-Limits-for-DFSA-Drugs.pdf.

[25] R.J. Dinis-Oliveira, T. Magalhães, Forensic toxicology in drug-facilitated sexual assault, Toxicol Mech Methods. 23 (7) (2013) 471-478. https://doi.org/10.3109/15376516.2013.796034.

[26] L. Humbert, G. Hoizey, M. Lhermitte, Drugs involved in Drug-Facilitated Crimes (DFC). Analytical aspects. 1 – blood and urine, in: Toxicological Aspects of Drug-Facilitated Crimes, P. Kintz Ed, Elsevier, 2014, pp 158-180. ISBN: 978-0-12-416748-3. https://doi.org/10.1016/B978-0-12-416748-3.00007-4.

[27] M. Chèze, J.M. Gaulier, Drugs involved in Drug-Facilitated Crimes (DFC). Analytical aspects. 2 – hair, in Toxicological Aspects of Drug-Facilitated Crimes, P. Kintz Ed, Elsevier, 2014; pp 181-222. ISBN: 978-0-12-416748-3. https://doi.org/10.1016/B978-0-12-416748-3.00008-6.

[28] P. Xiang, M. Shen, O.H. Drummer, Review: Drug concentrations in hair and their relevance in drug facilitated crimes, J Forensic Leg Med. 36 (2015) 126-135. https://doi.org/10.1016/j.jflm.2015.09.009.

[29] L.J. Anderson, A. Flynn, J.L. Pilgrim A global epidemiological perspective on the toxicology of drug-facilitated sexual assault: A systematic review, J Forensic Leg Med. 47 (2017) 46-54. https://doi.org/10.1016/j.jflm.2017.02.005.
[30] T.R. Fiorentin, B.K. Logan, Toxicological findings in 1000 cases of suspected drug facilitated sexual assault in the United States, J Forensic Leg Med. 61 (2019) 56-64. https://doi.org/10.1016/j.jflm.2018.11.006

[31] The French National Agency for Medicines and Health Products Safety, National survey of Rivotril® (clonazepam), information point on Modification of the prescribing and dispensing conditions (2011). https://archiveansm.integra.fr/S-informer/Points-d-information-Points-d-information/Rivotril-R-clonazepam-Modification-des-conditions-de-prescription-et-de-delivrance-Point-d-information. (Accessed April 14, 2022)

[32] The French National Agency for Medicines and Health Products Safety, Zolpidem. Information Point on Mandatory prescription of zolpidem on secure prescription (2017). http://dev4-afssaps-marche2017.integra.fr/S-informer/Points-d-information-Points-d-information/Prescription-obligatoire-du-zolpidem-sur-ordonnance-securisee-Point-d-Information. (Accessed April 14, 2022)

[33] S.S. Johansen, Detection of the antipsychotic drug quetiapine in the blood, urine and hair samples of the victim of a drug-facilitated sexual assault, Forensic Sci Int. 270 (2017) e12-e15. https://doi.org/10.1016/j.forsciint.2016.12.010.

[34] K.J. Lusthof, I.J. Bosman, B. Kubat, M.J. Vincenten-van Maanen, Toxicological results in a fatal and two non-fatal cases of scopolamine-facilitated robberies, Forensic Sci Int. 274 (2017) 79-82. https://doi.org/10.1016/j.forsciint.2017.01.024.

[35] O. Lepennetier, J.H. Raphalen, M. Deveaux, S. Carton, S. Léger, F.J. Baud, L. Lamhaut, P. Carli, Toxicodynétique lors d'une intoxication aiguë par inhalation de scopolamine par acte de malveillance, Toxicologie Analytique & Clinique. 31 (2019) 183-188. https://doi.org/10.1016/j.toxac.2019.03.136.

[36] K.S. Hagan, L. Reidy, Detection of synthetic cathinones in victims of sexual assault, Forensic Sci Int. 257 (2015) 71-75. https://doi.org/10.1016/j.forsciint.2015.07.040.

[37] L.M. Mehling, S.S. Johansen, X. Wang, E. Doberentz, B. Madea, C. Hess, Drug facilitated sexual assault with lethal outcome: GHB intoxication in a six-year-old girl, Forensic Sci Int. 259 (2016) e25-31. https://doi.org/10.1016/j.forsciint.2015.12.044.

