Pharmacological interventions for those who have sexually offended or are at risk of offending

Abstract

Background Sexual offending is a serious social problem, a public health issue, and a major challenge for social policy. Victim surveys indicate high incidence and prevalence levels and it is accepted that there is a high proportion of hidden sexual victimisation. Surveys report high levels of psychiatric morbidity in survivors of sexual offences. Biological treatments of sex offenders include antilibidinal medication, comprising hormonal drugs that have a testosterone-suppressing effect, and non-hormonal drugs that affect libido through other mechanisms. The three main classes of testosterone-suppressing drugs in current use are progestogens, antiandrogens, and gonadotropin-releasing hormone (GnRH) analogues. Medications that affect libido through other means include antipsychotics and serotonergic antidepressants (SSRIs). Objectives To evaluate the effects of pharmacological interventions on target sexual behaviour for people who have been convicted or are at risk of sexual offending. Search methods We searched CENTRAL (2014, Issue 7), Ovid MEDLINE, EMBASE, and 15 other databases in July 2014. We also searched two trials registers and requested details of unidentified, unpublished, or ongoing studies from investigators and other experts. Selection criteria Prospective controlled trials of antilibidinal medications taken by individuals for the purpose of preventing sexual offences, where the comparator group received a placebo, no treatment, or 'standard care', including psychological treatment. Data collection and analysis Pairs of authors, working independently, selected studies, extracted data, and assessed the risk of bias of included studies. We contacted study authors for additional information, including details of methods and outcome data.

Long-Term Forensic Mental Health Services: An Exploratory Comparison of 18 European Countries

“…In order to answer these questions, all countries would need to make seismic efforts to contribute towards establishing an evidence-base for appropriate treatment and outcome measures for particular patient populations, including personality disorder and sex offenders (which at present is limited -see Khalifa et al, 2010;Khan et al, 2015), as well as improve record-keeping and progress of individual patients. The Netherlands and Germany are highlighted as providing the most well established specific long-stay services.…”

Learning from research: Adapting interventions for sexual offending to improve outcomes

“…Nevertheless, studies have been carried out. Khan et al () conducted the most recent Cochrane review in this field, including seven prospective controlled trials using either testosterone‐suppressing or antipsychotic drugs. Only two studies, using medroxyprogesterone acetate, reported recidivism and found a significant reduction in those taking the drug.…”

The place of evidence in the treatment of sex offenders

“…selective serotonin re‐uptake inhibitors and gonadotropin‐releasing hormone analogues). We identified just seven older studies, yielding a total of 123 participants (Khan et al, ). Six of them evaluated one of three testosterone suppressing drugs (cyproterone acetate, ethinyl estradiol or medroxyprogesterone acetate) and one tested two anti‐psychotic drugs (benperidol and chlorpromazine) either against a placebo (in four studies), a no treatment control (in one study) and a combination of drug and psychological intervention against a psychological intervention (in two studies).…”

“…The gold standard for evidence is considered to be the randomised controlled trial (RCT). Having recently completed Cochrane Reviews into psychological and pharmacological interventions for sex offenders (Dennis et al, ; Khan et al, ), confined to RCTs, we propose to examine the place of such ‘gold standard evidence’ in determining the role of treatment of sex offenders.…”