DPH Legislative Report
The Commonwealth of Massachusetts
Executive Office of Health and Human Services
Department of Public Health
250 Washington Street, Boston, MA 02108-4619
KATHLEEN E. WALSH
MAURA T. HEALEY Secretary
Governor
Robert Goldstein, MD, PhD
KIMBERLEY DRISCOLL Commissioner
Lieutenant Governor
Tel: 617-624-6000
www.mass.gov/dph
October 28th, 2024
Steven T. James
House Clerk
State House Room 145
Boston, MA 02133
Michael D. Hurley
Senate Clerk
State House Room 335
Boston, MA 02133
Dear Mr. Clerk,
Pursuant to line item 4513-1136 Chapter 28 of the Acts of 2023 the FY24 General
Appropriations Act, please find enclosed a report from the Department of Public Health entitled
“Recommendations to Address Drink Spiking and Substance Facilitated Sexual Assault in the
Commonwealth.”
Sincerely,
Robert Goldstein, MD, PhD
Commissioner
Department of Public Health
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 DPH Legislative Report
Recommendations to
Address Drink Spiking and
Substance Facilitated Sexual
Assault in the
Commonwealth
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Legislative Mandate
The following report is hereby issued pursuant to Chapter 28 of the Acts of 2023 (General
Appropriations Act for FY24) of the Massachusetts General Laws as follows:
4513-1136: Provided further, that not less than $150,000 shall be expended for
the department of public health’s division of sexual and domestic violence
prevention and services, in consultation with relevant stakeholders, to develop,
research and recommend evidence-based and evidence-informed prevention
strategies to address the rising incidence of reported drink spiking in the
commonwealth; provided further, that funds may be expended for the bulk
purchase of drink spiking test kits to be distributed at bars, restaurants and
nightlife establishments in the commonwealth; provided further, that not later
than December 29, 2023, the department shall submit a report to the joint
committee on public health and the house and senate committees on ways and
means detailing: (a) recommendations for eligible, research-based drink spiking
prevention tools, including, but not limited to, drink spiking test kits; (b) an
examination of how prevention tools can be distributed in an effective manner
to individuals and vulnerable populations, including, but not limited to,
distribution directly to bars, restaurants and nightlife establishments; and (c)
other considerations the department may deem relevant for an evidence-based
or evidence-informed public health response to drink spiking incidents in the
commonwealth; provided further, that not less than $150,000 shall be expended
for the department of public health’s division of sexual and domestic violence
prevention and services to develop and launch a strategic and comprehensive
public awareness campaign to inform the public about the prevalence and
danger of involuntary drink spiking through the department’s website, digital
and social media, traditional media and other media; and provided further, that
the department may partner with relevant advocacy organizations, employers,
boards of health, institutions of higher education and community groups to
ensure that the campaign reaches populations deemed most at risk of being
targeted for drink spiking and includes evidence-based, evidence-informed and
culturally-relevant response and safety tips for patrons at bars, restaurants and
nightlife establishments.
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Executive Summary
Line item 4513-1136 of Chapter 28 of the Acts of 2023, the FY24General Appropriations Act,
charged the Department of Public Health’s Division of Sexual and Domestic Violence Prevention
and Services to:
• Develop, research and recommend evidence-based and evidence-informed prevention
strategies to address the rising incidence of reported drink spiking in the
commonwealth, including the bulk purchase of drink spiking test kits to be distributed at
bars, restaurants and nightlife establishments in the commonwealth.
• Develop and launch a strategic and comprehensive public awareness campaign to
inform the public about the prevalence and danger of involuntary drink spiking through
the department’s website, digital and social media, traditional media and other media.
A review of existing research indicates the following findings:
• While MDMA (ecstasy), LSD, GHB, ketamine, and Rohypnol are common substances
used in substance facilitated sexual assault, the most commonly used substance is
alcohol, in particular the overconsumption of alcohol. 1
• The efficacy of personal drink-spiking test tools has no evidence base. In addition,
research indicates problems with availability and implementation of personal testing
tools.
• Prevention, bystander intervention, and culture norms change are shown to be more
effective and durable strategies to prevent drink spiking and substance facilitated sexual
assaults.
Based on this review of the most recently available data, the division of sexual and domestic
violence prevention and services provides the following recommendation to address the rising
incidence of reported drink spiking:
• Implement prevention initiatives that address social norms, attitudes, and behaviors
that lead to substance-facilitated sexual assault.
• Engage bystander intervention programs, focused on staff and patrons of the hospitality
industry.
