Ambien is infamous for causing people to sleepwalk, raid their refrigerators, or even go for a drivewithout remembering any of it the following morning.
But can this sleeping pill be addictive? Experts say nonot if it's used as directed. However, people who take Ambien at higher-than-recommended doses or for long periods of time may be unaware that they are boosting its addictive potential.
Ambien is far less likely than some other prescription medications to provoke misuse and dependence, but it's not entirely benign, either. "We're now seeing more and more case reportsmany case reportsof people becoming genuinely addicted," says Stephen Ross, MD, an addiction expert at the New York University School of Medicine.
What typically happens in these cases, Dr. Ross explains, is that a person starts taking higher doses of the drug to get the same sleep-inducing benefit. (He has treated people who have become so tolerant to the drug that they pop up to 10 or 20 pillsinstead of the recommended one pillper day.) In the process of treating their insomnia, some people realize they like the "high" or the anxiety-easing effects that Ambien gives them, Dr. Ross adds.
The medication can become habit-forming if taken too oftena possibility that is more likely in those who have a family history of addiction or are currently addicted to other drugs, Dr. Ross says. Ambien can also be dangerous when taken recreationally, especially if mixed with alcohol or other drugs.
A popular drug
Ambien is by far the best-selling prescription sleep medicine in the U.S., followed by Lunesta and, even farther behind, drugs such as Rozerem and Sonata. And the popularity of Ambien and its generic version, zolpidem, has only grown in recent years.
The use of zolpidem has exploded since it first became available in 2007. That year, Americans purchased nearly 16 million zolpidem prescriptions, which represented 30% of all nonbarbiturate sleeping aids sold at pharmacies, according to IMS Health, a health-care information and consulting company. By 2009, the number of prescriptions sold had more than doubled, to 34.9 million. (Use of the brand-name drug fell when the cheaper version became available, but in 2009 Ambien still accounted for 12% of all sleep-medicine prescriptions sold.)
Sleep medications "are widely advertised, they have abuse liability, they are relatively easy to get," says Carol Boyd, PhD, a professor of nursing at the University of Michigan, in Ann Arbor, who studies prescription-medication abuse among young people. Doctors are increasingly prescribing sleep medications to adolescents, which heightens the chances that their friends and family will get access to these medications without a prescription, Boyd says.
The misuse of Ambien and other sleep aids does not appear to be widespread now, Boyd says, but it has the potential to become a problem. "These sleepers must be kept on our national radar."
Although its effect is milder, Ambien targets the same brain networks as drugs such as Xanax and Valium, potent anti-anxiety drugs known as benzodiazepines that can cause dependence when taken for long periods of time.
At standard doses, Ambien and similar medications are generally much less addictive than these benzodiazepines, Dr. Ross says. "It's a drug that works very well for insomniavery, very well," he says. "Overall I wouldn't say it's a drug that has enormous addictive potential or is super-dangerous."
Ambien has a relatively short half-life, meaning it's cleared from the body fairly quickly. The fact that it doesn't linger in the body and cause undue morning wooziness is one of the reasons it has become so popular as an insomnia drug. Still, people who take Ambien to get high or muffle their anxiety may experience a rebound effect as the drug wears off, and may take more pills to combat it.
"It starts out as an attempt at self-medication," Dr. Ross says. "In fact, much of addiction starts that way, [as] a failed attempt at treating one's own symptoms. Addicts are typically not a group that just goes seeking to have pleasure…. It's really people that are in pain or discomfort psychically, and drugs are very good self-treatments that then have the side effect of corrupting and reorganizing their reward and motivation circuits."
In a statement, a spokesperson for the maker of Ambien, Sanofi-Aventis, said that people should take Ambien only as directed.
A growing problem?
The misuse of prescription drugs is a serious and growing problem in the U.S. Many people don't think twice about sharing drugs they've been prescribed with friends or family members. And most of the time, people "borrowing" prescription drugs are using them for pain or to help them sleep, not to get high.
The most widely abused prescription drugs are opiates (such as Oxycontin), benzodiazepines and barbiturates, and stimulants (such as Ritalin). Sleep medications, including Ambien and Lunesta, which are known as sedative hypnotics, lag far behind.
"These are very popular, [and] prescription rates are increasing," Boyd says. The growing availability of sleep medications seems likely to contribute to higher rates of use without a prescription (also known as nonmedical use), she adds.
For now, however, the practice remains relatively uncommon. In an ongoing study of middle schoolers, Boyd and her colleagues found that between 2% and 3% had taken sleeping pills without a prescription, usually to help them go to sleep (rather than to assuage anxiety).
Monitoring the Future, a long-running annual survey of U.S. teenagers in grades 8, 10, and 12, began asking students specifically about their Ambien use only in 2007. Since then, less than 2% of high school seniors surveyed reported trying the drug.
The rates are similar among adults. In other national surveys, between 2% and 2.5% of adults said that they had used Ambien that wasn't prescribed to them.
And in recent Congressional testimony, Nora Volkow, MD, the director of the National Institute on Drug Abuse, highlighted Ambien as a "troubling sign of a growing problem." Ambien-related emergency-room visits more than doubled between 2004 and 2008, from 13,000 to about 28,000, she said.
Although the practice appears to be relatively rare, there are people out there who do take Ambien recreationally.
Mike, 26, who lives in Minnesota and works in the airline industry, says he got a prescription for Ambien without even asking for one. "I told the doctor I was traveling overseas and wanted something to help me sleep so that it would help with jet lag," he says. "I had heard Ambien could be used to ‘trip' when you take it and don't fall asleep. I was curious to try, so I did."
He experienced some visual distortions, and lost his sense of time. "It can be very dangerous because you get this feeling that you aren't under the effects of the drugs, although you are," he explains. "You will barely remember anything, especially when mixed with alcohol. Even a small amount of alcohol intensifies the trip; only a few beers can do it." (Ambien's label warns against taking the drug with alcohol.)
And the consequences weren't fun. "I think the biggest thing is just how you behave on the drug," says Mike. "I would call people such as ex-girlfriends, parents, friends, and have entire conversations that I would not remember. I would write emails and talk to people on my computer and wouldn't remember. One time, while I was on the drug, I talked to a friend on a webcam. He recorded me on his computer and showed me the video the next day. I did not remember any of it. Some of the things you do can be extremely embarrassing and are things you would never do sober."