New species of impaired motorist hitting the roads: the Ambien driver

New York Times
March 8, 2006

Some Sleeping Pill Users Range Far Beyond Bed
By STEPHANIE SAUL

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.

In some state toxicology laboratories Ambien makes the top 10 list of
drugs found in impaired drivers. Wisconsin officials identified Ambien
in the bloodstreams of 187 arrested drivers from 1999 to 2004.

And as a more people are taking the drug — 26.5 million prescriptions
in this country last year — there are signs that Ambien-related
driving arrests are on the rise. In Washington State, for example,
officials counted 78 impaired-driving arrests in which Ambien was a
factor last year, up from 56 in 2004.

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 postmarketing evaluation about the safety of our
products."

A spokeswoman for the F.D.A. said the drug's current label warnings,
which say it should not be used with alcohol and in some cases could
cause sleepwalking or hallucinations, were adequate. "People should be
aware of that," said the spokeswoman, Susan Cruzan.

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 the presentation.

Her presentation, which reported on six of the cases, was made at a
meeting of the American Academy of Forensic Sciences, where her
counterparts from other parts of the country swapped similar tales.

Several of Ms. Liddicoat's cases involved drivers whose blood revealed
evidence of Ambien overdoses. In one of them the driver, who was also
taking the antidepressant citalopram, 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.

Ms. 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.

"Luckily, neither of them got hurt," said Dr. Schenck, who added that
sleep-driving — which really occurs in a twilight state between sleep
and wakefulness — was more common than people generally suspect. He
said he believed that Ambien was an excellent sleep agent, but that
patients need to be better warned about its potential side effects.

The traffic cases around the country include that of Dwayne Cribb, a
longtime probation and parole officer in Rock Hill, S.C. Mr. Cribb
says he remembers nothing after taking Ambien before bed last
Halloween — until he awoke in jail to learn he had left his bed and
gone for a drive, smashed into a parked van and driven away before
crashing into a tree. Mr. Cribb is still facing charges of leaving the
scene of an accident.

A registered nurse who lives outside Denver took Ambien before going
to sleep one night in January 2003. Sometime later — she says she
remembers none of the episode — she got into her car wearing only a
thin nightshirt in 20-degree weather, had a fender bender, urinated in
the middle of an intersection, then became violent with police
officers, according to her lawyer.

The woman, whose lawyer says she previously had a pristine traffic
record, eventually pleaded guilty to a reduced charge of careless
driving after the prosecutors partly accepted her version of events,
said the lawyer, Lloyd L. Boyer.

Many states do not currently test for Ambien when making impaired-
driving arrests. But a survey still under way by a committee from the
forensic sciences group and the Society of Forensic Toxicologists
found that 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 that survey.

Ms. 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.

"Doctors are handing out these drugs like Pez," said William C. Head,
an Atlanta lawyer who is one of the nation's leading defense lawyers
specializing in impaired-driving cases.

The F.D.A., which would have to order any labeling changes, says it is
not aware of any pattern of problems with the drug. Still Ms. Cruzan,
in response to a reporter's question, said the agency would look into
unusual sleepwalking episodes.

Including the notifications from Sanofi, which as a matter of policy
the F.D.A. declined to discuss, the agency did receive 48 "adverse
event" reports in 2004 involving Ambien use without other drugs. They
involved three cases of sleepwalking, six reports of hallucinations
and one traffic accident.

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. Ambien
sales last year reached $2.2 billion, according to IMS Health. Among
the three drugs, Ambien accounted for 84 percent of prescriptions
dispensed.

A federal prosecutor was persuaded that Ambien played a part in a
well-publicized case last summer involving not a car but an airliner.
A US Airways flight from Charlotte, N.C., to London last July was
diverted to Boston, after a passenger who had taken Ambien became
"like the Incredible Hulk all of a sudden," according to his lawyer.

The man, Sean Joyce, a British painting contractor, became agitated,
tore off his shirt and threatened to kill himself and fellow
passengers, according to court documents. If convicted, Mr. Joyce
could have faced a maximum sentence of 20 years in jail for
interfering with a flight crew, according to his lawyer, Michael C.
Andrews.

But under a plea agreement Mr. Joyce was sentenced to five days
already served, after the prosecutor accepted his story that his
eruption, which he said he could not recall at all, occurred as a
result of taking one Ambien pill and drinking two individual-serving
bottles of wine.