1
Lahane, N., & Kaur, G. (2022). Drug facilitated sexual assault and their analysis. Materials Today: Proceedings, 48,
1240–1245. https://doi.org/10.1016/j.matpr.2021.08.262
2
 DPH Legislative Report
Introduction
The increased reports of incidents of drink spiking in the commonwealth was the impetus for a
legislative mandate to investigate and implement evidence-based and evidence-informed
strategies to address this issue. This has resulted in the need to identify prevention tools and
strategies and how to best implement them, particularly to vulnerable populations and
communities.
To that end, a review of existing research related to the prevention of and intervention
following drink spiking and substance-facilitated sexual assault was conducted. Due to the
reality that drink-spiking often occurs in public venues where the consumption of alcohol is
ubiquitous, strategies that prioritize the hospitality industry are essential. This includes but is
not limited to bars, restaurants, and nightlife establishments. As drink spiking is a common
strategy to facilitate assault, in particular sexual assault, recommendations to address this issue
will be grounded in sexual violence prevention and intervention strategies with an evidence
base of efficacy.
Data from the Massachusetts Department of Public Health’s Sexual Assault Nurse Examiner
program (SANE) demonstrate that just under 40% of the 916 individuals seeking SANE exams in
FY23 reported drug facilitated sexual assault, and toxicological testing is done for substances,
medications, or drugs such as marijuana, cocaine, alcohol, amphetamines, barbiturates,
opiates, antidepressants, antihistamines, and others. Toxicology tests and results are sent to
the Massachusetts State Police Crime Lab and are accessed by patients directly and/or by law
enforcement or prosecutors for use in the criminal legal process. DPH does not have access to
that data.
While it is important to be responsive to the reality of drink spiking through additive
substances, a more common occurrence in cases of sexual assault is a perpetrator using a
victim’s recreational substance and/or alcohol consumption or overconsumption to coerce or
force sexual activity. 2 In cases where an individual consumes substances against their
knowledge or will, regardless of whether an assault is attempted or successful, it is essential
that medical care is available in alignment with the individual’s wishes.
Based on this analysis, the department has identified several recommendations for prevention
tools and strategies that align with evidence-based best practice.
2
Anderson, L., Flynn, A., & Schumann, J. (2017). A global epidemiological perspective on the toxicology of drug-
facilitated sexual assault: A systematic review. Journal of Forensic and Legal Medicine, 47, 46–54.
https://doi.org/10.1016/j.jflm.2017.02.005
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 DPH Legislative Report
Response to Drink Spiking Test Kits:
A review of the relevant literature found a notable lack of research on the efficacy of personal
testing tools, including strip tests, nail polish, coasters, and cups, to indicate the presence of
substances. It should be noted that in the United States, no significant research on substance
facilitated sexual assault has been conducted; most of the evidence base comes from other
countries.
Further, existing evidence indicates a lack of reliability in commercially available and marketed
personal testing tools, including:
• High likelihood of false negatives and false positives. 3
• Some tools could only identify specific types of substances, which is problematic given
the reality that multiple common substances can be used.
• One-time use tests intended for administration on-site at the hospitality venue allow for
only a point in time analysis. Substances could be introduced after that without the
person’s knowledge. Retesting over the course of time would be required.
• Concern about the ability to source personal testing tools in large quantities.
• Lack of ability to consistently implement use of these tests in establishments serving
alcohol; e.g., plastic cup testing tools cannot be used in establishments that serve drink
using glass cups.
Without mechanisms in place to support the distribution and storage, as well as training for
industry staff, personal test kits do not constitute a durable strategy. In addition, research
indicates that the use of testing kits by the public requires further investigation and could cause
harm by creating a false sense of security and/or undue concern among users due to the
prevalence of false results. 4 Staff have focused recommendations on prevention and
intervention strategies that are supported by the evidence and, therefore, did not include the
bulk-purchase and distribution of personal test kits in our recommendations to address the
issue of drink spiking in the commonwealth.
3
Child, A. M., & Child, P. (2007). Ability of Commercially Available “Date-Rape” Drug Test Kits to Detect Gamma-
Hydroxybutyrate in Popular Drinks. Canadian Society of Forensic Science Journal, 40(3), 131–141.
https://doi.org/10.1080/00085030.2007.10757155
4
Beynon, C. M., McVeigh, C., McVeigh, J., Leavey, C., & Bellis, M. A. (2008). The Involvement of Drugs and Alcohol
in Drug-Facilitated Sexual Assault: A Systematic Review of the Evidence. Trauma, Violence, & Abuse, 9(3), 178–188.
