Rohypnol (Flunitrazepam) was created in 1972 by the pharmaceutical company Roche in Europe and was used in hospitals to induce deep sedation. It was first introduced to the commercial market in Europe in 1975 as Rohypnol produced by Roche, and became available in other countries in the 1980s. It was introduced in the US in the early 1990s. It was originally distributed in 1 mg and 2 mg doses, but due to its potency and potential for abuse, higher dose Rohypnol was taken off the market by Roche; it is now only available as 1 mg tablets. In the countries where Rohypnol is available for prescription as both 1 mg and 2 mg tablets, such as the Netherlands, generic alternatives are available for the 2 mg tablets.
Rohypnol, is classified as a nitro-benzodiazepine, is a strong hypnotic, sedative, anticonvulsant, anxiolytic, amnestic and skeletal muscle relaxant drug. It is considered to be one of the most effective benzodiazepine hypnotics on a dose basis.
Rohypnol is currently classified as a Schedule III drug under the international Convention on Psychotropic Substances of 1971, and in the United States it is on Schedule IV, but is currently under consideration to be rescheduled to Schedule I (Florida, Idaho, Minnesota; New Hampshire, New Mexico, North Dakota; Oklahoma, Pennsylvania, and Virginia already consider the drug Schedule I).
As a hypnotic drug, Rohypnol is generally intended to be for short-term treatment for chronic or severe insomniacs who are unresponsive to other hypnotics, especially in inpatients. As with other hypnotics, Rohypnol should only be used on a short-term basis or in those with chronic insomnia on an occasional basis.
Rohypnol has become infamous in the USA for its use as a date-rape drug, but it is used more frequently as a recreational drug, often used by high school and college students, people at raves and parties, and heroin and cocaine users. Rohypnol is used to produce profound intoxication, to increase sedative effect in combination with heroin, or ease the anxiety and/or sleeplessness of withdrawal, to counteract and soften the side effects of stimulants, such as cocaine or methamphetamine.
Rohypnol is usually consumed orally, and is sometimes combined with alcohol. It is also occasionally insufflated (crushed into powder and snorted). In some European countries, there was an alcohol solution of Rohypnol (known as Darkene), taken by injection, with very strong effects.
Some studies in Sweden show that Rohypnol was the second most common drug used in suicides, being found in about 15% of cases.
Rohypnol is often called a date rape drug because of its high potency, strong effects and the ability to cause strong amnesia during its duration of action. The main pharmacological effects of Rohypnol are the enhancement of GABA at the GABAA receptor. The physical effects of Rohypnol include sedation, muscle relaxation, decreased anxiety, and prevention of convulsions.
The adverse effects of Rohypnol include physical and psychological dependence, reduced sleep quality resulting in somnolence or hypersomnia, excessive sedation; impairment of balance and speech, respiratory depression or coma, and possibly death (Rohypnol is commonly used in suicide). When used in pregnancy, it might cause hypotonia (Floppy Infant Syndrome).
Rohypnol may cause a paradoxical reaction in some individuals, causing anxiety, aggressiveness, agitation; confusion, disinhibition, loss of impulse control; talkativeness, violent behavior, and convulsions. These effects may eventually lead to criminal behavior as a result of impaired judgment.
Like other benzodiazepines and nonbenzodiazepine hypnotic drugs, Rohypnol causes impairments in body balance and standing steadiness in individuals who wake up at night or the next morning. Other adverse effects include slurred speech, gastrointestinal disturbances, impaired coordination; impaired balance, dizziness, and respiratory depression. The use of Rohypnol with alcohol synergizes the adverse effects, and can lead to toxicity and death.
Drugs with effects similar to Rohypnol include other benzodiazepines, nitro-benzodiazepines and non-benzodiazepines such as nitrazepam, clonazepam, loprazolam; lormetazepam, temazepam, diazepam, and oxazepam.
The high strength of Rohypnol gives the drug a high potential for abuse, resulting in physical and psychological dependence and a build up in tolerance to Rohypnol’s effects and eventual addiction. Rohypnol addiction symptoms include more frequent use, using more of the drug to get the desired effect, preoccupation with using the drug; excessive spending on the drug, missing school or work to do drugs, inability to function without the medication, headaches and frequent insomnia when not taking the drug.
Cessation of Rohypnol use can result in benzodiazepine withdrawal syndrome. Gradual discontinuation may result in withdrawal symptoms including seizures, psychosis, severe insomnia; amnesia, loss of concentration, rebound insomnia; mood swings, depression and severe anxiety. Abrupt and rapid discontinuation may result in suicidal or homicidal ideations, psychosis, mania; delirium tremens, convulsions, violence, catatonia and coma. As withdrawal progresses patients often find that their physical and mental health improves with improved mood and improved cognition.
A Rohypnol overdose may result in excessive sedation, impairment of balance and speech, and may progress in severe overdoses to respiratory depression, coma, and possibly death. The risk of a Rohypnol overdose increases if the drug is taken in combination with central nervous system depressants such as alcohol and opiates. In a retrospective study of deaths, when benzodiazepines were implicated, the benzodiazepines Rohypnol and nitrazepam were the most common benzodiazepines involved.