Introduction

Recent seizures and anecdotal reporting indicate that distribution and abuse of flunitrazepam are increasing domestically, especially in southern and southwestern States. Of particular concern is the drugs low cost, usually below $5 per tablet, and its growing popularity among young people. Flunitrazepam is a benzodiazepine that is used in the short-term treatment of insomnia and as a sedative hypnotic and preanesthetic medication. It has physiological effects similar to diazepam (commonly known by its trade name, Valium®), although flunitrazepam is approximately 10 times more potent. Flunitrazepam neither is manufactured nor sold licitly in the United States. It is produced and sold legally by prescription in Europe and Latin America. The drug usually is smuggled into and transported within the United States through the mail or delivery services.

Manufacture and Distribution

Flunitrazepam marketed under the trade name Rohypnolis manufactured worldwide, particularly in Europe and Latin America, in 1- and 2-milligram tablets by Hoffman-La Roche, Inc., a large pharmaceutical manufacturer. However, the drug neither is manufactured nor approved for medical use in the United States.

Flunitrazepam has been encountered by U.S. law enforcement agencies in Southern States from California to Florida. Authorities in Texas and Florida have observed the most significant activity involving flunitrazepam. Distributors in Texas reportedly travel to Mexico to obtain the drug. In South Florida, the drug is delivered primarily from Colombia via international mail services or commercial airlines. Overnight mail appears to be the preferred method of importation. Several packages seized in Miami over the past 2 years were shipped from Cali, Colombia, and contained up to 11,000 dosage units each.

The most recent and largest seizures of flunitrazepam occurred in February 1995. On February 13, over 52,000 tablets, packaged loosely in plastic bags and located inside a car door, were seized by the State Police in Louisiana. On February 14, the U.S. Border Patrol in McAllen, Texas, seized over 57,000 tablets of Rohypnol, packaged in bubble packs, along with 53 pounds of marijuana. The drugs were obtained in Mexico and destined for Florida. Since 1990, over 1,000 Federal, State, and local investigations have been initiated regarding flunitrazepam. The DEA is pursuing over 70 investigations involving distribution of flunitrazepam. In many investigations, flunitrazepam was seized along with other illegal substances, including cocaine and marijuana.

Use and Effects

Flunitrazepam is ingested orally, frequently in conjunction with alcohol or other drugs, including heroin. The drugs effects begin within 30 minutes, peak within 2 hours, and may persist for up to 8 hours or more, depending upon the dosage. Adverse effects associated with the use of flunitrazepam include decreased blood pressure, memory impairment, drowsiness, visual disturbances, dizziness, confusion, gastrointestinal disturbances, and urinary retention. Paradoxically, although the drug is classified as a depressant, flunitrazepam can induce excitability or aggressive behavior in some users.

Flunitrazepam use causes dependence in humans. Once dependence has developed, abstention induces withdrawal symptoms, including headache, muscle pain, extreme anxiety, tension, restlessness, confusion, and irritability. Numbness, tingling of the extremities, loss of identity, hallucinations, delirium, convulsions, shock, and cardiovascular collapse also may occur. Withdrawal seizures can occur a week or more after cessation of use. As with other benzodiazepines, treatment for flunitrazepam dependence must be gradual, with use tapering off.

Flunitrazepam is touted as an effective parachute or remedy for the depression that follows a stimulant high. Reports indicate that flunitrazepam is used by drug addicts in Spain and Malaysia to allay withdrawal symptoms and to gain a state of oblivion. Abuse of the drug in Western Europe and the Caribbean has been reported over the last 10 years. In Germany, Roche recently removed the 2-milligram dosage from retail distributionrestricting it to hospital use onlydue to the increasing abuse of flunitrazepam in that country.

In the United States, flunitrazepam is used widely in Texas where it is popular among high school students. Flunitrazepam is reported to be readily available in the Miami area, and epidemiologists from that area have stated that it is South Floridas fastest growing drug problem. Additional reports from Miami indicate that the largest and fastest growing group of flunitrazepam users are high school students who take the drug with alcohol or use it after cocaine ingestion. Two common misperceptions about flunitrazepam may explain the drugs popularity among young people: first, many erroneously believe that the drug is unadulteratedand therefore safebecause it comes in presealed bubble packs; second, many mistakenly think its use cannot be detected by urinalysis testing.

Flunitrazepam is sold under the trade name Rohypnol, from which the street name Rophy is derived. In South Florida, street names include circles, Mexican valium, rib, roach-2, roofies, roopies, rope, ropies, and ruffies. Being under the influence of the drug is referred to as being roached out. In Texas, flunitrazepam is called R-2, or roaches.