What are roofies?
How are they used recreationally?
What’s the most commonly used roofie?
Roofies have been around for years. They hit their heyday in the late 80’s and 90’s. Women all over the world were warned not to set their drinks down, not to accept a drink from a stranger and perhaps even to stay home instead of going out. What we didn’t hear about was that people would take roofies on purpose, for fun. Recreational use of Rohypnol has always been a thing. Now, a powerful new drug is replacing the top tier of these drugs: GHB. GHB or Liquid Ecstasy is not just popular among the club scene, but also for recreational use and even everyday use. This drug has a party side and a dark side. In this episode we’ll explore the use of drugs that are “roofies” in the way they function and the way they are used.
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You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice. So join me each week as we talk about All Things Substance.
Welcome back to the All Things Substance podcast. This is episode 48. This week on the podcast we’re going to be covering roofies. Roofies have come to mean more than what it originally started. The word roofie refers to a specific drug called Rohypnol. However, in recent years it’s come to mean more than just Rohypnol. There are other drugs that are being used as roofies, which has changed from just being the word of a drug to something that happens to someone or is happening to someone. Those kinds of changes happen often in the English language, as language and culture evolves.
In pop culture, one of the main references to roofies comes from the movie The Hangover that came out in 2009. In the movie, a group of friends is in Vegas and one of them bought some drugs from a drug dealer that he thought was ecstasy. In the movie when they find out that they’ve been roofied accidentally, they’re calling them rufanil, but that’s because Rohypnol is a trademarked name.
The movie portrays being roofied as being something wild and different, but not potentially as scary as what it’s actually like. Not that I think Hollywood’s going to really portray these things in an accurate light. This was clearly meant to be a comedy and another “mistake” from one of the characters who was meant to be “that guy” in the ensemble.
Rohypnol is actually a benzodiazepine. There’s no legal application for Rohypnol in the United States. It is legal, however, and available by prescription in other parts of the world like Mexico, South America, and parts of Asia and Europe. It is often a widely used benzodiazepine in other areas.
There was a push to make Rohypnol a Schedule one drug, putting it on the same level as heroin. However, it’s currently a Schedule four drug. The interesting part about that is that the penalties for trafficking or possessing Rohypnol are actually really intense for a Schedule Four drug. Remembering that the way the drugs are set up is that a Schedule One means that there is a high abuse potential, and no known medical use. Schedule Four places it in the low abuse potential category with some medical use. It’s interesting to me that it was placed in Schedule Four, but the penalties are actually more like a Schedule One drug.
It was first patented in 1962, but didn’t come into medical use until 1974. It is said to be 10 times more potent than Valium. It was first sold in Switzerland in 1975 as a sleeping medication. It was also being used as a sedative prior to administering anesthesia for certain surgeries, including heart surgeries.
Not long after it was introduced there were reports that people were using it recreationally. Since Rohypnol is a benzodiazepine it’s a downer and falls into the depressant category. The late eighties and early nineties saw a huge increase in the abuse of benzodiazepine. In a 1989 article in the European Journal of Clinical Pharmacology, it reported that benzodiazepines accounted for 52% of drug prescription forgeries at the time.
So let’s talk about Rohypnol, what it is and how it works. It’s an intermediate acting benzodiazepine with properties similar to Valium. Intermediate acting has to do with how long it takes to kick in and how long it lasts. We talked about that distinction when we did the benzodiazepine episodes. In the nineties Rohypnol was being used to manage a depression that followed withdrawal from stimulants. Cocaine and methamphetamine are really hard to come off of due to the lack of dopamine flowing through the system.
Rohypnol does have therapeutic effects, just like other benzodiazepines. It causes sedation, muscle relaxation, reduces anxiety and can prevent convulsion. One of the things that sets this benzodiazepine apart is the strong amnesic effect. Rohypnol has also been used to help patients who are taking Ketamine. Rohypnol, reportedly lowers the side effects of taking ketamine resulting in less confusion in awakened states. It also has shown to help with stabilizing pulse rate and blood pressure in those who are taking Ketamine.
The reason that people would take roofers recreationally has to do with desire to be drowsy, to feel less connected to things, to have less anxiety, and to be able to relax. When I first heard about people using Rohypnol recreationally, I was a little surprised. Being born in the late seventies, I’ve known about roofies most of my life, and I never even thought about someone using them recreationally. It just seemed really dangerous because all I really understood about it was about the amnesia effect or the blackout. But Rohypnol is used recreationally. Most famously Kurt Cobain, the lead singer of Nirvana in the month before he died, ended up falling into a coma after mixing Rohypnol with champagne. Reports say that that coma nearly killed him because of the lethal combination.
