Ambien crashes onto police blotters
Prescription sleep pill is increasingly turning up as a factor in "Driving while Sleep-Walking" traffic arrests, officials claim.
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Stephanie Saul / New York Times
With a tendency to stare zombie-like and run into stationary objects, a new species of impaired motorist is hitting the roads -- the Ambien driver.
Ambien, the nation's best-selling prescription sleeping pill, is showing up with regularity as a factor in traffic arrests, sometimes involving drivers who later say they were sleep-driving and have no memory of taking the wheel after taking the drug.
Ambien's competitors -- Lunesta by Sepracor and Sonata by King Pharmaceuticals -- are not as widely used in this country, and do not seem to be cropping up with any frequency on police blotters.
The numbers
Last year in the United States, doctors wrote 26.5 million prescriptions for Ambien, which had sales of $2.2 billion, according to IMS Health. Among the three top prescription sleep drugs, Ambien accounted for 84 percent of prescriptions dispensed
Among laboratories that conduct tests of drivers' blood samples for two dozen states, 10 labs list Ambien among the top 10 drugs found in impaired drivers, according to Dr. Sarah Kerrigan, a forensic toxicologist in Houston involved in the survey.
Wisconsin officials identified Ambien in the bloodstreams of 187 arrested drivers from 1999 to 2004.
In Washington state, officials counted 78 impaired-driving arrests in which Ambien was a factor last year, up from 56 in 2004.
Ambien's influence
While alcohol and other drugs are sometimes also involved in the Ambien traffic cases, the drivers tend to stand out from other under-the-influence motorists. The behavior can include driving in the wrong direction or slamming into light poles or parked vehicles, as well as seeming oblivious to the arresting officers, according to a presentation last month at a meeting of forensic scientists.
"These cases are just extremely bizarre, with extreme impairment," said Laura J. Liddicoat, the forensic toxicology supervisor at a state-run lab in Wisconsin who made that presentation.
Several of Liddicoat's cases involved drivers whose blood revealed evidence of Ambien overdoses. In one of them, the driver, who was also taking the antidepressant Celexa, crashed into a parked car, was involved in another near collision, then drove over a curb. When confronted by police, he did not recall any of the recent events, according to the presentation.
But sleep-driving?
Liddicoat did not describe any of those cases as sleep-driving -- in fact, she said she had not heard of that defense -- and it is possible that some drivers' claims of driving while asleep may be mere Ambien alibis. But some medical researchers say reports of sleep-driving are plausible.
Doctors affiliated with the University of Minnesota Medical Center who have studied Ambien recently reported the cases of two users who told doctors they sleep-drove to the supermarket while under the drug's influence. Neither of the patients remembered the episode the next day, according to Dr. Carlos Schenck, an expert in sleep disorders who is the lead researcher in the study.
He said he believed that Ambien was an excellent sleep agent, but that patients need to be better warned about its potential side effects.
What the drugmaker says
Ambien's maker, Sanofi-Aventis, says the drug's record after 13 years of use in this country shows it is safe when taken as directed. But a spokeswoman, Melissa Feltmann, wrote in an e-mail message, "We are aware of reports of people driving while sleepwalking, and those reports have been provided to the U.S. Food and Drug Administration as part of our ongoing post-marketing evaluation about the safety of our products."
FDA: Heed the warning
The drug's label warnings, which say it shouldn't be used with alcohol and in some cases could cause sleepwalking or hallucinations, were sufficient, FDA spokeswoman Susan Cruzan said.
Liddicoat, in Wisconsin, is among experts who suggest that Ambien may need a stronger warning label. Others arguing that case include doctors, Ambien users and defense lawyers.
But the FDA, which would have to order any labeling changes, says it is not aware of any pattern of problems with the drug. But Cruzan said the agency would look into unusual sleepwalking episodes.
Ambien's alcohol warning is apparently ignored by many people. But William C. Head, one of the nation's leading defense lawyers specializing in impaired driving cases, says he has concluded that no one should take Ambien the same evening they have been drinking alcohol. "Not even a toast," he said.
