The Disturbing Side Effect Of Ambien, The No. 1 Prescription Sleep Aid
By Allison McCabe
On March 29, 2009, Robert Stewart, 45, stormed into the Pinelake Health and Rehab nursing home in Carthage, North Carolina and opened fire, killing eight people and wounding two. Stewart’s apparent target was his estranged wife, who worked as a nurse in the home. She hid in a bathroom and was unharmed. Stewart was charged with eight counts of first-degree murder; if convicted, he could face the death penalty. Even though there was evidence that Stewart’s actions were premeditated (he allegedly had a target), Stewart’s defense team successfully argued that since he was under the influence of Ambien, a sleep aid, at the time of the shooting, he was not in control of his actions. Instead of the charges sought by the prosecutors, Stewart was convicted on eight counts of second-degree murder. He received 142 – 179 years in prison.
Ambien, a member of the class of medications known as hypnotics, was approved by the FDA in 1992. It was designed for short term use to combat insomnia and was a welcome change from the prevailing sleep aid at the time, Halcion, which had been implicated in psychosis, suicide, and addiction and had been banned in half a dozen countries. Ambien works by activating the neurotransmitter GABA and binding it to the GABA receptors in the same location as the benzodiazepines such as Xanax and Valium. The extra GABA activity triggered by the drug inhibits the neuron activity that is associated with insomnia. In other words, it slows down the brain. Ambien is extremely effective at initiating sleep, usually working within 20 minutes. It does not, however, have an effect on sustaining sleep unless it is taken in the controlled release form.
After its approval, Ambien quickly rose to dominance in the sleep aid market. Travelers swore by it to combat jet lag, and women, who suffer more insomnia than men, bought it in droves. Sanofi, Ambien’s French manufacturer, made $2 billion in sales at its peak. In 2007 the generic version of Ambien was released, Zolpidem, and at less than $2 per pill, it still remains one of the most prescribed drugs in America, outselling popular painkillers like Percocet and prescription strength ibuprofen.
Although the Ambien prescribing information warned, in small print, that medications in the hypnotic class had occasional side effects including sleep walking, “abnormal thinking,” and “strange behavior,” these behaviors were listed as extremely rare, and any anecdotal evidence of “sleep driving,” “sleep eating,” or “sleep shopping”—all behaviors now associated with Ambien blackouts—were characterized as unusual quirks, or attributed to mixing the medication with alcohol. It wasn’t until Patrick Kennedy’s 2006 middle-of-the-night car accident and subsequent explanation to arriving officers that he was running late for a vote that the bizarre side effects of Ambien began to receive national attention. Kennedy claimed that he had taken the sleep aid and had no recollection of the events that night.
Shortly after the Kennedy incident, Ambien users sued Sanofi because of bizarre sleep-eating behaviors while on the drugs. According to Chana Lask, attorney for the class action suit, people were eating things like buttered cigarettes and eggs, complete with the shells, while under the influence of Ambien. Lask called people in this state “Ambien zombies.” As a result of the lawsuit, and of increasing reports coming in about “sleep driving,” the FDA ordered all hypnotics to issue stronger warnings on their labels.
In addition to giving consumers extra information so they could take the medication more carefully, the warning labels also gave legitimacy to the Ambien (or Zombie) defense. In March of 2011, Lindsey Schweigert took one Ambien before getting into bed at 6pm. Hours later, she woke up in custody with no idea how she’d gotten there. In the following weeks, Schweigert pieced together the events of that night. She’d gotten out of bed, drawn a bath, and left the house with her dog. She started driving to a local restaurant but crashed into another car soon after leaving her house. Police described her as swaying and glassy-eyed. She failed a sobriety test and was charged with DWI and running a stoplight.
Schweigert had a job that required a security clearance. She had never been in trouble with the law before and was terrified of losing her job and having a criminal record. Prosecutors initially wanted to impose a six month jail sentence in addition to other punishments, but Schweigert’s lawyer argued that Lindsey’s bizarre behavior on the night in question was a result of a medication which warned right on the label that “After taking AMBIEN, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night…Reported activities include: driving a car (“sleep-driving”), making and eating food, talking on the phone, having sex, sleep-walking.” In fact, the lawyer argued, Schweigert should have been taken to a hospital, not to jail. Prosecutors dropped the charges and allowed Lindsey to plead to the lesser charge of careless driving, which meant that she could keep her security clearance. Her license was suspended for a year, however, and she had to pay upwards of $9,000 in legal fees.
