CORK Bibliography: Rohypnol

14 citations. Januar 2003 to present

Prepared: December 2008

Britt GC; McCance-Katz EF. A brief overview of the clinical pharmacology of "club drugs". Substance Use & Misuse 40(9-10): 1189-1201, 2005. (56 refs.)

Four different "club drugs" are reviewed: MDMA (methylenedioxymethamphetamine, "Ecstasy"), GHB (gamma-hydroxybutyrate), ketamine, and Rohypnol (R) (flunitrazepam). The neurobiology, clinical pharmacology, and treatment issues for each are discussed.

Carlsten A; Waern M; Holmgren P; Allebeck P. The role of benzodiazepines in elderly suicides. Scandinavian Journal of Public Health 31(3): 224-228, 2003. (24 refs.)

Aims: In Sweden, suicides by drug poisoning have decreased in the population at large during the past two decades. However, drug poisoning suicides increased among the elderly during this period. Suicides by benzodiazepine poisoning increased in this age group despite a reduction in prescription sales of these drugs. This study aims therefore to determine the role of benzodiazepines in suicide late in life. Methods: Information concerning all definite suicides and deaths due to "undetermined" causes recorded among Swedish citizens aged 65 and above during 1992-96 was obtained from the Cause-of-Death Register. Death certificates were scrutinized to determine the type of drug employed in drug-related suicides. Results of the post mortem screening for drugs and alcohol were then examined. Results: A benzodiazepine was implicated in 216/548 (39%) of the drug poisoning suicides recorded among the elderly. Death certificates revealed that a benzodiazepine was the sole agent in 72% of these cases. Flunitrazepam or nitrazepam were implicated in 90% of the single benzodiazepine suicides. In addition to the suicides classified as drug poisonings, 82 cases were found in which a drug may have contributed to the cause of death. Benzodiazepines predominated. The terminal cause of death was drowning, often in the victim's own bathtub, in three-quarters of these cases. The annual fatality ratios for the newer benzodiazepine-like hypnotics zopiclone and zolpidem appear to be on the rise. Conclusion: Benzodiazepines, especially the hypnotics flunitrazepam and nitrazepam, are common in drug poisoning suicides in the elderly and should be prescribed with caution for this age group.

Community Epidemiology Work Group, eds. Epidemiologic Trends in Drug Abuse. Volume I: Proceedings of the Community Epidemiology Work Group. June 2004. Bethesda MD: National Institute on Drug Abuse, 2005. (Chapter refs refs.)

This volume provides the presentations by the 21 Community Epidemiology Work Groups, as well as the results of a special expert panel on presectip drug abuse. The first introductory section of the volume provides a bried description of the CEWG roles, functions, and attributes as well as the major data sources used. This is followed by a discussion of the key findings in respect to presectiption drug abuse, polysubstance abuse, cocaine/crack/heroin, methamphetamine, marijuana, club drugs (MDMA/ecstasy, GHB, ketamine), phencyclidine, and also infectious deseases related to drug abuse. The next section presents the discussion and presentation on trends in prescription drug aubse, with summaries on the general epidemiology, student use of prescription drugs, treatment admissions related to the use of narcotic painkillers, teen's use and abuse of benzodiazepines, the nonmenidal use of prescription drugs by college students, and finally prescriptiondrug abuse among ecstaasy users in Miami. The final section is an international paper on Mexico, and

Forrester MB. Flunitrazepam abuse and malicious use in Texas, 1998-2003. Substance Use & Misuse 41(3): 297-306, 2006. (7 refs.)

Flunitrazepam is a potent benzodiazepine that is subject to abuse and malicious use. This study describes the patterns of flunitrazepam abuse and malicious use calls received by Texas poison centers during 1998-2003. The distribution of calls by year of call, geographic location of caller patient gender and age, exposure site, and medical outcome were determined. There was no clear annual trend,for abuse calls, but there was a consistent decline in the number of malicious use calls. A significantly higher percentage of abuse calls originated in south and west Texas and of malicious use calls in west Texas. Most abuse patients were nudes (55%) and adolescents (76%), and most of the exposures occurred in patient's own residence (68%), followed by school (16%). Most of the malicious use patients were females (93%) and adults (74%), and the greatest proportion of the exposures occurred in public areas (47%), followed by the patient's own residence (26%). The highest percentage of both abuse (48%) and malicious use (55%) involved minor effects. However malicious use calls were significantly less likely to involve no effect (2% vs. 21%) and more likely to involve moderate effects (36% vs. 23%). Reported flunitrazepam abuse and malicious use calls in Texas differed with respect to geographic location of the caller patient gender and age, exposure site, and medical outcome. Poison centers and health care providers might want to consider these differences when targeting populations for education and prevention efforts.

Gable RS. Acute toxic effects of club drugs. (review). Journal of Psychoactive Drugs 36(3): 303-313, 2004. (141 refs.)

