Modern Bethesda Game Studios games have all been open world and included some kind of drug use, so it was expected when the game got a 18+ age rating in Australia. Now it's America's turn to follow tradition.
The Entertainment Software Rating Board confirms it has decided to give Starfield the Mature 17+ rating because it has blood, strong language, suggestive themes, use of drugs and violence. Fallout 3, The Elder Scrolls V: Skyrim, Fallout 4 and Fallout 76 got the same, so this wasn't surprising. Most of the reasons for it are also familiar:
"This is an open-world role-playing game in which players assume the role of a miner tasked with finding Artifacts across the galaxy. From first-/third-person perspectives, players interact with various characters, complete quests, and search for supplies while battling enemies (e.g., humans, robots, alien creatures). Players use futuristic guns, lasers, axes, and explosives to kill enemies. Combat is fast-paced, with frequent gunfire, cries of pain, and explosions. Attacks on some enemies can result in blood-splatter effects; several environments depict blood stains on the ground around corpses. The game contains some suggestive material in the dialogue, and after sharing a bed with characters (e.g., "Life is a sexually transmitted disease that's a hundred percent fatal"; "I'm all for getting a little wild, but next time let's try it without the jetpacks"; "Talk about seeing stars, whew... that was amazing."). A fictional drug (Aurora) is prominent in the game, with a section involving players' characters working in an illicit drug lab; players can also obtain Aurora by stealing or buying it from vendors (consuming Aurora results in a distortion effect on the screen). The words "f**k" and "bullsh*t" appear in the game."
Something unique is obviously the specific suggestive language used in the game, as it safe to say Starfield will have some goofy lines.
One thing few will find especially funny is that the rating also reveals the game includes "in-game purchases". This often means microtransactions, so I've contacted Xbox and Bethesda in hope of getting a comment.