As a result of the Schweigert verdict, an attorney successfully used the Ambien defense to overturn a 2006 DWI conviction for a New Jersey woman by arguing that the drug's labeling had changed six months after his client’s arrest. The court agreed, saying that it would be an "injustice to hold her responsible for the undisclosed side effects of a popular and readily available medication that she was lawfully prescribed and properly administered."
The Ambien defense was also used in the case of Julie Ann Bronson, a 45-year-old flight attendant from Texas. In April of 2009, Bronson took a couple of Ambien to help her sleep. She had been drinking wine earlier in the day, and went to bed early. She awoke the following morning in jail, still in her pajamas, barefoot and terrified. When she was told that she had run over three people, including an 18-month-old girl who suffered severe brain damage as a result of the wreck, she was horrified. “It was surreal. It was like a bad dream.” In May of 2012, Bronson pleaded guilty to the felonies of intoxication assault and failure to stop and render aid. “I did the crime but I never intended to do it,” she testified. “I wouldn’t hurt a flea. And if I would have hit somebody, I would have stopped and helped. We’re trained in CPR.” Bronson faced ten years, but because of the Ambien defense, she will serve six months in prison and have ten years of probation.
Not all prosecutors will consider the Ambien defense, and its position within established criminal rules is tenuous. It doesn’t really fall under “voluntary intoxication,” in which someone is responsible for his own intoxication and any events that occur as a result of that intoxication. The Ambien defendants knowingly took the drug, but they were not aware that they were drugging themselves in a way that could produce anything other than sleep. Nor does the Ambien defense fit under “involuntary intoxication,” which is when someone commits a crime after being drugged without his knowledge, or has an unpredictable reaction to a prescribed medication. The defendants knowingly took the medication, and the reactions, although surprising, were not unpredictable because they are listed as potential side effects in the prescribing information. Finally, there is the “unconsciousness/sleepwalking” defense, in which the person is not responsible for the crime if he did not intentionally cause the sleepwalking or unconsciousness. The whole motivation for taking Ambien in the first place is presumably to cause unconsciousness so this defense doesn't really apply either.
Ironically, you are more likely to be successful using the Ambien defense if you injure or kill someone than if you just crash into a parked car or a tree. DWI laws usually just require the prosecution to prove that the defendant was loaded and got into a car to drive. There’s no requirement to show intention. When someone is harmed, however, it is up to the prosecutor to prove that the defendant was aware enough to be guilty of the crime. If people on Ambien are acting in an automatic, or unconscious state, it’s hard to claim that they have knowledge of their actions. That’s why people like Lindsey Schweigert get suspended licenses while Donna Neely, who was sleep-driving on Ambien and killed a mother of 11, was acquitted of vehicular manslaughter.
Not everyone who engages in bizarre behavior as a result of taking Ambien ends up in legal trouble. And some people enjoy the high they get from the drug so much that they are willing to overlook the blackouts and negative consequences that result from their drug use. Most recreational users started out taking the drug to treat insomnia, but found that if they fought the drug’s sleep-inducing effect, they could get really high. “It's like having that last drink at the bar when you know you should go home -- I'd fight the pill's effects and stay up, often telling my friends insane things like how to turn the light in the room into energy, or how paintings of forest scenes on their walls were actually drawings of mermaids bathing themselves in blood,” writes one young woman whose addiction to Ambien caused increasingly bizarre and alienating behavior. She continued taking the pill and staying awake regularly until one morning she woke up with two black eyes and a cut across her nose. Her pillows were bloody, and there was a stranger, naked and wrapped in a rug, on her floor. Neither she nor the stranger had any recollection of the events of the previous night. That situation, though jarring, was not enough to get her to give up Ambien; the high was too good. She took a break, but was soon back to taking it regularly, filled with rationalizations for her erratic behavior (All 20-somethings take drugs!) It wasn’t until she was found wandering the Brooklyn streets in the middle of the night, nearly naked, that she was able to give it up for good.
Rapper Eminem, whose albums have titles like “Relapse” and “Recovery,” has been open about his battles with prescription drug addiction, including his near overdose on methadone, his relapse, and his eventual detox. He blames Ambien, however, for huge lapses in his memory over five years and an extended period of writer's block. “…a lot of my memory is gone. I don't know if you've ever taken Ambien, but it's kind of a memory-eraser. That shit wiped out five years of my life. People will tell me stories, and it's like, "I did that?" I saw myself doing this thing on [television network] BET recently, and I was like, "When was that?"” Eminem has kept some of his writing from that period, admitting to Rolling Stone that “It fucking creeps me out…Letters all down the page – it was like my hand weighed 400 pounds. I have all that shit in a box in my closet. As a reminder that I don’t ever want to go back.”
