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Belonging to a class of sedative-hypnotic drugs that are not benzodiazepines, but often termed non-benzodiazepine “z-drugs,” zolpidem is the active substance in Ambien, a popular sleep aid prescribed to treat insomnia. Ambien and Ambien CR (controlled-release) are marketed to help people fall and stay asleep.
Z-drugs were initially believed to have fewer potential side effects than the chemically similar benzodiazepine drugs. In fact, z-drugs are thought to have a similar method of action to benzodiazepines, slowing brain activity and suppressing functions of the central nervous system to enhance sleep. It has been reported that z-drugs like Ambien do have the potential for abuse, however, as well as both short-term and long-term risk factors for use.
Most common side effects of z-drugs like Ambien include stomach upset, dizziness, and headache. While these drugs have lower odds for overdose, the Journal of Medical Toxicology warns that overdose is possible, which can lead to coma, brain damage, or death. Abusing Ambien increases the risk for overdose.
Ambien CR releases the medication in a time-release fashion, and if the drug is chewed or crushed and then injected, snorted, or smoked, the whole amount of zolpidem enters the bloodstream at once, which can quickly overwhelm the body and brain and lead to a possibly fatal overdose.
Ambien overdose is not that different from benzodiazepine overdose. Sedation, nausea and vomiting, mental confusion, extreme drowsiness, loss of muscle and motor control, and low heart rate and pulse may occur. In 2011, just over 30,000 Americans received care in an emergency department (ED) for an adverse reaction to zolpidem abuse, the Drug Abuse Warning Network (DAWN) publishes.
Ambien clouds and impairs thinking and decision-making. It is meant to be taken to go to sleep, but even when taken as directed, it can result in next-day impairment. The U.S. Food and Drug Administration (FDA) issued a Safety Announcement regarding zolpidem medications (including Ambien and Ambien CR) in early 2013, recommending lower doses as impairment from these drugs can extend into the next day and the morning after taking them, particularly for women. Things like driving and anything that requires mental alertness may be impacted.
Prescribing information for Ambien warns of cognitive deficits and impaired motor skills, especially in the elderly population, after taking the drug. Individuals may unknowingly engage in activities, such as driving, sexual intercourse, eating, or talking on the phone while taking sleep aids and have no memory of these activities the next day.
When Ambien is taken recreationally (without a legitimate and necessary prescription), the potential side effects increase. A person under the influence of Ambien may appear drunk and be uncoordinated, sluggish, drowsy, have blurred vision and slurred speech, and not be able to remember things clearly or think rationally. Decision-making abilities are impaired, and risk-taking behaviors likely increase as inhibitions are lowered. The rate of injury and possible involvement in an accident are elevated as well. Questionable sexual behaviors may raise the risk for unwanted pregnancy or the transmission of sexually transmitted diseases.
Ambien is a sedative, which can impair short-term memory functions and make it more likely for a person to fall victim to sexual assault or other crimes. Ambien can cause a person to act in ways that are out of character and result in possible aggression, hostility, or other erratic behaviors.
Ambien is not designed to be taken as a long-term solution for insomnia. The U.S. National Library of Medicine (NLM) publishes that it should only be taken for a few days and not longer than 1-2 weeks to manage insomnia. Ambien is considered to be habit-forming, and taking it for longer than the recommended timeline can lead to tolerance and then drug dependence.
Ambien likely impacts levels of gamma-aminobutyric acid (GABA) in the brain. GABA is a neurotransmitter produced by the brain to mitigate anxiety and lower stress. In this manner, it acts like a natural tranquilizer, slowing functions of the central nervous system and enhancing relaxation. In time, the brain can become accustomed to the artificially elevated levels of GABA that Ambien causes, which can mean it will stop working at normal doses. As tolerance develops, a person will then need to take more of it for it to keep working. The more of a drug someone takes and the more often they take it, the higher the odds are that they will become physically dependent on it.
With Ambien, physical dependence can result in difficult withdrawal symptoms when the drug isn’t active in the bloodstream (i.e., after it wears off and another dose isn’t taken).
Ambien withdrawal may include the following side effects:
The British Journal of Clinical Pharmacology (BJCP) reports that in spite of earlier indications that zolpidem had fewer side effects than benzodiazepine drugs, it may still be abused, cause dependence, and create some of the same behavioral side effects as benzos do. Abuse of Ambien is likely more common in those who have a previous history of drug dependence and abuse, and also in individuals who suffer from co-occurring mental health and/or medical disorders.
Cravings and a desire to avoid withdrawal symptoms can entice a person to continue abusing Ambien and may lead to addiction. Addiction may result in loss of a job, poor grades at school, interpersonal relationship and social issues, health problems, homelessness, financial strife, possible criminal entanglements, and more.