[38] K. Walsh, H.M. Zinzow, C.L. Badour, K.J. Ruggiero, D.G. Kilpatrick, H.S. Resnick, Understanding disparities in service seeking following forcible versus drug- or alcohol-facilitated/incapacitated rape, J Interpers Violence. 31 (14) (2016) 2475-2491. https://doi.org/10.1177/0886260515576968.
[39] L. Monk, A. Jones, Alcohol consumption as a risk factor for sexual assault: A retrospective analysis, J Forensic Leg Med. 23 (2014) 55-61. https://doi.org/10.1016/j.jflm.2014.01.015.

[40] A. Abbey, Alcohol-related sexual assault: a common problem among college students, J Stud Alcohol Suppl. 14 (2002) 118-128. https://doi.org/10.15288/jsas.2002.s14.118.

[41] K.B. Carey, S.E. Durney, R.L. Shepardson, M.P. Carey, Incapacitated and forcible rape of college women: prevalence across the first year, J Adolesc Health. 56 (6) (2015) 678-680. https://doi.org/10.1016/j.jadohealth.2015.02.018.

[42] E.R. Wilhite, T. Mallard, K.A. Fromme, A longitudinal event-level investigation of alcohol intoxication, alcohol-related blackouts, childhood sexual abuse, and sexual victimization among college students, Psychol Addict Behav. 32 (3) (2018) 289-300. https://doi.org/10.1037/adb0000353.
Tables

<table><caption>**Table 1.** Summary of cases of DFC/CS and chemical vulnerability in France between 2001 and 2019</caption><thead><tr><th></th><th colspan="2">DFC/CS<br>[n=934 / 37%]</th><th colspan="2">CV using non-therapeutic<br>PAS (subgroup A)<br>[n=1131 / 45%]</th><th colspan="2">CV using therapeutic<br>and NT* PAS<br>(subgroup B)<br>[n=440 / 18%]</th></tr><tr><th></th><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td><strong>Gender and age</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Female</td><td>617</td><td>66</td><td>1014</td><td>90</td><td>403</td><td>92</td></tr><tr><td>Male</td><td>317</td><td>34</td><td>117</td><td>10</td><td>37</td><td>8</td></tr><tr><td>Minors</td><td>205</td><td>22</td><td>185</td><td>16</td><td>50</td><td>11</td></tr><tr><td>Mean age (y)</td><td>29.2</td><td>-</td><td>23.6</td><td>-</td><td>31.6</td><td>-</td></tr><tr><td>Extreme ages (d/y)</td><td>4 d-97 y</td><td>-</td><td>13-60 y</td><td>-</td><td>12-93 y</td><td>-</td></tr><tr><td><strong>Place of assault</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Informed cases</td><td>775</td><td>83</td><td>890</td><td>79</td><td>321</td><td>73</td></tr><tr><td>Home/hotel</td><td>480</td><td>62</td><td>321</td><td>36</td><td>162</td><td>50</td></tr><tr><td>Party place</td><td>212</td><td>27</td><td>466</td><td>52</td><td>111</td><td>35</td></tr><tr><td>Public place</td><td>60</td><td>8</td><td>103</td><td>12</td><td>48</td><td>15</td></tr><tr><td>Workplace</td><td>23</td><td>3</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td><strong>Aggressions</strong></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>N (&lt; 15 y)**</td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Sexual assault</td><td>474 (45)</td><td>51</td><td>964</td><td>85</td><td>385</td><td>88</td></tr><tr><td>SA and theft</td><td>34</td><td>4</td><td>44</td><td>4</td><td>31</td><td>7</td></tr><tr><td>Theft / burglary</td><td>174</td><td>19</td><td>63</td><td>6</td><td>16</td><td>4</td></tr><tr><td>Attempted DFC/CS</td><td>127 (11)</td><td>14</td><td>42</td><td>4</td><td>3</td><td>1</td></tr><tr><td>Simple sedation</td><td>57 (47)</td><td>6</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Sedation for the<br>purposes of homicide</td><td>52 (24)</td><td>6</td><td>-</td><td>-</td><td>-</td><td>-</td></tr></tbody></table>
<table><thead><tr><th rowspan="3"></th><th colspan="2">DFC/CS</th><th colspan="2">CV using non-therapeutic<br>PAS (subgroup A)</th><th colspan="2">CV using therapeutic<br>and NT* PAS<br>(subgroup B)</th></tr><tr><th colspan="2">[n=934 / 37%]</th><th colspan="2">[n=1131 / 45%]</th><th colspan="2">[n=440 / 18%]</th></tr><tr><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td>Physical assault</td><td>8 (1)</td><td>1</td><td>18</td><td>2</td><td>2</td><td>0</td></tr><tr><td>Kidnapping</td><td>4 (2)</td><td>0</td><td>-</td><td>-</td><td>1</td><td>0</td></tr><tr><td>Psychological<br>manipulation</td><td>2</td><td>0</td><td>-</td><td>-</td><td>1</td><td>0</td></tr><tr><td>Inheritance<br>misappropriation</td><td>2</td><td>0</td><td>-</td><td>-</td><td>1</td><td>0</td></tr><tr><td><strong>PAS used voluntarily</strong></td><td><strong>N</strong></td><td><strong>%</strong></td><td><strong>N</strong></td><td><strong>%</strong></td><td><strong>N</strong></td><td><strong>%</strong></td></tr><tr><td><strong>before assault</strong></td><td><strong>(850; age >10 y)</strong></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>Alcohol</td><td>398</td><td>47</td><td>1077</td><td>95</td><td>335</td><td>76</td></tr><tr><td>Cannabis</td><td>174</td><td>20</td><td>371</td><td>33</td><td>135</td><td>31</td></tr><tr><td>Cocaine</td><td>40</td><td>5</td><td>77</td><td>7</td><td>60</td><td>14</td></tr><tr><td>MDMA/Amphetamines</td><td>19</td><td>2</td><td>30</td><td>3</td><td>11</td><td>3</td></tr><tr><td>Heroin</td><td>-</td><td>-</td><td>4</td><td>0</td><td>4</td><td>1</td></tr><tr><td>LSD</td><td>-</td><td>-</td><td>4</td><td>0</td><td>-</td><td>-</td></tr><tr><td>GHB/GBL</td><td>-</td><td>-</td><td>2</td><td>0</td><td>1</td><td>0</td></tr><tr><td>Ayahuasca</td><td>-</td><td>-</td><td>1</td><td>0</td><td>-</td><td>-</td></tr><tr><td>Methoxetamine</td><td>-</td><td>-</td><td>1</td><td>0</td><td>-</td><td>-</td></tr><tr><td>"Poppers"</td><td>1</td><td>0</td><td>1</td><td>0</td><td>-</td><td>-</td></tr><tr><td>Nitrous oxide</td><td>-</td><td>-</td><td>1</td><td>0</td><td>-</td><td>-</td></tr><tr><td>Ketamine</td><td>2</td><td>0</td><td>-</td><td>-</td><td>1</td><td>0</td></tr><tr><td>Phenibut</td><td>-</td><td>-</td><td>-</td><td>-</td><td>1</td><td>0</td></tr></tbody></table>
* NT: non-therapeutic;

