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

Abstract

OBJECTIVE: To examine the research on the dependence and abuse potential of zopiclone and the concerns that may be raised for addiction treatment services and General Practice. The focus is on four main areas: Problems that may arise from recommended use; Driving; Issues relating to dependence, and Abuse or recreational misuse. METHOD: Internet-based searches were carried out using the key descriptors of zopiclone and driving, road traffic accidents, dependence, withdrawal, abuse, misuse and overdose. RESULTS: Problems arising from recommended use are rare and almost always confined to common side-effects. Drivingrelated studies indicate the potential for driving impairment for up to 12 hours following use and this has clear implications for both addiction services and general practice. The likelihood of dependence increases once recommended doses and time-frames are exceeded and vulnerable populations such as psychiatric patients and those with addiction problems are at risk. CONCLUSION: Somewhat contrary to impressions that Zopiclone has little or no abuse potential, there is evidence that this medication is prescribed at higher than recommended doses and for longer than recommended. It can also be obtained readily other than by prescription. The potential for deliberate abuse may now be regarded as established, albeit at low levels compared to the benzodiazepines and this requires a degree of vigilance by prescribers and care managers.

NOVEL MEASURES OF BENZODIAZEPINE & Z-DRUG UTILISATION TRENDS IN A CANADIAN PROVINCIAL ADULT POPULATION (2001-2016 )

“…[44][45][46][47] However, widespread substitution of BZD use with Z-Drug use, while often considered the 'lesser of 2 evils' in terms of safety, is neither devoid of substantial risk nor clearly superior in effectiveness. [48][49][50] Additionally, the increase in all measures of Z-Drug usage may indicate a rise in the burden of FIG 3 Proportion of annual prescriptions in first and last year by BZD e31 insomnia and related sleep disorders in the Manitoba population over the 15-year study period. Observed increases in DI or consumption of common hypnotic benzodiazepines such as temazepam and triazolam lend further support to this hypothesis.…”

Initiation and long‐term use of benzodiazepines and Z‐drugs in bipolar disorder

“…Although Z-drugs were initially perceived as having little or no abuse potential, more recent data show that Z-drugs are associated with considerable psychological and physiological dependence and abuse. 37,38 Furthermore, insomnia is common in all phases of bipolar illness 39 and may impair the overall prognosis if left untreated, 40 which is why off-label treatment with benzodiazepine/Z-drug hypnotics for a longer time than recommended may sometimes seem legitimate if patients fail to respond to non-benzodiazepine hypnotics. Notably, use of non-benzodiazepine hypnotics was associated with increased odds for benzodiazepine initiation and long-term use in the crude analysis, although this variable had to be removed from the adjusted analysis due to high correlation with other variables.…”

“…The Z‐drug zopiclone was the most frequently prescribed substance, and associated with a 21% absolute risk of long‐term use. Although Z‐drugs were initially perceived as having little or no abuse potential, more recent data show that Z‐drugs are associated with considerable psychological and physiological dependence and abuse . Furthermore, insomnia is common in all phases of bipolar illness and may impair the overall prognosis if left untreated, which is why off‐label treatment with benzodiazepine/Z‐drug hypnotics for a longer time than recommended may sometimes seem legitimate if patients fail to respond to non‐benzodiazepine hypnotics.…”