Flunitrazepam: an evaluation of use, abuse and toxicity

• Published in: Forensic science international Vol. 122; no. 2; pp. 136 - 141
• Main Authors: Druid, Henrik, Holmgren, Per, Ahlner, Johan
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ireland Ltd 01-11-2001; Elsevier; Elsevier Limited
• Subjects: Aggressive behavior; Alcohol; Anti-Anxiety Agents - blood; Anti-Anxiety Agents - poisoning; benzodiazepine; Benzodiazepines; Biological and medical sciences; Chromatography; Crime - legislation & jurisprudence; Crime - statistics & numerical data; Customs; Driving ability; Drug abuse; Drug intoxications. Doping; Drugged driving; Drugs; Ethanol; Fatal; Fatalities; Flunitrazepam; Flunitrazepam - blood; Flunitrazepam - poisoning; Forensic Medicine; Forensic pathology; Forensic science; Gas Chromatography-Mass Spectrometry; Humans; Immunology; Insomnia; Intoxication; Legislation; Mass spectrometry; Medical sciences; MEDICIN; MEDICINE; Narcotics; Pharmaceuticals; Pharmacology. Drug treatments; Pharmacy; Police; Scientific imaging; Seizures; Sexual assault; Sleep disorders; Substance-Related Disorders - epidemiology; Substance-Related Disorders - mortality; Sweden - epidemiology; Toxicity; Toxicology; Violence; Sweden; Europe; Drug abuse; Drugged driving; Intoxication; Fatal; Legislation; Flunitrazepam; Drug; Evaluation; Abuse; Legal medicine; Toxicity; Drug intoxication; Use; Hypnotic; Anticonvulsant; Cause; Benzodiazepine derivatives; Death; Sedative; Sanitary surveillance; Public health
• ISSN: 0379-0738; 1872-6283; 1872-6283
• DOI: 10.1016/S0379-0738(01)00481-9

The benzodiazepine flunitrazepam is extensively prescribed to patients with insomnia in many countries, but has also become popular among alcohol- and drug abusers. Several reports indicate that it is used as a date rape drug and suggest that it may precipitate violent behavior. Furthermore, flunitrazepam is involved in many fatal intoxications in Sweden. This study was designed and conducted to explore the negative consequences of flunitrazepam abuse in Sweden, and to assess the trends in its use and abuse. The occurrence of flunitrazepam in cases referred to the Department of Forensic Chemistry in Linköping, Sweden 1992–1998, was investigated in detail. The detections were studied separately for different groups; medicolegal death investigations, drug abuse cases, driving under influence cases, and other medicolegal cases. These data were further compared with the sales, and seizures by the Swedish Customs and the Swedish Police. During 1992–1998, 641 fatalities occurred, where the cause of death was attributed to intoxication with flunitrazepam solely (130) or in combination with other drugs, or concomittant conditions (511). In 78% of all driving under influence cases, where flunitrazepam was detected, the analyses also disclosed the presence of illicit drugs. A similar association was seen in drug abuse cases. The seizures reported by the Swedish Customs revealed a substantial and increasing illegal trade. Cases, where flunitrazepam seemingly induced violent behavior were identified, and one of these is described in some detail. It is concluded that the abuse pattern and the toxicity of flunitrazepam should be kept in mind by forensic investigators and that this panorama also should be considered when decisions about the registration and classification of flunitrazepam are made in different countries.