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What Is Flunitrazolam, and Can It Be Abused?

Flunitrazolam is a dangerous synthetic designer drug that is commonly abused as a recreational substance.

Because benzodiazepine derivatives are highly addictive, it is likely that flunitrazolam is habit-forming and can lead to drug dependence and potentially life-threatening withdrawal symptoms.

Designer Benzodiazepines

In recent years, many synthetic designer drugs known as new psychoactive substances (NPS) have popped onto the drug abuse scene.

Synthetic cannabinoids (Spice) and synthetic cathinones (bath salts) are two major classes of NPS. Another class is designer benzodiazepine derivatives, which includes flunitrazolam.

These designer benzodiazepines can be found online, often in the form of counterfeit or fake medications. They are not controlled substances and have emerged as new recreational drugs of abuse. 

They are often passed off as research chemicals, legal benzodiazepines, or designer benzodiazepines.

The issue with drugs like flunitrazolam is that they are not regulated or controlled. As a result, it is difficult to know what is in the drug you are taking.

The risk of overdose and long-term health effects is high.

NPS Use

Novel or new, psychoactive substances have exploded onto the recreational drug scene. In the United States, purchases of these drugs jumped nearly 12 percent from 2015 to 2016. Global use of NPS is close to five percent. These drugs are popular on the club scene and with college students.

As a hypnotic, flunitrazolam may be abused for the mellow high it can produce. It is also popular as an alternative to more tightly controlled and regulated benzodiazepines, such as Xanax (alprazolam) or Valium (diazepam).

Flunitrazolam can be purchased on the internet with relative ease. It is often marketed as a “legal” alternative to benzos.

Designer benzodiazepines are sold in both powder or tablet form. Since benzodiazepine drugs are highly addictive, these derivatives may be used to hold off withdrawal symptoms or to satisfy cravings for other drugs that are often more difficult to obtain.

Hazards of Flunitrazolam Use

Flunitrazolam was added to the UNODC (United Nations Office on Drugs and Crime) Early Warning Advisory (EWA) in 2017 as a drug abuse threat. The dangers of a synthetic and unregulated drug like flunitrazolam come from being possibly laced with other drugs or toxins during the manufacturing process, which could lead to life-threatening side effects that can be difficult to predict.

It is also important to note the chemical makeup, and therefore the mechanism of action, of flunitrazolam is not the same as the benzodiazepine drugs it may be used to replace. This makes its effects somewhat unpredictable.

Benzodiazepine drugs are central nervous system depressants with sedative and hypnotic effects. Combining a benzo drug with other depressant substances like alcohol, opioids, or other sedatives can greatly exacerbate the suppressant properties of each substance and therefore raise the risk for a fatal overdose. Likewise, combining flunitrazolam with these substances can substantially increase the overdose risk.

Since flunitrazolam is not regulated or controlled by federal or medical channels, it can be next to impossible to know how the drug will interact with the body or even how much of the drug a batch contains.

How Benzodiazepine Derivatives Work

Like benzodiazepines, benzodiazepine derivatives drugs lower body temperature while slowing down breathing, blood pressure, and heart rate.

They also reduce anxiety and stress by interacting with levels of GABA (gamma-aminobutyric acid) in the brain. An inhibitory neurotransmitter that helps to calm body systems and nerve firings, GABA is produced by the brain to lower the stress response.

Benzodiazepines are often prescribed for the short-term relief of anxiety for precisely this reason. Flunitrazolam may then mimic the effects of anxiety-reducing benzodiazepine medications.

Risk of Overdose

According to the National Survey on Drug Use and Health (NSDUH), around 2.5 million people in the United States misused a sedative or tranquilizer medication in 2016. This kind of misuse can lead to overdose. Flunitrazolam may overwhelm the system. Too much can lead to stroke, heart attack, respiratory failure, and death.

Signs of an overdose include:

  • Slow and shallow breathing
  • Cold skin that may appear blue
  • Extreme confusion and cognitive issues
  • Coordination problems
  • Drowsiness and possible loss of consciousness
  • Sluggishness and impaired reflexes
  • Nausea and vomiting

When mixed with other drugs like opioids, alcohol, or other sedatives, the odds of a fatal overdose increase exponentially.

