ABUSE LIABILITY OF FLUNITRAZEPAM

Flunitrazepam is among the most frequently prescribed hypnotics in man y countries. Although it was never marketed in the United States, flun itrazepam, in recent years, has been smuggled into the country, and re ports of abuse-including alleged use of the drug to facilitate ''date rape''-have attracted a great deal of scrutiny. It has been suggested that flunitrazepam may have greater liability for abuse than other ben zodiazepines; such suggestions are supported by surveys of opioid abus ers, many of whom report a distinct preference for flunitrazepam over other benzodiazepines. Experimental studies of animals and normal huma n subjects indicate that, although flunitrazepam has high efficacy and is very potent, it is pharmacologically similar to most other benzodi azepines. Although the studies are limited in number and scope, the da ta show no apparent differences between flunitrazepam and other benzod iazepines in ability to produce drug-taking or drug-seeking behavior, in capacity to produce physiologic dependence, nor in the characterist ics of withdrawal after administration of an antagonist or discontinua tion of treatment. Similar to other benzodiazepines, flunitrazepam pro duces dose-dependent effects on psychomotor performance and recall. Fl unitrazepam does not seem to be involved in medical emergencies more o ften than other benzodiazepines, and there is no indication that fluni trazepam is more toxic than other benzodiazepines when taken in overdo se by drug abusers or other individuals. Survey research among typical patient populations suggests that flunitrazepam is characteristic of benzodiazepines in that it is used appropriately and conservatively, w ith low liability for abuse. Thus the reported preference for flunitra zepam among opioid abusers seems to be the only way in which flunitraz epam is distinguished from other benzodiazepines; it is unclear what c haracteristics of the drug may be responsible for this reported prefer ence. The evidence considered in this review indicates that abuse of f lunitrazepam in this special population is not associated with any dis tinctive threats to the health of the general public.