Long-term misuse of zopiclone in an alcohol dependent woman with a history of anorexia nervosa: a case report

Abstract

IntroductionThe Z-drugs, zaleplon, zopiclone and zolpidem, are short-acting hypnotics which act at the same receptor as the benzodiazepines, but seemingly without the potential for misuse and the development of dependence of the older benzodiazepines. However, with increased prescribing of Z-drugs, reports of misuse and possible dependence began to appear in the literature, particularly in people with a history of substance misuse and comorbid psychiatric illness. Here we report the case of a woman with a history of chronic zopiclone use and anorexia nervosa, admitted for alcohol detoxification.Case presentationA 31-year old Caucasian British woman with a history of long-term zopiclone use and anorexia nervosa was admitted as an inpatient for a ten-day alcohol detoxification. Her weekly (four days out of seven) intake of alcohol was 180 units and her daily intake of zopiclone, 30 mg. Apart from a short period five years ago, she had been taking zopiclone for 13 years at daily doses of up to 90 mg. She admitted to using 'on top' of her prescribed medication, purchasing extra tablets from friends or receiving them gratis from her partner. After detoxification from alcohol and zopiclone, she was prescribed diazepam which she found ineffectual and voiced her intention of returning to zopiclone on leaving the hospital.ConclusionZopiclone is generally regarded as safer than benzodiazepines, however, this particular individual, who was using high doses of zopiclone over many years, may provide further evidence of a risk of dependency when this drug is prescribed for substance users with a comorbid psychiatric illness.

An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions

“…Despite the reported lack of tolerance and dependence (Lader, 1992; Voderholzer et al, 2001; Zammit, 2009), the occurrence of both rebound insomnia (Lader, 1992; Ebert et al, 2006) and withdrawal symptoms after a therapeutic dosage abrupt discontinuation of Z-drugs has been described, and especially so in alcohol-dependent and drug-abusing patients (Ayonrinde and Sampson, 1998; Hajak, 1999; Hajak et al, 2003; Johansson et al, 2003; Ebert et al, 2006; Zammit, 2009; Morinan and Keaney, 2010). Furthermore, a range of case series and postmarketing surveillance studies have given rise to growing clinical concerns among clinicians (Victorri-Vigneau et al, 2014), suggesting that the prevalence of Z-drug misuse issues could have been underestimated compared with benzodiazepines (Zammit, 2009).…”

A case of zolpidem dependence with extremely high daily doses

“…Zolpidem is now known to have potential to cause severe emotional and physical dependence (Victorri‐Vigneau et al, ), tolerance, euphoria, craving and withdrawal symptoms as highlighted in the case reported. Cases of zolpidem dependence in dosages of up to 600‐1700 mg/day have been reported in literature (Morinan & Keaney, ). But in the above case the daily use was up to 2400 mg/day.…”

“…Zolpidem is a short‐acting imidazopyridine hypnotic, an agonist at the gamma‐aminobutyric acid A type (GABA A ) receptor (Aragona, ; Cubała, Landowski, & Wichowicz, ; Holm & Goa, ; Lichtenwalner & Tully, ; Morinan & Keaney, ; Victorri‐Vigneau, Dailly, Veyrac, & Jolliet, ) which acts selectively on alpha subunit‐containing GABA benzodiazepine (BZ 1 ) receptors with (contrary to classic benzodiazepines) low or no affinity for other subtypes, usually used for the treatment of insomnia (Holm & Goa, ). Therefore, it has been proposed that it lacks the benzodiazepines‐like side‐effects leading to minimal abuse and dependence potential (Harrison & Keating, ).…”

Zopiclone: Is there cause for concern in addiction services and general practice?

“…Effects reported were sedation and euphoria, but also memory and emotional problems, craving and aggression. Other clients reported that they liked zopiclone because it did not cause amnesia, one person claiming a preference over the benzodiazepines, stating that she would return to zopiclone use as soon as she was free to do so [36]. It is evident that some subjects have obtained large quantities of zopiclone, either by 'doctor shopping' or by obtaining extra supplies for the streets, or from family and friends.…”

“…It is evident that some subjects have obtained large quantities of zopiclone, either by 'doctor shopping' or by obtaining extra supplies for the streets, or from family and friends. Intravenous use was rare [31,36], some subjects claiming that they were not aware that it could be injected.…”