Background: Prior reports and media attention have focused on the involuntary use of Rohypnol (flunitrazepam) and subsequent sexual assault. Recently, this drug has become increasingly popular among adolescents and young adults because it causes a euphoric, drunken-like high.

Objective: To evaluate the independent effects of depressive symptoms, self-esteem, and drug resistance self-efficacy on voluntary lifetime use and intentions to use Rohypnol. We hypothesized that those who used or intended to use Rohypnol would exhibit increased number of depressive symptoms, lowered self-esteem, and limited drug resistance self-efficacy.

Methods: 787 Caucasian, African American, and Mexican-American sexually active females between 14-26 years of age who presented to community-based family planning clinics in Southeast Texas between April and November 1997 completed an anonymous self-report questionnaire. Elicited information included lifetime use and intentions to use Rohypnol; demographic characteristics; other substance use (tobacco, alcohol and marijuana);and standardized measures of depressive symptoms, self esteem, and drug resistance self-efficacy.

Results: 5.5% (n=43) of subjects reported lifetime use of Rohypnol and 7.2% (n=57) indicated an intention to try this drug. Lifetime use and intentions to use differed by both age (younger adolescents more likely to report past use) and ethnicity with African-Americans least likely to report past use or intentions to use this drug. Logistic regression analyses controlling for confounding factors found that females with either moderate to severe depressive symptoms or diminished self-esteem were 2.6 times more likely to report lifetime use of this drug. However, intention to use was significantly associated with young women who reported the presence of both significant depressive symptoms and lowered self-esteem (AOR=2.3) as well as limited drug resistance self-efficacy (AOR=2.9).

Conclusions: These data suggest that Rohypnol, a highly addictive substance, is voluntarily used by some sexually active females to self-medicate mental health symptoms. Moreover, sexually active young women who report both significant depressive symptoms and diminished self-esteem and as well as limited drug resistance self-efficacy are at highest risk for future voluntary use, and perhaps addiction.