https://doi.org/10.1177/15248380083202
4
Recommendations:
Overwhelming evidence shows that misogyny, toxic masculinity, and sexism are root causes
behind sexual violence, particularly in nightlight establishments, and require responses that
support culture change. 5 6 Prevention strategies to address sexual assault that focus on
challenging these social norms in an effort to promote healthy relationships, effective boundary
setting, and consent are shown by data to be highly effective. Successful awareness and social
norms campaigns confront these social norms, increase public awareness to help victims
recognize the effects of substances, and provide encouragement and information to support
victims seeking help, including appropriate diagnosis and care from emergency services. 7
Efforts to raise awareness that alcohol is the most common substance to facilitate sexual
assault are also indicated. 8 Data show that campaigns warning about the risk of becoming a
victim, or even a perpetrator, of sexual assault by excessive use of alcohol are a necessary step
in addressing the problem. 9
Evidence-based skills-focused training programs have been shown to empower individuals
through experiential training and increase their knowledge and skills … to recognize warning
signs and take action as bystanders or potential victims to prevent and/or interrupt sexual
assault. 10 Prevention strategies must focus on addressing masculinity norms among male
patrons and staff, as these norms support sexual aggression; better management of the highly
sexualized and sexist environments of many bars is also indicated. 11 Therefore, awareness and
social norms campaigns paired with bystander and empowerment-based training initiatives
focusing on hospitality industry staff and settings should be implemented to prevent the
occurrence of drink spiking and/or substance facilitated sexual assault.
5
Graham, K., Bernards, S., Wayne Osgood, D., Abbey, A., Parks, M., Flynn, A., Dumas, T., & Wells, S. (2014).
“Blurred Lines?” Sexual Aggression and Barroom Culture. Alcoholism: Clinical and Experimental Research, 38(5),
1416–1424. https://doi.org/10.1111/acer.12356
6
Graham, K., Bernards, S., Abbey, A., Dumas, T. M., & Wells, S. (2017). When Women Do Not Want It: Young
Female Bargoers’ Experiences With and Responses to Sexual Harassment in Social Drinking Contexts. Violence
Against Women, 23(12), 1419–1441. https://doi.org/10.1177/1077801216661037
7
Busardò, F. P., Varì, M. R., di Trana, A., Malaca, S., Carlier, J., & di Luca, N. M. (2019). Drug-facilitated sexual
assaults (DFSA): A serious underestimated issue. European Review for Medical and Pharmacological Sciences,
23(24), 10577–10587. https://doi.org/10.26355/eurrev_201912_19753
8
Monk, L., & Jones, A. (2014). Alcohol consumption as a risk factor for sexual assault: A retrospective analysis.
Journal of Forensic and Legal Medicine, 23, 55–61. https://doi.org/10.1016/j.jflm.2014.01.015
9
Olszewski, D. (2009). Sexual assaults facilitated by drugs or alcohol. Drugs: Education, Prevention and Policy,
16(1), 39–52. https://doi.org/10.1080/09687630802128756
10
Banyard, V. L., Moynihan, M. M., & Plante, E. G. (2007). Sexual violence prevention through bystander
education: An experimental evaluation. Journal of Community Psychology, 35(4), 463–481.
https://doi.org/10.1002/jcop.20159
11
Graham, K., Bernards, S., Wayne Osgood, D., Abbey, A., Parks, M., Flynn, A., Dumas, T., & Wells, S. (2014).
“Blurred Lines?” Sexual Aggression and Barroom Culture. Alcoholism: Clinical and Experimental Research, 38(5),
1416–1424. https://doi.org/10.1111/acer.12356
5
Distribution and Implementation:
Training: There are existing organizations with a primary focus of providing training and
technical assistance to hospitality staff to increase skills of prevention and intervention in the
cases of sexual violence, harassment, and assault in environments where substances such as
alcohol and drugs are present. Relying on existing structures for statewide and local
collaboration and cross-training will be effective distribution mechanisms for training and skill-
building within the hospitality industry. Licensing renewal processes could include a
requirement that staff complete an evidence-based training, pending an assessment of the
feasibility of implementation given the number of providers qualified to provide this training
and the number of establishments across the state that would be required to do so.
Campaign: Implementation of awareness campaigns should include leveraging media, social
media, and website content to develop and elevate existing messaging that has been shown to
be effective to address culture norms and raise awareness for victims, bystanders, and
perpetrators.
Other Considerations:
Some individuals who experience drink spiking report an inability to obtain medical testing at
hospitals because they had not experienced sexual assault. This issue should be investigated for
additional opportunities to respond effectively to drink spiking.
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 DPH Legislative Report
Conclusion
While news media in Massachusetts have reported a marked increase in incidents of drink
spiking, substance-facilitated sexual assault is not a new issue. Therefore, not surprisingly,
strategies to address, prevent, and intervene with drink spiking strongly align with best
practices and research from sexual violence prevention efforts.
The findings and recommendations herein for prevention tools and strategies focus on culture
change in the form of awareness campaigns and skill-building trainings. These include:
• State and local level prevention and awareness initiatives that focus on shifting social
norms that lead to substance facilitated sexual assault, and raising awa