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Ambien Abuse: When Is It Time to Seek Treatment?

Ambien is one of the most prescribed and popular medications for the treatment of insomnia in the United States. It belongs to the class of drugs called Z-drugs, which are similar in action and mechanism to benzodiazepines. However, they were initially believed to have less potential for abuse and fewer side effects than their highly addictive cousins.

Ambien is a nonbenzodiazepine sleep aid. The Journal of the American Medical Association (JAMA) Internal Medicine reports that zolpidem, the active ingredient in Ambien, was one of the top five most commonly prescribed psychiatric drugs and the most widely used hypnotic medication in the U.S. in 2013.

Ambien is considered to be a sedative-hypnotic drug that treats insomnia by helping a person to fall asleep and stay asleep through the night. It comes as a tablet that is designed to be taken orally (by mouth) and swallowed once per day before bed.

Like benzodiazepine medications, Ambien is believed to calm overactivity in the brain by engaging with levels of the naturally occurring neurotransmitter GABA (gamma-Aminobutyric acid). The drug interacts with and binds to its receptor sites. Ambien can help a person to relax by calming and depressing the central nervous system and hyperactive nerve firings for sedative effects.

Ambien can be abused for a euphoric high or self-medication, and it does have addictive potential as well. Misuse of Ambien is a cause for concern and can signal that it is time to get professional help.

Dosing and Side Effects 

Insomnia drugs like Ambien are going to induce drowsiness as a side effect since that is what the medications are designed to do—help people fall asleep. The FDA warns that Ambien and other medications containing zolpidem can cause next-day impairment if enough time is not allowed for the drug to be completely metabolized and eliminated from the body. People have reported instances of eating, walking, and driving as well as talking on the phone or having sex while apparently asleep. They have no memory of these actions the next day. The New Yorker publishes that Ambien use has been linked to car accidents, suicide, and depression. 

Ambien interacts with brain chemistry and has mind-altering effects. Reflexes, coordination, balance, logical thinking, memory, and cognitive abilities can all be negatively affected by Ambien use. The medication can make a person feel sluggish, lethargic, and have trouble moving normally. Headache, dizziness, appetite changes, nausea, dry mouth, tremors, muscle cramps, lightheaded feeling, unusual dreams, and tingling in extremities are further side effects of zolpidem, the U.S. National Library of Medicine (NLM) publishes. The Journal of Medical Toxicology warns that psychosis and hallucinations are also potential side effects of zolpidem use.

Ambien comes in an immediate-release formulation and as Ambien CR, or controlled- Ambien CR doles out the dosage slowly over an extended period while the immediate-release form sends the entire dosage into the body at once.

Ambien dosage will vary from person to person, depending on how much it may take to be effective, which can be influenced by biology and genetics. Gender is a factor in Ambien dosing as it can take longer for the drug to be metabolized and eliminated in a woman than a man. Studies published in the New England Journal of Medicine (NEJM) show that zolpidem remains active in the blood longer for women than for men; therefore, the recommended dosage is lower for women than men. The dosage has been lowered from 10 mg to 5 mg for immediate-release Ambien and from 12.5 mg to 6.25 mg for Ambien CR for women. This recommendation came down because women were experiencing impaired driving abilities the morning after taking Ambien at higher rates than men were.

Overdose Potential

As a central nervous system depressant, Ambien can cause potentially life-threatening respiratory and cardiovascular suppression, leading to breathing difficulties, a weak pulse and low heart rate, and lowered body temperatures. An Ambien overdose can cause seizures, sedation, loss of consciousness, coma, lack of oxygen to the brain and brain damage, and even death.

Abusing Ambien carries a high risk for an adverse health consequence, such as a potential overdose. In 2011, there were more than 30,000 people who sought emergency medical treatment for a negative reaction to zolpidem misuse in an emergency department (ED), according to the Drug Abuse Warning Network (DAWN). Several things can increase the risk for a fatal Ambien overdose. Among them are:

  • Taking Ambien in doses beyond the recommended dosage
  • Altering the drug and abusing it in a way other than it is meant to be taken, such as chewing it, crushing it and then injecting, snorting, or smoking it (Ambien CR is intended to be delivered in a time-release fashion, and these methods of use send the whole dosage into the bloodstream at once.)
  • Taking Ambien with other drugs, particularly other central nervous system depressants like benzodiazepines, antidepressants, or opioids, or with alcohol
  • The presence of a co-occurring medical health concern, mental illness, or other biological factors that could influence drug metabolism

An Ambien overdose requires immediate medical attention.

Dependence and Risk for Addiction

One of the most noteworthy health risks for taking Ambien on a long-term basis is the potential for drug dependence and tolerance. A person’s brain can get used to certain levels of Ambien, which can then cause them to need to take higher doses for the drug to keep working the same way.

Ambien is recommended to be taken for a short time; it is not a long-term solution for insomnia because of its high potential for drug dependence. 
Drug dependence forms with regular and repeated use of Ambien. The British Journal of General Practice (BJGP) reports that about a quarter of the people who use Ambien experience withdrawal symptoms when they try to stop taking the medication.