The other effects of Rohypnol, other than dealing with anxiety and insomnia have to do with the more downside of it. There is deep and intense memory loss where the person who’s taken it is going to be missing several parts of the time period in which they were under the influence of Rohypnol.
Rohypnol lasts around six hours and some effects could be felt up to 12 hours later. It can cause you to lose the ability to move your limbs and causes a sharp decrease in the ability to coordinate any movement at all. Roofies, if used as intended, are supposed to be sedative and supposed to help with preventing convulsions. You can imagine how a dose change could make those effects really dangerous for somebody. Taking too much of it means that your entire body, your muscles and whatnot are relaxed. We know from studying opiates that that can cause respiratory depression, which can lead to death.
Amnesia is the most common side effect of the use of Rohypnol. One of the things we’ve talked about before is that depressants have an additive effect. So you take Rohypnol, which is already a depressant and you mix it with alcohol, which is another depressant and you have a compounded effect.
In the 1990s Rohypnol was in the headlines all over the place. Not for use as sedative, but for what we mostly know it as: a date rape drug. There were reports of people being roofied where a Rohypnol pill was crushed or dropped into their drink and that later the person found out that they had been sexually assaulted.
Rohypnol was banned in March of 1996 in the United States. At that time, you could still import a three month supply from another country. This is something that the United States sought to ban further in the coming years. Rohypnol is said to cause what’s called anterograde amnesia, which is the loss of the ability to create new memories after the onset of the amnesia.
So the person’s memories will be intact from before they took the Rohypnol, but anything after, until it’s no longer in the system and effective, will be shady at best. This is different from retrograde amnesia, which is where new memories can be created but old memories are lost.
The anterograde amnesia is what makes Rohypnol attractive for those who are wishing to commit a sexual assault on someone. It makes the person compliant largely unresponsive at times and it means that they won’t be able to remember clearly. It stays in the system approximately 72 hours and after that point, it would be really hard to determine with any kind of blood or urine test.
The difficulty here is that after someone’s been assaulted in what is called in the literature drug assisted or drug fueled sexual assault, the person may not necessarily go to report something or go to get a test to see if they had been roofied. If they wait very long, the chances that it’ll be detectable in their system go sharply down. This makes it difficult to prove whether or not the person had been given something in their drink or in another form.
What we know about people who have been sexually assaulted is that they don’t often tell right away. Part of that is because the nature of trauma makes us wonder whether something happened at all. And then the idea that maybe we’re making it up or making a big deal out of it further compounds the issue, making it even less likely for someone to want to report to authorities what had happened.
Roofies are addictive in long-term use. There is the tolerance and the withdrawal syndrome necessary to call something addictive. There are people who have become dependent on this drug. Remembering that in plenty of other countries Rohypnol is still manufactured and being used on a prescription basis. The withdrawal from it is going to be very similar to other benzodiazepines and is potentially dangerous to the person who has been using it long-term because the withdrawal from benzodiazepines can cause seizures.
Here’s where things take a little bit of a turn. Roofies in the form of Rohypnol aren’t nearly as common, but drug fueled sexual assaults are absolutely common. The difference here is that it’s not Rohypnol this time. It’s another drug.
It’s called gamma hydroxybutyrate, or GHB. GHB is a central nervous system depressant that also shows up in the club drug category. The term “club drug” isn’t something that’s really as commonly used in this day and age. In the late nineties and mid 2000’s club drugs were things that were used at raves. So ecstasy different kinds of psychedelics, and GHB fell into that category.
Until 1992, you could purchase GHB over the counter. It was primarily used by bodybuilders in hopes of reducing body fat and building muscle. In 2000 GHB was classified as a Schedule One drug. GHB was said to have been synthesized in 1874, but there’s no report about what it was used for at the time. It wasn’t until 1964, when a French doctor used a GHB to drop people’s temperature during surgery, trying to reverse the symptoms of shock caused by their injuries and the operation. It was used in Europe for several decades as an anesthetic in childbirth, because it helps the cervix. It does aid in sleep, but there were other drugs that were developed that worked better on sleep than GHB and so they were the ones who went to market.
GHB is created naturally in our own bodies, although in small amounts, GHB was banned in 1990, but currently is available by prescription in a specific medication. This medication has GHB as the primary active ingredient. Sodium oxybate, which is the chemical form of this medication, brand name Xyrem, is approved by the US FDA for the treatment of cataplexy associated with narcolepsy and excessive daytime sleepiness. GHB has been shown to reliably increase slow wave sleep, and decrease the tendency for REM sleep in modified multiple sleep latency tests.