This article summarizes the short-term physiological toxicity and the adverse behavioral effects of four substances (GHB, ketamine, MDMA, and Rohypnol(R)) that have been used at late-night dance clubs. The two primary data sources were case studies of human fatalities and experimental studies with laboratory animals. A safety ratio was calculated for each substance based on its estimated lethal dose and its customary recreational dose. GHB (ganuna-hydroxybutyrate) appears to be the most physiologically toxic; Rohypnol(R) (flunitrazepam) appears to be the least physiologically toxic. The single most risk-producing behavior of club drug users is combining psychoactive substances, usually involving alcohol. Hazardous drug-use sequelae such as accidents, aggressive behavior, and addiction were not factored into the safety ratio estimates.

Gahlinger PM. Club drugs: MDMA, gamma-hydroxybutyrate (GHB), rohypnol, and ketamine. American Family Physician 69(11): 2619-2626, 2004. (59 refs.)

Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation. The most widely used club drugs are 3,4-methylenedioxymethamphetamine (MDMA), also known as ecstasy; gamma-hydroxybutyrate (GHB); flunitrazepam (Rohypnol); and ketamine (Ketalar). These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. Club drugs often are adulterated or misrepresented. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Toxicologic screening generally is not available for club drugs. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. Severe drug reactions can occur even with a small dose and may require critical care. Club drug overdose usually resolves with full recovery within seven hours. Education of the patient and family is essential.

Horowitz A; Galanter M; Dermatis H; Franklin J. Use of and attitudes toward club drugs by medical students. Journal of Addictive Diseases 27(4): 35-42, 2008. (12 refs.)

This study assesses medical students' use of and attitudes towards club drugs, classified as "Generation I" (i.e., cocaine and lysergic acid diethylamide), and "Generation II" (ie, methylenedioxymethamphetamine [MDMA], ketamine, gamma hydroxybutyrate, methamphetamine, rohypnol, dextromethorphan) club drugs based on their initial widespread use in club settings. An anonymous questionnaire was administered to 340 medical students. The prevalence of any club drug use was 16.8%, with MDMA (11.8%) and cocaine (5.9%) the most commonly used. Results discussed also include the relationship of age and gender to having ever used club drugs and to their attitudes regarding use. Additionally, the study identifies differences in patterns of use and attitudes toward Generation I versus Generation II club drugs based on age, gender, and participants' prior club drug use. Findings are compared to those of earlier studies about medical students and those in a similar age group in the general population.

Johnston LD; O'Malley PM; Bachman JG; Schulenberg JE. Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2004. Bethesda MD: National Institute on Drug Abuse, 2005. (0 refs.)

This is a summary of the key finding from the Monitoring the Future's 2004 survey of 8th, 10th, and 12th graders in respect to alcohol and other drug use, levels of perceived risk, and approval/disapproval of different substance use, as well as trend in drug use, with data from 1991-2004 provided. For this survey there are declines in several classes of drug use (marijuana, amphetamines, methamphetamines, anabolic steroids). Among those whose use has held steady are the hallucinogens, heroin and other narcotics (except for OxyContin and Vicodin) cocaine, tranquilizers, and two of the "club drugs", Rohypnol and GHB. Drugs with increased use include the inhalants and OxyContin. In terms of licit drugs more than half of teens have tried cigarettes by 12th grade, a quarter by 8th grade and 11% are current smokers, this represents a slight improvement over recent years. Drinking too remains widespread, with three-quarters being drinkers by senior year, although the figures are slightly improved for the two younger age grouups. The findings are summarized in 13 tables and 64 figures.

Maxwell JC. Party drugs: Properties, prevalence, patterns, and problems. (review). Substance Use & Misuse 40(9-10): 1203-1240, 2005. (172 refs.)

This review summarizes the latest literature on "party" or "club" drugs, defined as MDMA, GHB, ketamine, and Rohypnol, as published from 2002 to early 2005. Club drugs have been categorized as being used at raves and dance parties. The literature shows that each drug has different properties, users, and settings. Each drug has different adverse effects and requires different acute care protocols. Although these drugs were identified early, scientific information about them, including the toxicological tests to identify them, is still evolving. Increasing numbers of studies on the short- and long-term effects of these drugs on humans are being published, but because of limitations on research using human subjects, they may not always be as rigorous as desired and can be cited by drug users to discredit findings of harm. The lack of research-based information on these drugs has led to the emergence of web sites that may or may not provide accurate data. Evaluated chemical dependency treatment protocols using the latest research for each of these different drugs are needed.

Maxwell JC; Spence RT. Profiles of club drug users in treatment. Substance Use & Misuse 40(9-10): 1409-1426, 2005. (31 refs.)