British Journal of General Practice (BJGP)

Withdrawal can be intense when Ambien processes out of the body. The medication guide for Ambien CR warns that the following side effects can occur for one to two days after stopping the medication:

  • Sleep difficulties
  • Stomach cramps
  • Nausea
  • Lightheadedness
  • Uncontrollable bouts of crying
  • Flushing
  • Stomach pain
  • Nervousness
  • Panic attacks
  • Vomiting

Depression, restlessness, anxiety, appetite changes, agitation, tremors, cravings, and insomnia are all potential side effects of Ambien withdrawal. The intensity and duration of withdrawal can be affected by the level of drug dependence a person struggles with. This is directly influenced by how much Ambien a person takes regularly and how often they have been taking it.

These uncomfortable withdrawal symptoms can make it tough to stop taking Ambien without help. This can lead to compulsive drug-seeking and using behaviors and possible addiction.

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How and When to Get Help for Abuse and Addiction

Nearly a half million Americans misused a sedative drug in the month leading up to the 2016 National Survey on Drug Use and Health (NSDUH). Any use of Ambien outside of the way it was prescribed is drug abuse as is any use of a prescription medication without a valid prescription. 

With Ambien, use may start out innocently enough and turn problematic, as drug dependence and cravings happen. There are some signs that it’s time to get professional help for Ambien abuse. They include:

  • Taking Ambien in between doses or in higher doses than prescribed
  • Exaggerating symptoms to get more Ambien
  • Going to more than one doctor to try and get multiple prescriptions for Ambien, called doctor shopping
  • Taking Ambien after a prescription runs out
  • Illicitly obtaining an Ambien prescription or the drug to take without a legitimate or medically necessary prescription
  • Spending a large amount of time figuring out how to get more Ambien, using the drug, and recovering from its effects
  • Keeping the medication in easy-to-reach locations and finding lots of empty pill bottles in the trash
  • Significant mood swings, out-of-character behaviors, and even a potential shift in personality
  • A decline in physical health and appearance, including weight fluctuations and lack of attention to personal hygiene
  • An inability to stop taking Ambien and needing to take it to feel balanced
  • Continuing to take it even knowing that doing so will have negative side effects
  • Taking it in situations that may cause physical harm and be potentially hazardous, such as before driving
  • A drop in work or school attendance and in one’s ability to keep up with regular obligations consistently
  • Interpersonal relationship difficulties, social isolation, increased secrecy, and changes in social circles as well as a decreased interest in activities that were previously important

Ambien use should be closely monitored by a healthcare professional, as the drug does have a potential for abuse and addiction. Any nonmedical use of the medication is considered problematic.

Treatment Methods 

Ambien is a drug that should be tapered off slowly and not stopped cold turkey. As such, if drug dependence is high, a medical detox program is the ideal starting point for a treatment program. With medical detox, Ambien can be weaned out of the body in a controlled fashion, and medications can be used to manage withdrawal symptoms.

After detox, Ambien abuse is optimally treated through either an outpatient or inpatient (residential) specialized program. Programs for Ambien abuse and addiction will focus on supportive and therapeutic methods, helping to teach coping mechanisms for stress and tools for minimizing relapse.

Since Ambien is a sleep aid and individuals may struggle with sleep issues after stopping the medication, holistic measures such as yoga, massage therapy, and mindfulness meditation can improve sleep naturally and be a helpful part of treatment. Support groups and medication management are also components of a complete treatment program. Each person will benefit from a specialized treatment program that is tailored to them.

Sources

(September 2018). Assessment of Patterns of Potentially Unsafe Use of Zolpidem. JAMA Internal Medicine. from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2687525

(February 2018). Questions and Answers: Risk of Next-Morning Impairment After Use of Insomnia Drugs; FDA Requires Lower Recommended Doses for Certain Drugs Containing Zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). U.S. Food and Drug Administration. from https://www.fda.gov/drugs/drugsafety/ucm334041.htm

(December 2013). The Big Sleep. The New Yorker. from https://www.newyorker.com/magazine/2013/12/09/the-big-sleep-2

(August 2018). Zolpidem. U.S. National Library of Medicine. from https://medlineplus.gov/druginfo/meds/a693025.html

(June 2013). The Clinical and Forensic Toxicology of Z-Drugs. Journal of Medical Toxicology. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657020/

(August 2013). Zolpidem and Driving Impairment- Identifying Persons at Risk. New England Journal of Medicine. from https://www.nejm.org/doi/full/10.1056/nejmp1307972

(May 2013). Drug Abuse Warning Network 2011: National Estimates of Drug-Related Emergency Department Visits. Substance Abuse and Mental Health Services Administration. from https://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf

(June 2008). Magic Bullets for Insomnia? Patients Use and Experiences Of Newer (Z Drugs) Versus Older (Benzodiazepine) Hypnotics for Sleep Problems and Primary Care. British Journal of General Practice. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2418994/

(October 2014). Medication Guide Ambien CR. Sanofi-Aventis. from http://products.sanofi.us/ambien_cr/ambiencr_MedGuide.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. from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm

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