Tiger Woods was also famously associated with Ambien when one of his mistresses claimed that she and the golfer would have “crazy Ambien sex.” Ambien lessens inhibitions and erases memories, an ideal combination for someone who is cheating on his spouse. The buzz created by the drug appears to enhance sex as well. One woman described feeling “very relaxed and sensual” when she had sex on Ambien. “I suddenly have floaty energy. . I am tired, but energetic. It’s almost like I’m in a dreamlike state. I might compare it a little to weed, but nothing that I’ve done really compares, to be honest.”
The darker flipside to Ambien’s purported sex-enhancing qualities is that it is becoming increasingly used as a date rape drug. In fact, the only case of “sleep-sex” that appeared in a 2008 medical journal review of case reports on Ambien-related sleep behaviors involved the Ambien taker being raped. The same lack of inhibition combined with amnesia that allows people to commit crimes, indulge in dishonest behavior, and have great sex on Ambien is also an ideal formula for a sexual predator. Ambien is also much more widely available and easily accessible than rohypnol, the drug usually associated with date rape.
Ambien is an effective sleep aid and a huge money maker for its manufacturer. Most people take it as prescribed and treat their insomnia successfully with no problems. But the problems that do occur with the drug are often extreme and tragic, and they seem to be increasing. (These cases only scratch the surface – currently a man in Northern California is using the Ambien defense to fight a charge of second degree sexual abuse of a minor and third degree sexual abuse of a minor. He allegedly molested a 10-year-old girl in April of 2012. He has no recollection of the alleged molestation and a polygraph test supports his claim. His court case is set for March. There is also a whole website, Ambien Outrage, dedicated to making “the public aware of the dangers of Ambien, Ambien CR and Zolpidem.” Additionally it maintains a database of “victims of Ambien,” those people who have either been harmed or killed by people on Ambien, or who have themselves committed bizarre acts while on Ambien.)
In May of last year, the FDA acted again to change the labeling on Ambien, this time lowering the recommended dose and warning people who take the controlled release version that they "should not drive or engage in other activities that require complete mental alertness the day after taking the drug because zolpidem levels can remain high enough the next day to impair these activities." If the whole idea of taking a sleep aid is to treat insomnia so that you can function more effectively during the day, being instructed to avoid driving and other activities that require mental alertness seems to defeat the purpose of taking the drug in the first place.
The DEA categorizes drugs according to their potential for abuse and addiction. Schedule I drugs are the most likely to be abused, and Schedule V drugs have the least potential for abuse or addiction. Ambien is a schedule IV drug, and can be prescribed and refilled without restriction. Some toxicologists, such as Janci Lindsay, believe that many Ambien-related tragedies would be avoided if the drug were upgraded to Schedule II, a category that includes controlled substances such as Ritalin and Oxycontin. Other countries, such as Australia, Taiwan, and Japan, have all issued special warnings about Ambien and have begun regulating the drug more carefully ever since reports started surfacing about “potentially dangerous” Ambien-induced behaviors.
Julie Ann Bronson took ambien and then later got out of bed and got behind the wheel in a blackout. She ended up running over people and causing a baby to have severe brain damage. Lindsey Schweigert also got out of bed, unconscious, and engaged in bizarre behavior before crashing her car. Even in the wake of these and other tragedies, Sanofi still maintains that "When taken as prescribed, Ambien is a safe and effective treatment for insomnia." Sanofi also points out that the prescribing literature warns patients not to drive or to get out of bed after taking the medication.
Just think: If only Julie, Lindsey, and countless others had followed Sanofi's instructions and not gotten out of bed, all these tragedies could have been prevented!
Merck is currently working on a new sleep medication which acts on different receptors than the hypnotic medications. In early studies, the drug appears to be effective at treating insomnia while lacking the disturbing side effects of the hypnotics. If successful, the drug would be a much needed alternative to the current group of sleep aids which all work the same way in the brain. It's not clear, however, that any new medication could even make a dent in the $1.6 billion U.S. market for insomnia treatments currently dominated by Ambien.