Flunitrazepam, trade name Rohypnol, is a central nervous system depressant in a class of drugs called benzodiazepines. Benzodiazepines are sedative-hypnotics used to treat anxiety, insomnia and sleep disorders, and seizure disorders; they are also used as skeletal-muscle relaxants. 1 (Sedative-hypnotics are dose-dependent drugs; lower doses promote sedation and relaxation, higher doses promote sleep.2) Other benzodiazepines include alpranzolam (Xanax), bromazepam chlordiazepoxide (Librium), lorazepam (Atavan), and diazepam (Valium), all of which are prescribed in the United States.3 Rohypnol, however, is ten times more potent than Valium, and while commonly prescribed for anxiety and sleep disorders in Europe, Latin America, and elsewhere, it was never approved for use or sale in the United States.4 Rohypnol pills are smuggled into the United States, often via international mail, and sold on the street in the manufacturers blister packaging (similar to over-the-counter cold medicine or birth control pill packaging). The round white tablets contain one or two milligrams of flunitrazepam. They are odorless, tasteless, and dissolve undetected in liquid.5,6 In response to reports implicating Rohypnol in drug-facilitated sexual assaults, the manufacturer reformulated the tablets. They now appear as oblong green tablets that include a dye that turns blue when dissolved in liquid, which makes the drug more easily detected in some drinks.7 The original white tablets are still available, however.8
Though not approved for use in the United States, Rohypnol (flunitrazepam) is currently scheduled with other benzodiazepines as a Schedule IV controlled substance.9 However, under the Drug Induced Rape Prevention Act, federal penalties for trafficking Rohypnol are the same as those for Schedule I, II, and III substances, depending on quantity.10
Swiss pharmaceutical company Hoffman-La Roche first described and developed benzodiazepines in the 1950s. Roche modified the basic benzodiazepine structure and introduced a number of tranquilizers 1960s and 1970s, including Rohypnol in 1975.11 Though it is the most widely prescribed sedative-hypnotic in Western Europe and is legal in many countries, Rohypnol is not approved for manufacture or sale in the United States.12,13 Reports of Rohypnol misuse in Europe surfaced in the 1970s, and in 1995 the United Nations reclassified it from a Schedule IV to a Schedule III drug, which requires more thorough record keeping of its legal distribution than was previously in place.14 (Schedule IV substances have a lower potential for abuse relative to Schedule III substances.) In the early 1990s, Rohypnol emerged as a drug of abuse and misuse in the United States, and some states have reclassified it as a Schedule I substance at the state level; the DEA is also reviewing the possibility of reclassification.15
Rohypnol tablets come in doses of one or two milligrams and users may take one or more tablets at a time.16 The most common route of administration is oral. Users swallow or chew the tablets, or allow them to dissolve under the tongue.17 They also crush pills and snort the powder to feel the effects more quickly;18 the powder can also be sprinkled on marijuana and smoked or dissolved and injected.19 Users feel the effects 15 to 20 minutes after ingestion, and they may last for twelve or more hours.20
Users may take Rohypnol with other drugs, including marijuana, ecstasy, LSD, and alcohol to enhance the effects of these drugs.21, 22 There are reports that heroin users use Rohypnol to enhance the effects of low-quality heroin or to relieve withdrawal symptoms. Similarly, cocaine users take Rohypnol to soften the negative effects of coming down from a binge.23
Rohypnol depresses central nervous system activity and brain function. This depressed CNS activity manifests as sedation, sleep, muscle relaxation, and reduced anxiety.24 When mixed with alcohol, another CNS depressant, blackout, stupor, respiratory depression, and death are more likely to occur.25
Regular use of Rohypnol results in increased tolerance to the drug, requiring users to take larger doses over time to achieve the same effect. As with other Schedule IV substances, abuse of Rohypnol may lead to physical dependence. Withdrawal symptoms can range from restlessness and anxiety to more severe effects similar to those of alcohol withdrawal, such as tremors, hallucinations, and convulsions.30 Withdrawal symptoms may also include headaches, muscle pain, tension, numbness, tingling of extremities, loss of identity and delirium, and shock. Seizures caused by withdrawal from Rohypnol may occur more than a week after use has stopped.31
In the mid-1990s, reports surfaced that Rohypnol was being used in drug-facilitated sexual assault, victimizing both men and women, and it became known as a "date-rape" drug. Potential victims often are unaware that they are in danger when sexual predators slip Rohypnol into their drinks, where it dissolves and goes largely undetected. When mixed with alcohol, Rohypnol incapacitates and induces amnesia in its users, making them more vulnerable. Predators can appear to be helping or rescuing a drunk friend, making it easy for them to move the victim to another location. Victims under the influence of Rohypnol are unable to fight back or negotiate with their rapists. They may be confused or unable to remember the rape when the drug wears off; this can delay reporting of the crime or hinder law enforcements response to it. The inability to remember an attack can be traumatic to victims of drug-facilitated sexual; they experience feelings of horror, powerlessness, degradation, and humiliation related to not knowing or remembering what happened to them.32
In response to the apparent trend of drug-facilitated sexual assaults, the United States Congress passed the Drug Induced Rape Prevention Act in 1996, which provided harsher penalties for the distribution of controlled substances without the individual's consent and with the intent to commit a crime of violence, including sexual assault. Under this act, the punishment for the importation and distribution of Rohypnol includes up to 20 years in prison and a fine; possession is punishable by three years and a fine.33
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16 Calhoun, Sarah R.; Wesson, Donald R.; Galloway, Gantt P.; and David E. Smith. 1996. Abuse of Flunitrazepan (Rohypnol) and other Benzodiazepines in Austin and South Texas. Journal of Psychoactive Drugs 28(2):183-189.
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25 Carson-DeWitt, Rosalyn (editor). 2001. Vol. 1.
26 Calhoun, Sarah R. et al. 1996.
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28 DEA Resources For Law Enforcement Officers Intelligence Reports- Flunitrazepam (Rohypnol): "roofies."
29 Fitzgerald, Nora and K. Jack Riley. 2000. Drug-Facilitated Rape: Looking for the Missing Pieces. National Institute of Justice Journal, April 2000: 8-15.
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31 DEA Resources For Law Enforcement Officers Intelligence Reports- Flunitrazepam (Rohypnol): "roofies."
32 Fitzgerald, Nora and K. Jack Riley. 2000.
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