The medication form of GHB is a Schedule Three drug versus just straight up GHB, which is Schedule One. GHB is also a naturally occurring metabolite in our own systems. This naturally occurring metabolite is present in much lower concentrations in the brain than those found in the drug. Some natural GHB can also be found in the fermentation in certain beer and wine.
GHB is often manufactured in homes with recipes and kits found on the internet. It’s made from a combination of Gamma Butyrolactone or GBL and sodium hydroxide or potassium hydroxide. These substances are commonly used in floor stripping solvents and in drain cleaners.
GHB is usually taken orally in liquid or in powder. It’s said to have a salty taste, but it’s often diluted in liquids that make it undetectable. It can be sold in powder form in capsules with powder inside or in just a powder or a paste but that tends to be rare. GBL, which is one of the components, has a strong chemical taste and smell as we would expect since it’s being used in floor stripping, solvents, and other cleaners. When it’s in GHB form, which is the drug form, it really doesn’t have much smell at all .
Taking GHB or GBL in its pure form orally would cause severe burns to the mouth and throat. For this reason, it’s definitely diluted before someone takes it. You typically can’t inject GHB. Now, technically somebody could try it because it’s liquid form and you can inject pretty much anything that’s liquid form, but it’s extremely risky and it’s not something that the people who are using it typically do.
It can take about 10 minutes to an hour to kick in and the effects last for several hours. It doesn’t stay in the system for very long and typically will show up only for about 24 hours. This makes it difficult to detect later outside of that window.
The natural function of GHB in the body is to slow down brain activity. During sleep GHB affects several nerve pathways in the brain, including activating the body’s painkilling system and raising the levels of growth hormone. Negative effects may include sweating, loss of consciousness, nausea, hallucinations, amnesia, and coma among other side-effects.
Overdose on GHB is incredibly easy. There are accounts all over the internet of people suggesting how long you should wait before dosing again. I read an article about a couple girls who were going out to the bars and they were carrying a small spritzer bottle in their purses that had GHB in it. Each one of them took a couple spritzes to the drink they had and then set a timer so that they would know when to dose again.
Again, Part of the difficulty is that the margin for error is really small. We’re talking about people diluting this who aren’t necessarily really careful about how much part of the drug per how many parts of water are going into it. Especially as a night wears on the girls aren’t necessarily going to be careful about timing or dosage when they just want to increase the effects.
GHB is said to loosen inhibitions, increase confidence, increase euphoria, and cause an increase in sexual desire. You can imagine that mixing this with alcohol can increase some of the dangers there. GHB is sometimes referred to as liquid ecstasy. Because of this there are people who use it when they go out and party. There are also people who use it on a daily basis.
It is addictive. There is a tolerance and or withdrawal effect necessary for classification as an addiction. Withdrawal effects can include insomnia, anxiety, tremors, and sweating. It can be severe and incapacitating. Depending on the level of depressants in the system that’s going to determine how the comedown is and how the withdrawal is. Having too much of a depressant effect could of course, lead to things like vomiting, aspiration and at the extreme end, respiratory depression.
High doses of GHB, even without other substances, such as alcohol, can result in profound sedation, seizures, coma, severe respiratory depression, and even death. In the article where the girls were out at the bar they’ve talked about the fact that they have “slipped under” a few times each and they don’t really think of it as a big deal. What they mean is that they fell asleep or passed out because of the GHB in their system. They take it as a message to change the dosage, not necessarily a message about the danger of the drug itself.
This party drug is said to be so powerful that it can melt plastic. I suppose we shouldn’t be super surprised by that considering that it has substances that are used for stripping floors. It doesn’t necessarily melt plastic right away but over the course of a few hours or days, it does degrade the plastic. A typical dose is going to cost around $10 depending on where you are.
There’s a lot of news coming out of the UK regarding the use of GHB among the club going scene. Similarly in big cities in the US GHB is being talked about quite a bit, but not for the party drug that you would think. There are a number of reports coming out of cities in the U S, the UK, Australia about people being given GHB without their knowledge.
Sometimes this has to do with sexual assault and sometimes not. And that’s one of the interesting things. We can imagine its use in sexual assault. Somebody puts it in someone’s drink. It makes them more open to suggestion. It makes them have some euphoria and be a little more affectionate and it gives them the amnesia part where they’re not going to really remember everything.
