Military use
As of 2012, the United States Air Force used zolpidem as one of the hypnotics approved as a "no-go pill" with a six-hour restriction on subsequent flight operation to help aviators and special duty personnel sleep in support of mission readiness. (The other hypnotics used are temazepam and zaleplon.) "Ground tests" are required before an authorization is issued to use the medication in an operational situation.[78]
Recreational use
Zolpidem has potential for medical misuse when the drug is continued long term without or against medical advice, or for recreational use when the drug is taken to achieve a "high".[79][80] The transition from medical use of zolpidem to high-dose addiction or drug dependence can occur with use, but some believe it may be more likely when used without a clinical recommendation to continue using it, when physiological drug tolerance leads to higher doses than the usual 5mg or 10mg, when consumed through insufflation or injection, or when taken for purposes other than as a sleep aid.[79] Recreational use is more prevalent in those having been dependent on other drugs in the past, but tolerance and drug dependence can still sometimes occur in those without a history of drug dependence. Chronic users of high doses are more likely to develop physical dependence on the drug, which may cause severe withdrawal symptoms, including seizures if abrupt withdrawal from zolpidem occurs.[81]
Other drugs, including benzodiazepines and zopiclone, are also found in high numbers of suspected drugged drivers.[15] Many drivers have blood levels far exceeding the therapeutic dose range, suggesting a high degree of excessive-use potential for benzodiazepines, zolpidem, and zopiclone.[82] U.S. Congressman Patrick J. Kennedy says that he was using zolpidem (Ambien) and promethazine (Phenergan) when he was caught driving erratically at 3 a.m.[83] "I simply do not remember getting out of bed, being pulled over by the police, or being cited for three driving infractions," Kennedy said.
As of 2009, nonmedical use of zolpidem is common for some adolescents. Some users have reported decreased anxiety, mild euphoria, perceptual changes, visual distortions, and hallucinations.[84][85] Zolpidem was used by Australian Olympic swimmers at the London Olympics in 2012, leading to controversy.[86]
International travel
Zolpidem is among the agents used in the short-term management of insomnia associated with jet lag, typically at doses of 5–10 mg. Its clinical use, similar to that of other hypnotics, is constrained by the potential for adverse effects and dependence, and guidelines generally recommend limiting treatment duration to short periods, usually under one week.[87]
Regulation
For the stated reason of its potential for recreational use and dependence, zolpidem (along with the other benzodiazepine-like Z-drugs) is a schedule IV substance under the Controlled Substances Act in the US.[18] The United States patent for zolpidem was held by the French pharmaceutical corporation Sanofi-Aventis.[88]
Use in crime
The Z-drugs, including zolpidem, have been used as date rape drugs.[15][89] Zolpidem is available by prescription, and broadly prescribed unlike other date rape drugs: gamma-hydroxybutyrate (GHB), which is used to treat narcolepsy, or flunitrazepam (Rohypnol), which is only prescribed as a second-line choice for insomnia. Zolpidem can be detected in bodily fluids for 36 hours, though it may be possible to detect it by hair testing much later, which is due to the short elimination half-life of 2.5–3 hours.[15] This use of the drug was highlighted during proceedings against Darren Sharper, who was accused of using the tablets he was prescribed to facilitate a series of rapes.[90][91]
Sleepwalking and complex sleep behaviors
Zolpidem has drawn significant media attention due to reports of complex sleep behaviors (CSBs), including sleepwalking, sleep-driving, and other activities performed while not fully conscious. Notable incidents include media reports in the United States concerning events such as Congressman Patrick Kennedy's motor vehicle accident[35][92][93] and in Australia following a fatal 20 m fall from the Sydney Harbour Bridge involving an individual reportedly under the influence of zolpidem.[94][95]
In May 2018, actress Roseanne Barr attributed a controversial remark on Twitter to the effects of zolpidem. Barr's tweet compared Valerie Jarrett, a Black woman and former advisor to Barack Obama, to an ape. The comparison sparked widespread condemnation and led to the cancellation of
Brand names
As of September 2018, zolpidem is marketed under many brands, examples include: Ambien 5 mg & 10 mg (IR oral tablets), Ambien CR 6.25 mg & 12.5 mg (controlled release tablets), Edluar 5 mg & 10 mg (sublingual tablets), Intermezzo 1.75 mg & 3.5 mg (sublingual tablets), and ZolpiMist 5 mg (oral spray).[99][100][7]