There is little in the literature about treatment of persons with problems with "club" or "party" drugs. This paper looks at the characteristics of individuals admitted to treatment for primary, secondary, or tertiary problems with club drugs such as ecstasy, gamma-hydroxybutyrate (GHB), ketamine, flunitrazepam (Rohypnol), methamphetamine, and hallucinogens (e.g., LSD) in programs funded by the Texas Commission on Alcohol and Drug Abuse. Some 38,350 unduplicated records front 1988 through 2003 of persons admitted with problems with club drugs were compared against users of alcohol or other drugs. Club drug users were more impaired on five of six Addiction Severity Index (ASI) indices at admission and they were more likely to use multiple substances more often. They were more likely than users of alcohol or other drugs to complete treatment, but this varied by drug. At follow-up 90 days after discharge, club drug users continued to report more ASI problems. Profiles of these clients show that ecstasy use has spread beyond the club culture, as indicated by the changes in client demographics over time. GHB clients presented a mixed picture of severe problems at admission and good response to treatment. Hallucinogen clients were young and less likely to complete treatment, while Rohypnol users were on the Texas-Mexico border The methamphetamine epidemic has resulted in increased admissions, and the proportion of "Ice" smokers has increased. However, methamphetamine clients were less likely to complete treatment and their higher level of problems at admission and follow-up are of concern. Of special note are the indications of co-occurring problems and the need for both mental health and substance dependence treatment for some clients.

Morral AR; McCaffrey DF; Chien S. Measurement of adolescent drug use. Journal of Psychoactive Drugs 35(3): 301-309, 2003. (22 refs.)

There is widespread agreement that estimates of adolescent drug use prevalence from the National Household Survey of Drug Abuse (NHSDA) and Monitoring the Future (MTF) are subject to considerable measurement error. Nevertheless, some have suggested that trends over time in these prevalence estimates probably reflect true trends in drug use, since underreporting may be assumed to be constant over time. A recent National Research Council report criticizes this assumption on logical grounds. The present study examines adolescent drug use responses on the NHSDA and MTF for evidence of "drug omission," "jargon confusion" and "conceptual confusion," three types of misreporting expected to vary in magnitude with changes in drug use practices and changes in survey items. Results demonstrate that adolescent drug users are significantly more likely than adults to report use of drugs not listed in the NHSDA. Among adolescents who wrote in the "other" drugs they used, 66% and 86% of hallucinogen and inhalant, responses showed confusion over the meaning of the pharmacological terms used in the NHSDA. Almost 20% of MTF respondents who report lifetime use of Rohypnol or ecstasy, when specifically queried about these drugs, deny lifetime use of any substances in the drug classes intended to assess use of Rohypnol and ecstasy. MTF respondents reporting lifetime use of PCP underreport use of hallucinogens at rates that vary substantially over time, from a high of 45% (in 1986), to a low of just 8% (in 1998). The implications of these findings for adolescent drug use prevalence estimation and survey design are discussed.

Parks KA; Kennedy CL. Club drugs: Reasons for and consequences of use. Journal of Psychoactive Drugs 36(3): 295-302, 2004. (33 refs.)

This preliminary descriptive study was designed to assess the reasons, primary contexts, and consequences (physical, psychological, lifestyle) of club drug use in a sample of young adults in a mid-size U.S. city. Fifty young adults (18 to 30 years old) reported on their use of club drugs (Ecstasy, GHB, ketamine, Rohypnol(R), methamphetamine, LSD) in face-to-face interviews that included quantitative and qualitative measures. Ecstasy was the most frequently used club drug followed by ketamine, LSD and methamphetamine. All of the participants reported using club drugs to "experiment" and most reported using these drugs to feel good and enhance social activities. Club drugs were frequently used at raves, in bars or clubs, and at home with friends. An average of 16 negative physical, psychological, and lifestyle consequences were reported for club drug use. Despite substantial negative consequences, participants perceived several positive consequences of regular recreational club drug use. These findings corroborate descriptions of club drug use in other countries (e.g., Australia, United Kingdom) and provide additional information on perceived positive consequences that users experience with club drug use. Further exploration of the reasons and positive consequences that are associated with use of each of the club drugs may provide important information on the growing trend in use of these drugs.

Rimsza ME; Moses KS. Substance abuse on the college campus. Pediatric Clinics of North America 52(1): 307-+, 2005. (39 refs.)

Substance abuse is a major health and behavioral concern in college students. Alcohol and marijuana are the most commonly abused drugs on college campuses. Others include tobacco, 3,4-methylenedioxymethamphetamine, gamma-hydroxybutyrate, flunitrazepam (Rohypnol), lysergic acid, ketamine, methamphetamine, phencyclidine, cocaine, and psilocybin mushrooms. This article reviews the use of these drugs by college students. Substance use is a major contributing factor in poor academic performance and failure to successfully complete a college education.

Wu LT; Schlenger WE; Galvin DM. Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths. Drug and Alcohol Dependence 84(1): 102-113, 2006. (101 refs.)

Background: The magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16-23 (N = 19,084). Methods: Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs. Results: Approximately 20% of youths aged 16-23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18-21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16-19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence. Conclusions: Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.