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Ambien defence: the real side effects of sleeping pills

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Shortly after her hit show was cancelled earlier this week, Roseanne Barr took to Twitter to blame Ambien, the sleeping pill, for her racist outburst.

“Guys I did something unforgivable so do not defend me,” she told her 838,000 followers. “It was 2 in the morning and I was Ambien tweeting.”

It was the second time in as many months that the insomnia medicine played a central role in the downfall of someone in the public eye. In April, Ronny Jackson withdrew as a candidate to lead the Department of Veterans Affairs following allegations that he had misprescribed the drug.

The allegations, which Dr Jackson denies, related to his time as a White House physician during the Obama administration, when he apparently earned the nickname “Candyman” because he handed out the sleeping pills so liberally.

Nor is Ms Barr the first US celebrity to attribute her strange behaviour to Ambien.

In March, Sean Penn, the Oscar winning actor, announced he had just taken the drug during a bizarre interview on The Late Show. Tom Brokaw, the news anchor, was rushed to hospital in 2012 after swallowing a tablet by mistake before appearing on the set of Morning Joe. And Tiger Woods reportedly had the drug in his system when he crashed his SUV into a fire hydrant in 2009.

Indeed, the sleeping medication is identified as a factor in so many bizarre incidents — from sleepwalking to amnesiac midnight feasts — that people describe the excuse, often incredulously, as the “Ambien defence”.

Sanofi, the French drugmaker that launched Ambien in the US in 1992, was quick to rebuff Ms Barr’s implication of its medicine, which has since lost patent production and now tends to be prescribed as a cheaper generic called zolpidem.

“While all pharmaceutical treatments have side effects, racism is not a known side effect of any Sanofi medication,” the company said in a tweet.

The pharmaceuticals group earned plaudits for its tart response, although some wondered whether the company was being too glib given the very real dangers of taking the sleeping drug.

“Nobody should be taking zolpidem at all because the side effects are so dangerous,” said Daniel Kripke, an emeritus professor of psychiatry at the University of California San Diego. “If Roseanne were under its influence, she very well might have said things she’d never say sober.”

Dr Kripke said Ms Barr, 65, especially should not have been prescribed the drug given the particular risks for users aged over 60, who are more susceptible to side effects such as dizziness, drowsiness and diarrhoea, according to the US Food and Drug Administration.

The prevailing view among doctors and psychiatrists is that Ambien would not turn someone into a racist but could make them less circumspect about telegraphing their opinions.

“It would not make a person hold bigoted views, but it might make him or her more prone to express them,” said David Juurlink, head of the Clinical Pharmacology and Toxicology division at Sunnybrook Health Sciences Centre in Toronto.

He added: “One can blame Ambien for her sending the tweet, but not for the content.”

Whether or not Ambien can credibly be blamed for Ms Barr’s outburst, Dr Juurlink said the medicine is over-prescribed in the US given the dangers. Over time, the drug can “clearly mess with a person’s sleep architecture” so that they become dependent on the medicine, he explained.

“There is no end to cases of patients who insist they can’t get to sleep without Ambien because their brain has been rewired by regular use of the drug,” he said.

Thursday, 31 May, 2018

The number of sleeping and insomnia tablets prescribed in the US — including Ambien and other popular alternatives such as Lunesta — has been steadily declining in recent years, according to figures from Iqvia, a data provider. About 47m tablets were prescribed in 2017, about 10m fewer than in 2013.

One explanation is that US doctors have become more circumspect about giving patients habit-forming drugs amid a raging opioid epidemic that has been blamed for falling life expectancy in America.

“It’s possible there’s been a bit of reflection and scrutiny that’s spilled over from the opioid crisis,” said Dr Juurlink.

But even if prescribing is falling in the general population, it would not account for what he described as a “casual acceptance” of the drug in politics and show business, where people often contend with unforgiving schedules.

The medical evidence suggests they should not be so blasé, regardless of whether Ms Barr’s protestations ring true.

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