d: day; y: year; SA: sexual assault

** (data from minors under 15)
<table><caption>**Table 2.** Means of PAS administration and suspected vectors used by assailants in DFC/CS between 2001 and 2019</caption><thead><tr><th rowspan="2">Informed cases = 711</th><th colspan="2">Victims aged 15 and over (n=649)</th><th colspan="2">Victims under the age of 15 (n=62)</th></tr><tr><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td>Alcoholic beverage</td><td>286</td><td>40</td><td>4</td><td>1</td></tr><tr><td>Soft drink</td><td>101</td><td>14</td><td>18</td><td>3</td></tr><tr><td>Unspecified beverage</td><td>83</td><td>12</td><td>5</td><td>1</td></tr><tr><td>Food</td><td>62</td><td>9</td><td>5</td><td>1</td></tr><tr><td>Infusion in physiological saline</td><td>5</td><td>1</td><td>-</td><td>-</td></tr><tr><td>Cigarette</td><td>4</td><td>1</td><td>-</td><td>-</td></tr><tr><td>Forced ingestion</td><td>86</td><td>12</td><td>4</td><td>1</td></tr><tr><td>Direct ingestion</td><td>22</td><td>3</td><td>26</td><td>4</td></tr></tbody></table>
<table><caption>**Table 3.** Information relative to assailants between 201 and 2019</caption><thead><tr><th rowspan="2"></th><th colspan="2">DFC/CS</th><th colspan="2">CV using non-therapeutic PAS (subgroup A)</th><th colspan="2">CV using therapeutic and non-therapeutic PAS (subgroup B)</th></tr><tr><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td><strong>Informed cases</strong></td><td><strong>754</strong></td><td>-</td><td><strong>845</strong></td><td>-</td><td><strong>334</strong></td><td>-</td></tr><tr><td>Single aggressor</td><td>578</td><td>77</td><td>643</td><td>76</td><td>149</td><td>45</td></tr><tr><td>Group of aggressors</td><td>176</td><td>23</td><td>202</td><td>24</td><td>185</td><td>55</td></tr><tr><td><strong>Informed cases</strong></td><td><strong>732</strong></td><td>-</td><td><strong>813</strong></td><td>-</td><td><strong>334</strong></td><td>-</td></tr><tr><td>Known Aggressors</td><td>467</td><td>64</td><td>302</td><td>37</td><td>149</td><td>45</td></tr><tr><td>Unknown Aggressors</td><td>265</td><td>36</td><td>511</td><td>63</td><td>185</td><td>55</td></tr><tr><td><strong>Of which cab driver or false cab driver</strong></td><td><strong>2</strong></td><td>1</td><td><strong>40</strong></td><td>8</td><td><strong>11</strong></td><td>6</td></tr></tbody></table>
<table><caption>**Table 4.** Biological sampling delays and matrices analyzed between 2001 and 2019</caption><thead><tr><th rowspan="2"></th><th colspan="2">DFC/CS</th><th colspan="2">CV using non-therapeutic PAS (subgroup A)</th><th colspan="2">CV using therapeutic and non-therapeutic PAS (subgroup B)</th></tr><tr><th>N</th><th>%</th><th>N</th><th>%</th><th>N</th><th>%</th></tr></thead><tbody><tr><td colspan="7"><strong>Biological sampling delays</strong></td></tr><tr><td>Informed cases</td><td>901</td><td></td><td>1128</td><td></td><td>436</td><td></td></tr><tr><td>&nbsp;&nbsp;&nbsp;&nbsp;&lt;16H</td><td>307</td><td>34</td><td>696</td><td>62</td><td>207</td><td>47</td></tr><tr><td>&nbsp;&nbsp;&nbsp;&nbsp;17-24H</td><td>147</td><td>16</td><td>195</td><td>17</td><td>83</td><td>19</td></tr><tr><td>&nbsp;&nbsp;&nbsp;&nbsp;25-72H</td><td>204</td><td>23</td><td>110</td><td>10</td><td>74</td><td>17</td></tr><tr><td>&nbsp;&nbsp;&nbsp;&nbsp;&gt;73H</td><td>243</td><td>27</td><td>127</td><td>11</td><td>72</td><td>17</td></tr><tr><td