Many of the impaired-driving cases involve people who drank alcohol
before taking Ambien. Mr. Cribb, for instance, said he had two beers
with dinner before he took the drug and went to bed.

Sanofi-Aventis says that while sleepwalking may occur while taking
Ambien, the drug may not be the cause. It also notes that the warnings
with Ambien, including those in its television ads, specifically
instruct patients not to use it with alcohol and to take it right
before bed.

Alcohol has sometimes been shown to cause sleepwalking, and it can
also magnify Ambien's effects, according to Dr. Mark Mahowald,
director of the Minnesota Regional Sleep Disorders Center at Hennepin
County Medical Center, who is also involved in Dr. Schenck's study.

In the past, the center has received grant funding from Sepracor,
Lunesta's maker, but Dr. Mahowald said that none of the researchers
currently received any funding from sleeping pill companies.

Ambien's alcohol warning is apparently ignored by many people. But Mr.
Head, the defense lawyer, says he has concluded that no one should
take Ambien the same evening they have been drinking alcohol. "Not
even a toast," he said.

Mr. Head is now defending a man in Decatur, Ga., who, after having
three drinks one night, said he took two Ambien and was in bed
watching David Letterman's monologue on television. Without realizing
it, the man says, he got back out of bed and behind the wheel and was
arrested on multiple charges that included driving on the wrong side
of the road.

Too many other people taking Ambien also evidently disregard the other
label guidelines.

Ann Marie Gordon, manager of Washington State's toxicology lab, said
that many of those arrested reported that they took Ambien while
driving so it would "kick in" by the time they got home. "Hello — it
kicked in before you got home?" Ms. Gordon said. "That's not a good
thing. I'm amazed at the number of people who do that."

But misuse of the drug may not explain all the cases. The nurse near
Denver took a single Ambien and went to bed, according to her lawyer,
Mr. Boyer of Englewood, Colo. Mr. Boyer said that only when the woman
returned home after her arrest did she discover a partly consumed
bottle of wine on her counter — unopened when she went to bed, she
said — leading her to suspect she had begun drinking after taking
Ambien.

Research by Dr. Schenck and others elsewhere have found evidence that
Ambien users engaged, unawares, in various middle-of-the-night
behaviors. In a study published in 2001, researchers at the Mayo
Clinic Sleep Disorders Center reported on five cases of unusual
nighttime eating, sometimes while sleepwalking, in patients taking
Ambien. The chief of physical medicine and rehabilitation for the VA
North Texas Health System in Dallas, Dr. Weibin Yang, said he became
aware of Ambien's potential side effects while at another hospital
treating a 55-year-old patient after hip surgery.

The man, who had no history of sleepwalking, walked into a hospital
corridor one night, where he urinated on the floor. On another night,
he got out of bed and told nurses he was going to church. Dr. Yang
said the patient was also taking other medications, but the
sleepwalking stopped when Ambien was discontinued. The patient, he
said, had no recollection of either event.

Dr. Yang said such experiences persuaded him that people could drive,
without realizing it, after taking Ambien.

Meanwhile in South Carolina, Mr. Cribb, who has already pleaded guilty
to driving under the influence, still faces a charge of leaving the
scene of an accident. He says he has sworn off Ambien. "There has to
be a stronger warning," he said, "about what this drug does to you."

reeder wrote:
> New York Times
> March 8, 2006
>
> Some Sleeping Pill Users Range Far Beyond Bed
> By STEPHANIE SAUL
>
> 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.

Yes, we can thank the pharmaceutical industry and the doctors
for this. Sometimes I think half the people driving are zonked on
something their doctor gave them. The other half are yacking
on the phone.

--
Flores

wrote:
> reeder wrote:
> > New York Times
> > March 8, 2006
> >
> > Some Sleeping Pill Users Range Far Beyond Bed
> > By STEPHANIE SAUL
> >
> > 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.
>
> Yes, we can thank the pharmaceutical industry and the doctors
> for this. Sometimes I think half the people driving are zonked on
> something their doctor gave them. The other half are yacking
> on the phone.
-----
Which group would you fall into... ;>)-

I've used maybe 8 Ambien (back when it first came on the market) and I
thought it was the greatest drug I'd ever taken. That stuff put me to
sleep like a baby in 15 minutes and if I was disturbed I was wide awake
and aware, as if I'd taken nothing.

My daughter OTOH, hated it. Made her feel doped up and gave her crazy
dreams.