Rate of Addiction and Drug Dependence

Benzodiazepine drugs are considered to be highly addictive because they can quickly lead to drug tolerance and dependence.
Drug tolerance occurs when the brain gets used to the dosage, and more is needed for it to keep having the same impact. When taken in high amounts regularly, dependence can form.

In the case of the familiar and popular benzodiazepine Xanax (alprazolam), drug dependence can form when the drug is taken in doses greater than 4 mg per day for 12 weeks. After dependence sets in, cravings and emotional and physical withdrawal symptoms begin as the drug processes out of the body.

Dependence and addiction are not the same things. Drug dependence can form when you take a drug regularly. It is a physical manifestation of chronic drug use. Addiction is a brain disease that has both physical and psychological aspects.

Drug dependence and tolerance often accompany addiction, which is a chronic disease involving behavioral changes and even potential personality shifts.

As a benzodiazepine derivative, flunitrazolam may also lead to high rates of drug dependence.

Someone addicted will have difficulty stopping the use of flunitrazolam. They will not be able to control how much and how often they take the drug. Significant mood swings, inability to fulfill obligations, interpersonal relationship issues, and isolation are typical signs of addiction. More than 600,000 people struggled with addiction to tranquilizers in 2016. This drug class includes flunitrazolam.

Physical Withdrawal and Medical Detox

When stopping a sedative-type drug like flunitrazolam suddenly, difficult withdrawal symptoms can begin. Withdrawal can be emotionally exhausting and physically dangerous. It can include drug cravings, anxiety, depression, mood swings, irritability, restlessness, trouble thinking clearly, and increased suicidal thoughts.

There are also risks of physical danger, including:

  • Irregular heart rate
  • High blood pressure
  • Elevated body temperature
  • Insomnia
  • Coordination issues
  • Tremors or seizures

Flunitrazolam withdrawal should be managed through a medical detox program. Professionals will likely shift the person to a legal and longer-acting benzodiazepine medication. The dosage will usually be tapered over time to minimize withdrawal.
Flunitrazolam should not be stopped cold turkey, as the withdrawal symptoms could potentially be fatal. Withdrawal requires medical management.

Additional medications may be useful to address withdrawal symptoms during medical detox. Vital signs will be closely monitored, and supportive care is offered until things stabilize.

After medical detox, comprehensive therapy is needed.

Treatment for Substance Abuse

Use of flunitrazolam is problematic at any level, as the drug is not legal and not intended to be taken at all.
The U.S. Drug Enforcement Administration (DEA) reports that abuse of NPS is most popular with young adults and teenagers who crush and snort the medications. As such, addiction treatment for flunitrazolam should address this younger demographic.

Behavioral therapies can be highly beneficial. These therapies aim to help clients manage cravings, address stressful situations, handle peer pressure, and work on impulse control.

Support groups made up of other similar individuals can be helpful. Group members can benefit from their shared experiences, often giving tips to promote sobriety and healthy lifestyle choices.

Addiction is a relapsing disease. But recovery can be achieved and sustained with a high level of support and specialized treatment.

Sources

(February 2019) Detection of the Designer Benzodiazepine Flunitrazolam in Urine and Preliminary Data on its Metabolism. Drug Testing and Analysis. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pubmed/30109775

(November 2016) The Prevalence of Novel Psychoactive Substances (NPS) Use in Non-Clinical Populations: A Systematic Review Protocol. Systematic Reviews. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117541/

(September 2016) Metabolites Replace the Parent Drug In the Drug Arena. The Cases of Fonazepam and Nifoxipam. Forensic Toxicology. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214877/

(September 2018) Global Smart Update. UNODC. Retrieved March 2019 from https://www.unodc.org/documents/scientific/Global_SMART_Update_2017_Vol_18.pdf

(November 2018) Benzodiazepine Toxicity. StatPearls. Retrieved March 2019 from https://www.ncbi.nlm.nih.gov/books/NBK482238/

(September 2016) Xanax. Pfizer. Retrieved March 2019 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf

(September 2017) Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved March 2019 from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm

(2017) Drugs of Abuse a DEA Resource Guide. U.S. Drug Enforcement Administration. Retrieved March 2019 from https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf%23page=42

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