colspan="7"><strong>Matrices analysed</strong></td></tr><tr><td>Blood</td><td>641</td><td>69</td><td>889</td><td>79</td><td>328</td><td>75</td></tr><tr><td>Urine</td><td>566</td><td>61</td><td>791</td><td>70</td><td>280</td><td>64</td></tr><tr><td>Hairs</td><td>315</td><td>34</td><td>172</td><td>15</td><td>95</td><td>22</td></tr><tr><td>Vector</td><td>56</td><td>6</td><td>4</td><td>0</td><td>2</td><td>0</td></tr><tr><td>Gastric content</td><td>11</td><td>1</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Substance</td><td>6</td><td>1</td><td>-</td><td>-</td><td>3</td><td>1</td></tr><tr><td>Laundry</td><td>2</td><td>0</td><td>-</td><td>-</td><td>2</td><td>0</td></tr></tbody></table>
<table><caption>Table 5: summary of all PAS used/detected in cases of DFC/CS between 2001 and 2019</caption><thead><tr><th></th><th>Psychoactive substances (n mentions)</th></tr></thead><tbody><tr><td><strong>Benzodiazepines and z-drugs</strong></td><td>clonazepam (132), zolpidem (116), bromazepam (116), alprazolam (49), zopiclone (49), diazepam (46), nordazepam (46), oxazepam (22), lormetazepam (20), Flunitrazepam (18), lorazepam (17), tetrazepam (14), prazepam (11), midazolam (5), loprazolam (4), triazolam (2), lormetazepam/lorazepam metabolite (2), dipotassium clorazepate (1), clotiazepam (1), temazepam (1)</td></tr><tr><td><strong>H1 Antihistamines & various sedatives</strong></td><td>doxylamine (53), hydroxyzine (42), cyamemazine (27), alimemazine (13), cetirizine (11), diphenhydramine (8), loxapine (9), amoxapine (6), niaprazine (4), oxomemazine (4), haloperidol (3), phenobarbital (2), propericiazine (2), risperidone (2), acepromethazine (1), bilastine (1), chlorpheniramine (1), clozapine (1), droperidol (1), desloratadine (1), gabapentin (1), mequitazine (1), pregabalin (1), quetiapine (1), tiapride (1), trihexyphenidyl (1)</td></tr><tr><td><strong>Opioids</strong></td><td>codeine (11), buprenorphine hydrochloride (9), tramadol (9), pholcodine (8), morphine (5), dextropropoxyhene (3), methadone (3), dextromethorphan (2), propoxyphene (2), oxycodone (1), trimebutine (1)</td></tr><tr><td><strong>Antidepressants</strong></td><td>amitriptyline (14), mianserine (5), citalopram (3), mirtazapine (3), trazodone (3), clomipramine (1), fluoxetine (1), imipramine metabolite (1), moclobemide (1), paroxetine (1), tianeptine (1), venlafaxine (1)</td></tr><tr><td><strong>Miscellaneous</strong></td><td>ketamine (8), sildenafil (3), paracetamol (2), pseudoephedrine (2), ibuprophen (2), carbamazepine (1), ketoprofen (1), propranolol (1), diltiazem (1), etifoxine (1), levamisole (1), lidocaine (1), nefopam (1)</td></tr><tr><td><strong>Non-therapeutic substances</strong></td><td>MDMA/amphetamines (74), alcohol (41), GHB/GBL (36), cannabis (33), cocaine (29), ether (4), MDPV/ methylenedioxypyrovaleron (1), 4-MEC / 4-methylethcathinone/ (2), scopolamine (3), LSD (2), chloroform (2), 8-chlorotheophylline (1), pesticide (1), toluene (1), n-decane (1)</td></tr></tbody></table>
Figures

