Abstract Background Barcelona handles 400 to 500 sexual assaults yearly. Substance use is expected in one-third of reported assaults, being alcohol and cocaine the most detected substances. Nevertheless, there is a lack of updated information with reliable, recent, and context-specific data. Methods Retrospective observational study in people attended at the reference hospital for sexual assault care in Barcelona (H.Clinic) within 24 hours of the drug facilitated sexual assault (DFSA) in the period 2018-2022. Univariate and bivariate analysis have been carried out to describe the characteristics of the victims and identify possible associations with the assault settings, relationship with the aggressor and substances involved. Results Among 682 cases of DFSA, women represent 85%. Most incidents (73%) occur in the 18 to 35 age group, primarily in homes (42%), public spaces (23%), and nightlife establishments (15%). Spanish nationality is most common in both sexes (50%), yet Latin American men are prominent in drug-involved cases compared to non-Spanish European men. While alcohol (55%) and cocaine (28%) remain common, emerging drugs like GHB (15%) and MDMA (23%) are rising. The aggressor varies depending on the age and sex of the victim, with the perpetrator often being known (46%) in cases involving minor victims, while it tends to be unknown (46%) in cases involving adult victims. Chemical submission-related cases increased steadily, reaching 17% in 2022. Among these victims, 75% were women, with MDMA and cocaine being prevalent, while methamphetamine and GHB were more common among men. All these findings are statistically significant. Conclusions The study highlights a significant number of drug-facilitated sexual assaults mostly among young women, often occurring domestically, alongside emerging substance use trends. Adaptable surveillance systems are crucial to address these dynamic patterns and support vulnerable populations for safer environments. Key messages • Drug facilitated sexual assaults are a global health issue that demands attention through a gender perspective. Substances, spaces and consumption patterns evolve over time and across generations. • Patterns in substance use vary by age, nationality, sex, and consumption type, highlighting vulnerable population groups needing focused protection and assault prevention.