Just shows to go ya...
-----

- gpsman

wrote:
> reeder wrote:
> > New York Times
> > March 8, 2006
> >
> > Some Sleeping Pill Users Range Far Beyond Bed
> > By STEPHANIE SAUL
> >
> > 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.
>
> Yes, we can thank the pharmaceutical industry and the doctors
> for this. Sometimes I think half the people driving are zonked on
> something their doctor gave them. The other half are yacking
> on the phone.

I hate docs but don't blame them. The fault is with the drivers who
think they have some sort of "right" to drive while on drugs.

wrote: <brevity snip>

> People are taking legal drugs more than ever now. The drug companies
> spend billions on advertising, and the doctors are ready teddies to
> hand them over to you (for a fee of course).

Doctors don't have much of a reason to deny a patient a prescription
unless it's "contraindicated". I know you're not suggesting that
Doctors should see patients for free, I don't know why you mentioned a
fee.

> > Just shows to go ya...
>
> Yep, they're drugs, and not good for the body. The way I feel about
> sleep is
> this: If I truly need sleep, I'll sleep, you will too. I've averaged
> only about
> 6 hours a night for years...no problems.

I take it you're not an MD. And you don't believe in insomnia.

Your experience is similar to mine and could be described as "normal".
But to feel that another's experience outside the normal range, even
temporarily, doesn't exist and that drugs couldn't be used to improve
it suggests perhaps an overly zealous bias.

Ambien is a relatively new drug that has shown great promise but, like
all drugs, doesn't affect all people exactly the same. Some of the
incidents report patient error in following the ****in' directions.
Remove those an we have a much smaller sample of detrimental effects.
-----

- gpsman

gpsman wrote:
> wrote: <brevity snip>
>
> > People are taking legal drugs more than ever now. The drug companies
> > spend billions on advertising, and the doctors are ready teddies to
> > hand them over to you (for a fee of course).
>
> Doctors don't have much of a reason to deny a patient a prescription
> unless it's "contraindicated". I know you're not suggesting that
> Doctors should see patients for free, I don't know why you mentioned a
> fee.

Doctors like to have a prosperous practice, often with that desire
taking dominance over what's best for a particular patient. You'd
have to be brain-dead not to be aware of the sizeable % of doctors
now who play it fast and loose when it comes to ordering tests,
prescribing drugs, etc. Prescribing drugs is VERY much encouraged,
of course, by the drug companies, who use various lures to give the
doctors incentive for doing so.

> > Yep, they're drugs, and not good for the body. The way I feel about
> > sleep is
> > this: If I truly need sleep, I'll sleep, you will too. I've averaged
> > only about
> > 6 hours a night for years...no problems.
>
> I take it you're not an MD.

Correct.

> And you don't believe in insomnia.

Hmmm, insomnia, inability to sleep, right? It's not uncommon for me
to wake up at 3-4 a.m., start thinking about something, and be
unable to get back to sleep. I don't run off to the doctor for pills
about it.
When my body needs sleep, it will sleep. So will yours. People who
have a habit of seeking help in a bottle often end up worse off. I
like
to keep life simple and live without such crutches that really don't
help at all in the long run. The philosophy hasn't failed me yet.

> Your experience is similar to mine and could be described as "normal".
> But to feel that another's experience outside the normal range, even
> temporarily, doesn't exist and that drugs couldn't be used to improve
> it suggests perhaps an overly zealous bias.

Maybe, but I've seen way too many people seeking that "easy solution"
that ends up being a rather bankrupt enterprise, in more ways than one.
Do you and your family takes lots of prescription drugs?

--
Flores

> :
> You'd
> have to be brain-dead not to be aware of the sizeable % of doctors
> now who play it fast and loose when it comes to ordering tests,

Two words: malpractice lawsuit.

necromancer wrote:
> > :
> > You'd
> > have to be brain-dead not to be aware of the sizeable % of doctors
> > now who play it fast and loose when it comes to ordering tests,
>
> Two words: malpractice lawsuit.

That would be a hard one to pull off. After all, the doctor would
claim that all he/she was trying to do was what was best
for the patient, by ordering all the tests to find out exactly what
the problem was. AFAIK, successful malpractice suits involve
doctors who misdiagnose, or are negligent in some way.
Typical would be a surgeon who, say, leaves some tool in
a patient by accident; who causes death or injury due to
incorrect treatment; who puts some lady patient under, then
screws her, etc.

--
Flores