**Fig. 1.** Distribution of collected cases of suspected confirmed DFC/SC and chemical vulnerability between 2001 and 2019. The number of cases increased in time and were dominated by the not well-documented DFC/CS cases.

**Fig. 2.** Distribution of the age groups of victims in the three categories: the proportions of young victims in the 15 to 29 age group are statistically higher in the group of CV using non-therapeutic PAS (subgroup A) (p<.001), while in the group of CV using therapeutic and non-therapeutic PAS (subgroup B), the victims aged 30-49 were predominant (p<.001).

**Fig. 3.** Distribution of PAS according to substances families used in the minors under 15 years and the other victims between 2001 and 2019. The proportions were calculated from the number of PAS used but not on the number of victims.

**Fig. 4.** Distribution of the main BZD used in the DFC/CS between 2001 and 2019.

**Fig. 5.** Distributions of the main H1 antihistamines and sedatives (doxylamine, hydroxyzine, cyamemazyne, alimemazine) used in DFC/CS between 2001 and 2019.

**Fig. 6.** Distribution of the number of phenethylamines and GHB/GBL detected. The cases of GHB/GBL were distributed over time while those of phenethylamines showed a growth curve from 2011.

**Fig. 7.** Qualitative and quantitative (mass) composition of the beverage (50cL) used in serial theft (alcohol, flunitrazepam, cyamemazine, doxylamine, clonazepam, zolpidem and lorazepam) and of two dropper bottles (clonazepam/Rivotril®) found at the perpetrator's home. The picture of these two bottles of pharmaceutical product is not available.

**Fig. 8.** Distribution of various delays of sampling according to DFC/CS and vulnerability cases. Significant differences were seen in the delays of sampling between the three groups. The group of CV using non-
therapeutic PAS (subgroup A) had higher rates of sampling within 16h (p<.001) while the DFC/CS group had consulted between 25-72h (p<.001) and beyond 73h (p<.001).

**Fig. 9.** Distribution of cases of amnesia, consciousness disorders and physical injuries according to DFC/CS and vulnerability groups. The group of CV using non-therapeutic PAS (subgroup A) had significantly a highest proportion of amnesia than subgroup and DFC/CS (p<.001). The DFC/CS group was distinguished by a significant high rates of consciousness disorders (p<.001) and less physical injuries (p<.001).
<figure><img src="image_2.png" /><figcaption>Figure 2</figcaption></figure>

<figure><img src="image_3.png" /></figure>
<figure><img src="image_4.png" /><figcaption>Figure 4</figcaption></figure>

<figure><img src="image_5.png" /></figure>
<figure><img src="image_6.png" /><figcaption>Figure 6</figcaption></figure>

<figure><img src="image_7.png" /></figure>
<figure><img src="image_8.png" /><figcaption>Figure 7</figcaption></figure>

XVth Congress of SFTA, 2007

<figure><img src="image_9.png" /><figcaption>Figure 9</figcaption></figure>
<figure><img src="image_10.png" /></figure>

<figure><img src="image_11.png" /></figure>