If the dose is carefully controlled, then the person also might be slightly more functional than they might be on Rohypnol. It can be dropped in liquid form and so it doesn’t even need time to dissolve. Drug facilitated sexual assaults are definitely something that we see becoming more common in the news. I’m not saying that it went away ever necessarily, but the invention and the use of this drug are causing these reports to skyrocket.
It’s hard to detect though, because remember we talked about it being in the system only about 24 hours. It is detectable in hair, but that’s not the kind of thing that most people have access to. What tends to be happening is that people who wake up the next day realize that something is wrong and they’re missing parts of their evening. Have to spend time trying to recreate it. The idea that they had been somehow drugged isn’t necessarily the first thing that comes to their mind. By the time they might decide to go get a test, that’s going to be gone.
There are scientists working on ways to detect the presence of an adulterant in a drink. Sometimes using special lights to be able to tell if something’s in there that shouldn’t be. This technology is not ready yet and so we don’t have any way to really tell that.
One of the articles I read talked about a woman who had been given GHB in a bar where the bartender was known to her and the people around her were all relatively known to her too. She was not sexually assaulted, but had been brought back to one of the guys’ apartments and woke up fully dressed. She wasn’t even sure what to call this.
When she talked to a friend about it, the friend said, oh yeah, that happened to me too. And the more that this person went around mentioning it, other people were saying, oh, my friend had that happen or my cousin had that happen, or I had that happen. Where they’re not being sexually assaulted, but they are being drugged. They’re calling it a GHB assault.
And in these cases it’s happening more often to men than just specifically to women. Of course, there are men who have been drugged with roofies, with GHB and other things. And we know that the majority of sexual assaults happen to women.
So the issue with this drug is that it’s seen as something that can enhance the party. You’re going out and you’re going to drink, and you’re going to hang out with friends and flirt with people that you’re attracted to. And so you spritz a little bit of this in there and it just enhances everything. It seems relatively harmless. It’s just a couple of spritzes.
However, there are a number of problems with us because of the fact that it’s a depressant. Alcohol is a depressant and if there’s any other substances that someone’s going to use, say smoking weed, for instance, all of those things have an additive effect. The truth is that GHB is actually really dangerous. There are very few medical situations where this is still used and it’s a by-product of it. The salt part of it that is taken out that’s used in the prescription medication.
Even though overdoses occur, even though people might drift under so to speak, it’s still not seen as something that’s a big problem. Liquid G as it’s called, is seen as something that just adds to the fun. Because GHB is being made in illegal labs the user isn’t able to trust exactly what’s in it. This isn’t being done by people with necessarily a lot of chemistry experience. And of course, if something is lacking, might as well or replace it with something that’s similar and sell it as though it’s the real thing.
When drugs on the street get sent in for testing, they often don’t come up with the right amount of drug that they’re said to have. Sometimes the drug that they’re said to have doesn’t have anything in it at all. We’ve talked about this in almost every episode I think when talking about things that are manufactured. Like a tablet of ecstasy having no MDMA in it, or a Lortab being primarily fentanyl. Drugs being cut with other substances is an everyday occurrence. And this compounds the problem of the overdose potential and other side effects.
You can imagine that emergency rooms have a really difficult time with GHB cases. A person comes in and it’s clear that they’re intoxicated in some way and GHB may or may not be detectable. It’s also not necessarily the first thing someone’s going to assume when a patient comes in with delirium and acting intoxicated.
When it comes to our clients, this is something that we need to ask about. GHB is not something that’s been super common until recent years and likely something that a lot of us weren’t even really aware of.
I’ve seen it on lists of “club drugs” for a long time, but hadn’t had anyone who’d been using it until the last couple of years. There are people who use it to treat their depression because it helps them forget about it and they feel a little more euphoric, taking multiple spritzes of it a day. The problem of course, is the tolerance and the withdrawal and the downside of it being intense and the withdrawal is really unpleasant.
It’s one of the drugs that we need to be asking about. If the person looks at you, like what, I’ve never even heard of that. Then you’re good. Then you want to check on how often, how much, if they’ve ever gone under, so to speak or passed out from it or had blackouts, that kind of thing.
There’s another drug that gets on the club drug list that we’ve talked about before Ketamine Ketamine shows up in a number of different places. It shows up as a dissociative hallucinogen. It shows up in treatment for depression and sometimes for PTSD. It’s an anesthetic that is often used by veterinarians for doing surgery on animals. And it is an illegal drug on the street called Special K.
Ketamine is also a depressant and it has hallucinogenic properties. Check out the episode on the dissociative hallucinogens in order to find out more about Ketamine. For this episode, Ketamine is being used as a date rape drug as well. It’s something that can be put in a liquid where it’s not detectable. It makes the person more compliant, happy, a little more open and somewhat intoxicated, as well as experiencing some kind of hallucinogenic and dissociative effects.
