In 2011, around 60 million prescriptions for sleep aids were dispensed in the United States, The New York Times publishes. Ambien is a prescription sleep medication containing the active ingredient zolpidem, a benzodiazepine-like drug often referred to as a “z-drug.” It is a sedative-hypnotic drug that is useful for treating insomnia, making it easier for people to fall and stay asleep.
This class of drugs has traditionally been considered “safer” than benzodiazepine drugs, which are notoriously habit-forming and have a high potential for diversion and abuse. Ambien is still a mind-altering drug, however, and can be dangerous when abused. More than 30,000 people sought emergency medical treatment for a negative reaction to the misuse of zolpidem in 2011, the Drug Abuse Warning Network (DAWN) publishes. Anytime Ambien is used outside of a necessary prescription, it is considered drug abuse, and such abuse can lead to many potential negative consequences.
Short-Term Side Effects of Ambien Abuse
Due to many reports of next-day impairment after taking Ambien at night to promote sleep, in 2013, the US Food and Drug Administration (FDA) changed the recommended dosage and approved label modifications for Ambien to warn potential users of the risks. Ambien may cause a kind of “hangover” the next day, leaving individuals feeling mentally sluggish and impairing their ability to concentrate, think clearly, and drive.
Reaction time, motor coordination and cognitive abilities are disrupted with Ambien use, and the risk for accident, injury, and making questionable decisions is high. Individuals may sleepwalk, eat, have phone conversations, drive, or engage in sexual activities while under the influence of Ambien and have no memory of doing so the next day.
The Primary Care Companion to the Journal of Clinical Psychiatry also warns that zolpidem use may result in psychotic symptoms, like hallucinations, delusions, and distortions of the senses. The FDA prints warnings in the Ambien prescribing information that the drug may cause abnormal thoughts and behaviors, potentially leading to depressive or suicidal thoughts, panic attacks, mental confusion, or aggressive behaviors.
The National Highway Traffic Safety Association (NHTSA) reports the following as potential side effects of zolpidem use:
- Difficulties concentrating
- Leg cramps
- Cognitive impairment
- Double vision
- Dry mouth
- Speech issues
Abusing Ambien can increase the potential risks and side effects of the drug. For example, Ambien CR (controlled release) is meant to be swallowed and slowly broken down in the body for a slow and extended release into the bloodstream. If the drug is chewed or crushed to then be snorted, smoked, or injected, the entire dosage is sent into the system at once. This can lead to a potentially toxic overdose as the body is unable to handle such large amounts at one time. Mixing Ambien with other drugs or alcohol can also amplify its effects as well as the risk for overdose. Pinpoint pupils, shallow breathing, drowsiness, loss of consciousness, coma, and potential respiratory failure may occur as the result of an Ambien overdose.
More than 25,000 Americans died from a prescription drug overdose in 2014, the National Institute on Drug Abuse (NIDA) publishes. Additionally, the British Medical Journal (BMJ) reports on studies finding that hypnotic drugs (including zolpidem) increased the hazard of death up to four times over those not taking this type of drug. Incidence of cancer, increased mortality, and excessive deaths are linked to zolpidem (Ambien) usage, BMJ warns.
Ambien Dependence and Withdrawal
Long-term and regular use of zolpidem can cause a withdrawal syndrome similar to that of benzodiazepines when the drug is discontinued, the Indian Journal of Pharmacology reports. Benzodiazepine withdrawal can be difficult as the brain suffers a rebound after the drug is removed.
Benzodiazepines and z-drugs increase levels of gamma-aminobutyric acid (GABA) in the brain. GABA is one of the brain’s chemical messengers that serves to slow down nerve firings involved in the stress response, thus lowering anxiety and muscle tension, and promoting sleep. Heart rate, respiration, body temperature, and blood pressure are all reduced with increased levels of GABA in the brain. Once the brain relies on the presence of Ambien to regulate levels of GABA, it may no longer self-regulate its own chemical makeup. If Ambien use is then suddenly stopped, the brain can suffer a rebound as it struggles to regain balance.
The central nervous system may become hyperactive, and tremors, heart palpitations, sweating, high blood pressure, and irregular respiration rates may occur. Anxiety, depression, agitation, irritability, and cognitive deficits often accompany the traditional benzodiazepine withdrawal syndrome, which can be difficult and even potentially dangerous. Ambien withdrawal is best managed through medical detox, which often uses a tapering schedule to slowly reduce the amount of the drug in a person’s system over a period of time to avoid and control the more significant symptoms of withdrawal.
Signs of Ambien Abuse
Ambien may be used safely under proper medical supervision to treat symptoms of insomnia. Using the drug beyond a necessary prescription, or outside of medical supervision, can be dangerous, however. Individuals abusing Ambien may seek out prescriptions of it after they no longer need the drug, go to multiple doctors to try and get prescriptions of the drug (called “doctor shopping”), take it in higher doses than prescribed, or alter the drug to take it in a manner other than intended.
More than half of the time a prescription drug is abused, the individuals got it for free from a relative or friend, the 2013 NSDUH reports. Families and loved ones should keep a close watch on their medicine cabinet and an eye out for missing medications, as well as be aware of any prescription medications that were not prescribed for a family member or roommate appearing in the house. Some additional signs to watch for if Ambien abuse is suspected include:
- Mood swings
- Unpredictable behaviors
- Increased sociability interspersed with social withdrawal
- More risk-taking behaviors
- Appetite changes
- Decline in physical appearance
- Sleep pattern fluctuations
- Episodes of aggression and behaviors that are odd
- Engaging in activities that there is no memory of the next day
- Near obsession with getting, taking, and recovering from the drug
- Drop in attendance and production at work and/or school
- Inability to consistently fulfill familial and other obligations
- Changes in social circles
Unchecked, chronic Ambien abuse can lead to addiction, or a loss of control over use of the drug. Individuals may then not be able to stop taking Ambien even if they wish to do so. They may take more of it at a time than they intended and may make many unsuccessful attempts to stop use. Individuals may continue to take the drug in potentially dangerous situations, even though they know taking it brings multiple negative consequences. Interpersonal relationships likely suffer, and individuals may struggle to hold down a job and keep up grades in school. Finances may suffer.
Drug dependence, cravings, and difficult withdrawal symptoms are all possible side effects of Ambien addiction that can be treated through a complete addiction treatment program.