There is a point to which overdose is a problem, and the person may become incapacitated. The same problem exists if you put ketamine and alcohol together because they both have depressant qualities, and the compounding effect that comes from that.
There are three other drugs that fall into this category of things that are being used to roofie someone. Besides Rohypnol, the original roofie, GHB, and Ketamine. We also have the common sleep medication, Ambien. Most of us know Ambien as it’s sleep medication self. Some of our clients take it and it’s shown up in the news at different times for some of the reported behavior that people do while they’re on Ambien. There are reports of people doing online shopping, binge eating and other behaviors while taking Ambien that they don’t remember.
There was a famous case in 2014, that came up when a former NFL star, Darren Sharper, was found to have Ambien pills in his possession. He was a Super Bowl champion formerly of the New Orleans Saints, who was given a 20 year prison sentence for drugging and raping two women. It was suggested that he had done this to up to 16 women across four different states.
There are times in my career when I’ve had students at the high school talk about being sold Ambien from their peers. Typically they’re getting it from a relative who’s taking it or stop taking it and didn’t get rid of it. It can also be bought on the street just as easily as anything else. Ambien is known for its sedative effect as well as sleepwalking. Ambien is reported to be the most used substance in drug facilitated sexual assaults in South Korea.
Roofies: Restoril and Versed
There are two other drugs that are often mentioned when talking about drug facilitated sexual assaults. Both are benzodiazepines. One is Midazolam, and another is Temazepam. Temazepam is known as Restoril, it’s a medication used to treat insomnia. Typically it’s only recommended for use in episodes of 10 days or less. The side effects are typically sleepiness, which is of course what people want. Also listed anxiety, confusion, and dizziness. There are some serious side effects which may include hallucinations, anaphylaxis and some suicidal ideation. Restoril Is considered an intermediate acting benzodiazepine and hypnotic.
Midazolam is sold under the brand name Versed. This medication is often used for anesthesia, procedural sedation, trouble, sleeping and severe agitation. It works by inducing sleepiness, bringing anxiety down, and the side effect that we’re most interested in today is it causes a lack of ability to create new memories.
Of course, when we’re talking about drug facilitated sexual assaults, the most common drug that’s used is alcohol. Alcohol is a drug if we’re talking about mood and mind altering substances. It is a depressant that can cause someone to blackout, to lose coordination, to not remember things and it’s used as a part of many sexual assaults. This wasn’t meant to be an episode fully about drug facilitated sexual assault. However we can’t separate the two when we’re talking about these drugs.
GHB is a party drug and being used more and more by people in their twenties and thirties. The chances that we’re going to run across somebody who’s tried it or used it are growing. When we’re talking about doing a substance abuse assessment, this needs to be on our list of things that we ask about.
I hope you found the information today. I know that roofies aren’t something we think about as being a recreational drug .GHB, Liquid G Liquid Ecstasy, as it’s known along with a ton of other names is something that might seem like just a little bit of something and not very harmful. It’s never my practice to try to scare people away from something. I do want to share with my clients the real dangers of something in a really practical way that is designed to just inform.
Psychoeducation is a huge part of what we do as therapists. And I always want you to have the best information that we can. If you want to read more on any of the things we talked about today, you can always go over to the show notes that are included with each episode betsybyler.com/podcast is the place to find all those episodes.
If you haven’t had a chance already, I would encourage you to go download the free treatment planning tool. It’s designed to help you conceptualize their use and plan interventions. You can get that over on the website to betsybyler.com/treatment tool.
Next week, we’re going to be talking about sleep medications. We started a little bit today by mentioning Ambien, but there are a lot of sleep medications that our clients use. It’s one of the main things that we ask about when people come in: how are you sleeping? Are you able to stay asleep when you fall asleep? Do you stay up? Do you wake up early? How do you feel when you wake up, do you feel rested? Are you having nightmares?
There are a lot of questions around sleep and there’s a lot of medications. Some of our discussion is going to be about the ways that people abuse them, but also about the different medications and how they work.
I hope you’ll join me for that podcast. And until then have a great week.
Thank you for listening to the All Things Substance podcast. For show notes, links and downloads, please visit betsybyler.com/podcast. If you loved what you heard today, it’d be great if you would share those with your therapist friends and colleagues. If there are topics that you think would be useful and you’d like to hear me cover them, please let me know. Just send a message to firstname.lastname@example.org. I’ll see you on next week’s podcast. And until then have a great week.
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